Some patients with active lifestyles have skin that's been overexposed to sun and wind, while others are genetically predisposed to early signs of aging. Many patients want to eliminate crows feet and superficial face lines and wrinkles around the eyes. Some are looking for improvements in the fine lines around the mouth and others are looking to remove "age spots," pigmentary changes in the skin. One of the most common requests we hear is "for the outward appearance to reflect the more youthful energy I feel inside." Patients who request one or any combination of these improvements are seeking information about skin resurfacing.

Skin resurfacing is the removal of the outer layer of the skin - using abrasion, chemicals or a laser - uncovering a more younger beauty hidden just underneath the surface. The best way to see what skin resurfacing can accomplish is to look at before and after photos. Skin resurfacing is performed to restore a more youthful appearance and less fatigued look. Once thought a plastic surgery procedure sought by only wealthy women, men in today's competitive corporate workplace are increasingly seeking skin resurfacing procedures.

At your initial consultation, your plastic surgeon will evaluate the bony and soft tissue architecture as well as the form and function of the head and neck. An overall assessment of the face provides the basis for what one may expect from skin resurfacing. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of plastic surgery.

As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. For example, skin resurfacing will tighten the skin somewhat but it will not eliminate sagging skin (sometimes called a "turkey wattle") that hangs down under the neck. Your understanding of plastic surgery procedures and routines is essential to a successful final result. It is also essential to feel confident with your Plastic Surgeons & Staff including board certifications, training and experience.

BEFORE SKIN RESURFACING SURGERY
At your preoperative laser resurfacing appointment our nurse will provide all the instructions for you to follow before and after your operation. On the business day prior to the procedure we ask you to call to confirm your arrival time for surgery. Upon arrival for your plastic surgery, you will talk with a nurse (who will start an IV), discuss anesthesia and meet with your plastic surgery before going to the operating room. Patients who have only a limited anatomical area (such under the eyes) resurfaced remain awake. For full-face skin resurfacing, patients are asleep. Laser resfurfacing surgery time estimates depend on the size of the area we are addressing, therefore surgery estimates are individual. It is quite common to have skin resurfacing combined with plastic surgery procedures that address the underlying architecture of the face, such as a browlift to minimize deep frown lines, a facelift to soften laugh lines or blepharoplasty. If you are having a combination of procedures the length of the plastic surgery time will be longer.

PREOPERATIVE SKIN RESURFACING INSTRUCTIONS

1. Please avoid any aspirin, aspirin-containing products, or ibuprofen (Advil, Aleve, etc.) for one week prior to and two weeks following your surgery. See our "Medication List" for products to avoid prior to skin resurfacing surgery. If you are on any medications that affects bleeding (such as coumadin or warfarin) please notify the office immediately.
2. Please refrain from tobacco products and alcohol for one week prior and three weeks following sking resurfacing surgery. Along with delayed wound healing, persistent skin redness and other complications may persist when tobacco and alcohol are not discontinued.
3. Please notify us of all routine medications and significant health history. We ask that you remain on your daily medications unless instructed otherwise. At the preoperative appointment, our nurse will tell you which daily medications to take with just a sip of water on the morning of laser resurfacing surgery.
4. At your preoperative laser resurfacing appointment you will be given prescriptions for use following surgery including an oral antibiotic, antibiotic eye ointment (if you also have eyelid surgery), pain medications, over-the-counter ointments and moisturizer with at least a 30 SPF sunscreen. Please obtain these medications and items before your laser resurfacing surgery so you will have them ready for use when you return home after surgery.
5. We will ask if you have any history of "cold sores" which are caused by a virus. If you do, we will pretreat you so that the virus does not recur while you are healing from skin resurfacing. We will ask you to take Arnica, a natural herb that significantly decreases bruising, before and after surgery. We will also ask you to take Vitamin C 1000 mg (ascorbic acid), which helps promote healing, before and after laser resurfacing surgery.
6. Please call the Lindsay House Surgery Center at 244-1135 before noon on the business day prior to your skin resurfacing procedure to confirm your arrival time.
7. You may not eat or drink after midnight the evening before the laser resurfacing procedure unless instructed otherwise. You may brush your teeth. Your procedure will be cancelled if you do not follow these instructions.
8. Do not bring valuables (cash, credit cards, watches, jewelry, etc.) to the Lindsay House on the day of laser resurfacing surgery. Remove all make-up and nail polish before arriving for your laser resurfacing procedure.
9. It is not required that a family member or friend to stay at the Lindsay House during your laser resurfacing surgery. However, someone must be available at all times while you are here at the Lindsay House for laser resurfacing surgery. Someone will need to drive you home after your laser resurfacing surgery and stay with you that evening. Transportation to the office for packing removal the day following surgery is also required.

