What You Should Know About:

LASER RESURFACING

A dermatologist named Leon Goldman first applied lasers to skin care in the 1960’s. Since that time, lasers and in particular those that smooth wrinkles and remove sun damage, have evolved greatly. Currently we offer the latest laser technology for skin rejuvenation. We offer the Coherent UltrapulseTM CO2 for deep, weathered wrinkles, and the Sciton ContourTM Erbium laser for medium and fine wrinkles.

It is important to know that while resurfacing lasers will smooth and rejuvenate the skin, they do very little for sagging skin. Both lasers will produce redness during the healing phase—though the Erbium laser produces less downtime. Either laser resurfacing procedure can be performed under local anesthesia while you are awake, or with twig light sedation with an anesthesiologist present. There will be an extra charge for this service. Laser resurfacing is considered a cosmetic procedure, and is not covered by insurance.

When sun-damaged or acne-scarred skin is treated with special smoothing procedures, patients are given complete instructions concerning post-operative care. Here is a reminder of the important changes that may occur during the healing phase:

• Swelling
Swelling occurs and is most intense between two and five days after resurfacing. For some, the swelling is most pronounced around the eyes and upper cheeks. At times, the eyes may be swollen almost shut for a day or so. This is an entirely natural phenomenon and is in no way detrimental to healing or harmful to you. We advise sleeping with an extra pillow to minimize swelling.

• A Rosy Hue
When the skin has finished growing (usually in six to ten days), the skin takes on a rosy or pink color. This pinkness is the new fresh skin before it assumes its natural color tones. The pinkness fades over the first several weeks, but some people will note a degree of pinkness for some months. The rosy or pink tones can be easily camouflaged with appropriate foundation or make-up and will not be a problem with daily activities. This initial pinkness will increase with exercise, excitement and warm environments. ® Itching and Discomfort
Some patients note itching during the healing phase. This is a totally normal result of re-growing or healing skin. However, increased PAIN after the first 48 hours is an important sign that there may be a problem. While rare, increased pain after 48 hours should be reported immediately to the physician or nurse.

• Oozing
When the old skin is removed, and before the new fresh, smooth surface is restored, there is a measure of oozing and draining for the first two to four days. Most of the fluid is either clear or slightly yellow-tinged over a surface which is moist and light pink. Because we apply ointments or membranes to keep the skin moist, this drainage is entirely appropriate.

• Residual Lines or Scars
Your physician has discussed the fact that not every scar or wrinkle line will be removed by our resurfacing procedure. This is because each scar and wrinkle is a separate problem and some are more resistant to treatment than others. While our patients enjoy a high degree of satisfaction, some measure of disappointment may occur when the patient recognizes that not every line or scar has been removed. As discussed, we may be able to further improve those residual wrinkle lines and scars with a "touch-up" procedure at a later time.

• Darker Pigmentation
In spite of appropriate preparation, some darker-skinned patients may recognize a measure of deeper pigmentation after laser resurfacing. This darkening, which may occur at any of the resurfaced areas, will be treated and will fade over time.

• Lighter Pigmentation
In spite of our efforts to test for this beforehand, a few patients may note over some months the occurrence of a lighter-than-normal spot in the resurfaced skin. This occurs because of an unusual response to the healing process. While rare, it can occur and remain permanently. These areas can be covered with make-up and usually blended satisfactorily to the surrounding skin.

• Prolonged Sensitivity
The new skin may be more easily irritated or sensitive to topical agents, including sunscreens which were easily tolerated before resurfacing. We have special treatments for sensitive skin and most patients return to normal after a month or so.

• Acne
During the first two or three months following resurfacing, some acne may occur. This is easily treated by your physician

• Continued Improvement
Most patients find the skin continues to improve for at least one year after laser resurfacing as it continues to replace collagen and elastic tissue.

WHAT YOU NEED TO KNOW BEFORE YOUR LASER RESURFACING
• You have been scheduled for your preoperative Laser Resurfacing visit two weeks before your procedure. During this time the entire procedure will once again be covered in depth including all pre and post operative care. You will be given many of the materials that you will use during the healing stage as well as appropriate prescriptions. All questions pertaining to the procedure will once again be reviewed to your satisfaction.

