What is laser surgery?
The ablative lasers have been in use for over twenty-five years and can be employed to treat many skin conditions. There is minimal scatter of the laser beam, so that normal surrounding tissue is hardly affected. Superficial skin cancer, sun-damaged lips, warts, some types of scarring, rhinophyma (lobular enlargement of the nose) and a variety of benign skin conditions, e.g. syringomas, moles and xanthelasma, can all be treated with ablative laser.
Wrinkles of the upper lip and the lower eyelids also lend themselves to treatment using the erbium laser. Full-face resurfacing is also performed for extensive changes secondary to conditions such as acne scarring, sun damage and wrinkling.
How many treatments will I need?
Typically, one treatment suffices for most conditions. However, occasionally two treatments may be needed for benign growths such as moles and syringomas.
How long will it take to recover?
Erbium laser is an invasive procedure, creating a wound. These wounds usually heal in about a week. Full-face resurfacing heals in a week, but patients typically require an extra week off before returning to work.
What should I expect after treatment?
Dressings are required and will be performed by a laser nurse. These become more complex according to size. The wounds are initially oozy and sometimes bloody. All areas are red initially, and this fades over 4 – 6 weeks.
Will it be uncomfortable?
Local injections of anaesthetic are required to perform resurfacing. This may be supplemented with topical anaesthetic cream and oral pain tablets. General anaesthetic is recommended for full-face treatment.
What will happen during the procedure?
Your eyes will be protected with shields or glasses. Injections will be performed. The procedure may take a few minutes to half an hour, depending on the size of the area to be treated. The erbium laser causes a very loud “popping” noise.
What aftercare do I need?
Dressing changes are required following ablative laser. The first dressing change is usually performed 1 – 2 days post-procedure, and then every three days or so until healed. The first dressing change is usually performed by a nurse; smaller dressings can then usually be performed at home. Larger dressings are usually attended to by the nurse — this does necessitate several trips during the first week.
Following healing, you will typically be given skincare products and instructions on how to use them. This will minimise your risk of inflammation and redness and ensure the shortest healing time. You will be sensitive to ultraviolet light and you must avoid direct sun exposure until redness has faded fully. Use a SPF30+ broad spectrum sunscreen if you have to be outdoors.
What are the side-effects and possible complications of ablative laser surgery?
The most common side-effects and complications of ablative laser surgery are:
- Pain — ablative laser requires local anaesthetic to block pain during treatment. This may be supplemented with topical anaesthetic cream.
- Healing wound — ablative laser surgery causes a superficial to deep wound to the skin, which takes a week or so to heal. The superficial burn of the outer layer of the skin results in swelling and weeping, and sometimes a little crusting. Once the surface has healed, it is pink and may be sensitive to the sun for another 4 – 6 weeks. A deep wound may be necessary to remove certain growths, resulting in a crater-like wound that may take 2 – 6 weeks to heal, and which usually heals with a scar.
- Pigment changes — the treated area may heal with increased pigmentation (hyper-pigmentation). This occurs most often in darker pigmented skin and following exposure of the area to the sun. Some patients have a predisposition to this type of reaction and may have noticed it with minor cuts, abrasions or acne lesions. It is thought that protecting the treated area from exposure to the sun for three months following treatment minimises the risk of hyperpigmentation. In some patients, hyperpigmentation occurs even though the area has been protected from the sun. Hyperpigmented spots usually fade away in 3 – 6 months; sometimes, however, the pigment change can be permanent. Creams may be used to treat hyperpigmentation. In some patients, the treated area may lose pigmentation (hypopigmentation) and become a lighter colour than the surrounding skin. When this occurs, the skin area will not tan normally. This type of reaction tends to gradually fade away, but may be permanent.
- Excessive swelling— immediately after laser surgery, there may be swelling of the skin. This is a temporary condition and is not harmful in itself, but it may be frightening. This swelling usually subsides in 3 – 7 days and requires frequent applications of ice for treatment.
- Scarring— there is a small chance of scarring, including hypertrophic scars (thickened scars) and, rarely, keloid scars (which are abnormal, raised scar formations which may extend beyond the limits of the original scar). Scarring is an uncommon occurrence but is a possibility because of the disruption of the skin surface. To minimise the chances of scarring, it is important that you follow all post-operative instructions carefully.
- Eye exposure— eyes need to be protected from laser energy. Suitable eye protection will be provided during procedures and should not be removed until you are advised that it is safe to do so.
- Temporary patterning— minor gridding is very occasionally seen, usually following more aggressive resurfacing. This fades over a month or so.
What are the possible complications if I do not have laser surgery performed?
Many of the conditions that are treated with ablative laser may be treated with other physical modalities. If not treated at all, some of these conditions may worsen with time, such as skin cancers, precancerous growths and warts. However, some lesions are considered cosmetic in nature and pose no medical threat if not treated.