AFTER SKIN RESURFACING SURGERY
When you wake up from laser resurfacing surgery you may notice a soft, bulky dressing. This dressing is covering a moist gel-type dressing underneath. Following your skin resurfacing, it is common for the skin to "weep" as the old skin exfoliates and the new skin reappears. The soft bulky dressing will catch this drainage. Our nurses will be there when you awaken to assist you in meeting the discharge criteria: to drink liquids, walk with a steady gait, void and manage your discomfort. The nurses will review all instructions you will need for care following your skin resurfacing.

Skin resurfacing is done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment. Patients having laser resurfacing surgery must stay in the immediate Rochester area overnight within 30 minutes of our East Avenue facility.

You will be asked to come to the private entrance of our Lindsay House office (not the Surgery Center) the following day after laser resurfacing surgery for a dressing change. Although most patients describe this first dressing change as relief rather than discomfort, you are encouraged to take your pain medication about an hour prior to arrival. At this visit we will teach you how to change the dressing yourself the next morning. Changing the dressing yourself allows you to take a much-anticipated shower between dressing changes. You will be asked to discontinue the dressings on postoperative day three and switch to ointment at that time. You will return to the office on approximately postoperative day seven when we will change the wound care from the application of ointment to a moisturizer with sunscreen.

POSTOPERATIVE SKIN RESURFACING INSTRUCTIONS

Wound care
Keep dressing dry and intact the evening after surgery. Notify your doctor if the dressings become loose or fall off. If the dressing should fall off, cover the skin with the recommended ointment until you come to our private entrance in the morning for your first appointment. We will replace the dressing and review instructions for changing from dressing to ointment, most commonly on postoperative day three. It is uncommon for patients to complain of significant pain with dressing change.

Medications

• Most patients complain of discomfort more than pain. Use pain medication (Vicodin/hydrocodone) as directed/as needed. Vicodin contains Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin. Do not drive or drink alcohol while taking pain medication. Taking pain medication with food helps minimize nausea sometimes associated with pain medications.
• Start your antibiotic (Keflex/cephalexin) when you get home and one at bedtime. It is not uncommon to have a low-grade fever for 24 hours following laser resurfacing surgery.
• Start swelling medication (Medrol Dosepak/methyl prednisolone) when you arrive home and at bedtime. Then follow package directions. Take with food.
• Take Vitamin C (ascorbic acid), which helps promote healing, for two weeks following skin resurfacing surgery.
  We will also ask you to take Arnica, a natural herb that significantly decreases bruising.

Diet
Advance diet from liquids to soft food (oatmeal, French toast, yogurt, soup, pasta) to your regular diet as tolerated. There are no dietary restrictions following skin resurfacing.

Activity
Rest for entire day after laser resurfacing surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. Two weeks off work is recommended.

Bathing is ok as long as you don't get the skin resurfaced area wet. You are encouraged to shower and wash your hair before changing the dressing at home as instructed. When the skin is healed (at about postoperative day ten) the bright pinkness can be camouflaged with a green-based make-up. The pinkness associated with skin resurfacing can last six to eight weeks. For that reason, patients use make-up to camouflage the pinkness until it settles. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. Avoid unprotected prolonged sun exposure for six months following skin resurfacing to prevent uneven pigmentation.

Please Remember!
Swelling, bruising and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Assistance with daily activities the first two to three days after laser resurfacing surgery is strongly recommended.

Final Result
Following skin resurfacing, it takes time for the swelling to subside and for the skin to heal. Most patients return to work two weeks following laser resurfacing surgery, however three weeks is ideal, depending on the degree of privacy one is trying to maintain. At three weeks postoperatively, swelling and pinkness may be apparent to you but not to many of your coworkers and closest friends.

Final results following skin resurfacing are not apparent for one full year following surgery. After three months, the changes are ever so subtle, although still important. Being perfectionists about our work, you may tell us you are pleased long before the one-year anniversary. However, we request that you follow-up with us at that time for postoperative laser resurfacing photographs and so that we can enjoy your final result.

Please notify the office 244-1000 and ask for our nurse for any concerns. For an emergency, please contact our office or professional answering service at 258-4851. Remember, we are all here to help in any way we can.