• At the preop visit 25% of the payment is required to reserve the procedure time. The remainder is due at least one week before the procedure. You may pay by cash, check, or credit card.

• Have you reviewed your health history with your doctor including all medications you take regularly ( vitamins, aspirin, sleeping pills, medications for anxiety or depression) ? In addition, please tell us about allergies you may have to any medications including "numbing medicine". Please remember to stop any aspirin 10 days before the procedure.

• If you have been on Accutane or any other retinoid (orally), you must tell Dr. Gladstone.

• Please stop Ibuprofen/Advil/Naproxen/Vitamin E/C/ Gingko Bilboa one week prior to the procedure.

• If we have prescribed topical medications such as retin A or hydroquinone, please remember to continue to use it.

WHAT TO EXPECT THE DAY OF SURGERY
• It is absolutely necessary that you arrange transportation for you to be driven to our facility for the procedure and once again driven home. You will be receiving medicine that will make it impossible for you to drive yourself. I t is important for you to understand that you cannot drive the day of the procedure, nor can you take a taxi or public transportation.

• If you are receiving only a local anesthetic, then please eat your usual meal, whether it’s breakfast or lunch, the day of the procedure. If you are receiving "twighlight" sedation, the anesthesiologist will tell you whether and what to eat.

• Please arrive thirty minutes before your scheduled procedure. This is required in order for appropriate preparations.

• Please wear a button-up shirt or top to the office the day of the procedure.

• Following the signing of consent forms, and photographs, Dr. Gladstone will mark your face with a surgical pen.

• We will place anesthetic drops in your eyes, and then place protective eyeshields in your eyes.POST

LASER RESURFACING CARE
• Sleep and rest with your head and shoulders elevated on two or three pillows for the first 48 hours to help minimize the swelling that will occur around the eyes and cheeks.

• You may apply ice packs as often as often as needed for the first 72 hours; however, do not get the dressings wet. You may use a ziplock baggy with ice, or a bag of frozen peas in a wash cloth.

• An over the counter sleeping medication or antihistamines such as Benadryl can be helpful to encourage you to rest. You may ask for a prescription for a sleeping pill for the night before surgery, and the first 5 nights following the procedure.

• Once home, remember to take prescribed medication, drink plenty of fluids, and eat as tolerated. Remember to avoid very hot or very cold foods and fluids for the first 24 hours as your mouth may be partly swollen due to the procedure. Apply vaseline ointment to the lips as required as they may become dry.

• Do not remove the bandages for the first 3 days.

• After 3 days have passed, the bandages can be removed in the shower with water running over them. The dressing may adhere to the face, and may need to be eased off—very gently. Once the bandages have been removed, you can wash your hair, and even let the shower beat on your face as this will stimulate the treated areas and promote wound healing. Stinging may occur when you splash your face with water.

• At least 4-6 times/ day, you will need to hold your face over the sink and splash water on to the treated areas with your hands.

• Each time after you have rinsed your face, you will need to apply vaseline or Aquaphor to promote and stimulate wound healing. Vaseline or Aquaphor prevents scabbing or dry skin. These products can be kept in the refrigerator for cool application.

• Do not scratch or pick at the crusting as this may cause scarring. Crusting will fall off as the laser areas heal. A small amount of vaseline or aquaphor should be kept on these areas until they heal. The skin may be fragile for the first month so that bruising or scratches may be seen.

• The laser peel will often leave the skin pink or red for up to three months. The redness will be more intense in the first few weeks following the treatment, and then will slowly fade. Some of the treated areas may continue to peel and itch for several weeks. You may use Benadryl if the itching persists. Acne lesions can occur up to four months after surgery.

• You can start to wear make-up in 10 days. We recommend a green base under foundation which dulls the redness.

• Depending on the day of the week, your first appointment with Dr. Gladstone will be either the 3rd or 4th day after the procedure. Your second appointment will be the tenth day after the procedure. Then at 1 month; 3 months; 6 months.

IN CASE OF EMERGENCY:
During regular office hours, please call our clinic 650.723.6316, and ask for
Dr. Gladstone. After hours, please call the paging operator 650.723.6661 and ask for Dr. Gladstone. If your page has not been returned, then please ask for the dermatologist on-call.