Laser Skin Resurfacing
The patient is a 36 year old woman who wanted to do something about the wrinkles around her lips. She said they reminded her of the wrinkles her mother has. She wanted to know the best way to remove wrinkles and how much downtime was involved.
The patient underwent laser skin resurfacing and since her wrinkles were only of intermediate depth, the healing was quick and the patient was back to wearing makeup in six days. She was very happy with her cosmetic result and thought it made a big difference in her facial appearance despite the fact that the area that was improved was a small part of her face.
Patterns in Facial Aging
The laser is the best tool in the toolbox in the eradication of facial wrinkles. There are two general areas in facial aging of concern to facial plastic surgeons: wrinkling and facial laxity (looseness of the skin and underlying tissues). Each person ages in a different way. Some patients begin to “show their age” when they are younger as wrinkles about the lower eyelids and around the mouth. As they continue with the aging process, finer lines can deepen and even form folds as skin looseness develops. With time, the wrinkles between the lids and the mouth seem to extend over the cheeks and attach to each other into a series of long wrinkles.
Two Kinds of Aging
Despite the way patients develop their wrinkles, its best to treat what one sees at the current moment. If a patient has wrinkles about the mouth and the lower lids, those areas can be treated with the laser. And should the same patient also have facial laxity, a face lift can be performed at the same time if the patient wishes. These are two different procedures and they are treating two different issues: wrinkling and laxity. Probably the most important thing for patients to bear in mind is that each patient is different in terms of not only skin aging but what they see and what bothers them. For example, many patients have both facial wrinkles and laxity but only want to eliminate the wrinkles and not want to have a face lift.
The Patient and the Plastic Surgeon Are Both Right Because They See Different Things
After all, cosmetic surgery is really done for the patient and so it is very important for the patient to communicate what they see in the mirror that is bothering them and what they wish to improve. Patients usually want to also hear from their plastic surgeon what they think will help them the most. In the case where patients have both wrinkles about the eyes and mouth and also have significant facial laxity, having both laser treatment and facelift surgery is probably the best way to not only look younger but also achieve a unified and harmonious result. When doing both procedures together, facial plastic surgeons can carry the edge of the layered area far out enough on the face so that there is overlap with the face lift and so when looking at the patient it is hard to tell where one procedure stopped and the other has begun.
Laser Skin Resurfacing is Good in Combination with Other Procedures
Since patients can develop wrinkles in their younger years and especially in the warmer areas of the country, patients who have plastic surgery of the body like tummy tucks and cosmetic breast surgery may opt to combine their surgery with laser treatment. The laser goes with most other surgeries in good combination because it is a small part of the body and the surgery time is also very short and therefore can be easily added to any procedure, even if that procedure is of longer duration. The “down times” for both surgeries can be overlapped so the patient doesn’t have to have two surgeries.
Laser Can Be an Important Part of Eyelid Surgery
Besides combining the laser with a face lift, the most common combination is the use of the laser in conjunction with eyelid surgery. Upper eyelid surgery (upper blepharoplasty) is best done without the laser but for treating the lower eyelids, the laser provides a great alternative and is very versatile in achieving great results. Lower eyelid surgery goals include removal or repositioning of the lower eyelid fat pads that patients refer to as “eye bags”. Removal of excess lower eyelid skin is also a goal of lower lid surgery but more often there is no excess skin but simply fine wrinkles. There are two basic ways to perform lower eyelid surgery and they each have benefits that must be explained to a patient when in consultation with a plastic surgeon.
Lower eyelid surgery, or lower blepharoplasty is a procedure where a hidden external incision is made right beneath the lash line and so is hard to see after surgery. Through this incision, both fat pads and skin can be removed and the fat can also be relocated. Since most patients don’t have skin excess of the lower eyelid, a simpler and more direct approach called TCB or transconjunctival blepharoplasty. In TCB surgery, the approach to the lower lid fat pads is from the inside of the lower lid. The tremendous advantage of TCB is that the procedure is not really performed within the lid but rather directly on the fat pad inside the eyelid. So because no surgery is done within the lid there is no weakening of the lower lid like there is with lower eyelid surgery.
The other advantage of TCB is that the laser can be combined with TCB to remove fine wrinkles on the skin surface. That isn’t the case when the lower eyelid external approach is used for fat removal because the laser cannot be added in this case. The skin removal that comes with the external approach to lower lid surgery is not that great for wrinkles and it’s really the laser that is best for fine wrinkles. Therefore, TCB with laser of the lower lids is usually the best way to treat fat bags of the lower eyelids and also remove fine wrinkles at the same time.
In any event, a thorough discussion with a plastic surgeon can help patients decide on which procedure is best for them.
