Have you ever considered a cosmetic dermatology procedure, but had a question you couldn’t find the answer to online?  Can you really trust the information you find on Yahoo Answers, Twitter or Google?  Here’s your chance to ask a cosmetic dermatology expert!  Every month, Dr. Zimmet will provide up-to-date answers to frequently asked skincare & cosmetic dermatology questions submitted to his blog.

May’s topic is Fractional CO2 Laser Resurfacing.

Does laser resurfacing hurt?

Laser resurfacing feels hot. We find that it’s pretty well tolerated with good topical anesthestics that are applied an hour before the treatment, along with local anesthetic nerve blocks and a cold air blower (Zimmer Chiller). We also offer Xanax to help you relax and a pain medication, if desired.

Why take Valtrex before CO2 fractional laser?

Valtrex is used to prevent a herpes fever blister outbreak. Many, if not most physicians recommend this for all patients undergoing facial resurfacing, even if there is no history of fever blisters.

What are pre-op instructions for fractional C02 laser?

Below is Dr. Zimmet’s fractionated CO2 (Active/Deep FX) pre-op care instructions:

-Avoid sun exposure and self-tanning cream for 4 weeks

-Avoid topical exfoliation for 2 weeks

-Understand the post-op care, and prepare by getting old pillowcases, shirts, etc

-Start the antiviral (Zovirax, Valtrex), if prescribed, the day before the procedure

- Eat a meal the morning of the procedure

-Shower and wash your face with an anti-bacterial soap

-Shampoo your hair

-Wear an old button-down shirt

Women (morning of procedure):

Do not use make-up, mascara, lipstick, lotions

Don’t wear jewelry

Do not use hair products of any kind

Do not use perfume

Men(morning of procedure)

Do not use any lotions on your face

Do not use hair products

Shave areas to be treated

What are post treatment instructions for fractional CO2 treatment?

Your physician should provide clear and preferably written instructions on how to care for your skin. The most important things are to apply Aquaphor to the treated area several times a day, and to be very gentle with your skin. Check out our survival guide for fractionated CO2 resurfacing.

Will I experience skin dryness after fractional C02 laser?

Your skin may ooze for the first day or so. We recommend Aquaphor ointment to speed healing. Without Aquaphor ointment, your skin would become very dry. Letting your skin dry out will greatly impede healing, so the Aquaphor or similar ointment is very important.

Can I use Cerave moisturizer after laser resurfacing?

I recommend nothing but Aquaphor ointment until your skin peels, generally about 5-6 days for the face. Following this, we advise SkinCeuticals Epidermal Repair for about 1-2 weeks.  Beyond 2 weeks, we recommend daily application of moisturizers like Cerave or Cetaphil.

What is the recovery time for fractionated CO2?

Recovery time depends on the area treated, the depth/aggressiveness of treatment and on the individual. Generally you can expect the following for the initial major healing phase: Face 5-6 days, Neck 7-10 days, Chest 10-14 days.

Should I ice my face after CO2 fractional laser?

Cold compresses or ice packs can help reduce the sunburn sensation that is typical the first day after treatment, and help reduce swelling.

Should I lay down after fractional laser?

You may be tired after the treatment, and laying down is fine. However, I do recommend sleeping with your head elevated for a couple of days, to help minimize facial swelling.

What are some tips for healing from C02 active laser?

The most important things are to apply Aquaphor to the treated area several times  a day, and to be very gentle with your skin. Your physician should provide clear and preferably written instructions on how to care for your skin. Check out our survival guide for fractionated CO2 resurfacing.

When does peeling start after fractional C02?

Peeling can start within a day or so, and is usually completed by day 5-6.

What does it look like when you have fractionated C02?

Your skin will usually be rather red for about a week, with gradual fading over a several week period. In my experience things look much better once the treated skin is fully peeled, usually about 5-6 days after treatment. There may be some oozing the first day, and swelling may be present the first few days. Learn more by reading our laser resurfacing diary.

Why does your face itch after fractional laser?

Itching is very common after fractionated CO2 resurfacing. The underlying cause probably relates to nerve signals stimulated by the inflammation and healing process. Medication such as Benadryl may be recommended if the itching is significant, but don’t drive or do similar activites as Benadryl can cause drowsiness.

Photo: By Craig Cloutier

Here is the third and final part of the video from my laser resurfacing procedure, taken by my talented friend Julia Hilder of Hilder Productions. If I do say so myself, my skin looks great. I will post additional “after” pictures soon.

It’s Day 7 and I am going about my normal activities. So far, no one has pointed and/or gasped. Without the ointment now my face feels tight and very, very smooth. Still a tiny bit of peeling and the one bruise over my right eyebrow still slightly visible. I’m obsessed with being covered with sunscreen, and yet still, for the few minutes I’m in really intense sun walking to my car between meetings, I’m paranoid about my tender new skin. I put on sunscreen at 6:30 in the morning to walk the dog–that’s new. I’m carrying sunscreen in my car in case I need to re-apply, or ever forget to put it on in the first place (unlikely).

Read the rest of this entry »

Still puffy, a little sore, and my face feels slightly hot. It’s not terrible, but I took an aceteminophen w/codeine earlier. My face is reddish/brown and swollen. I washed my face for the first time with the extra-gentle cleanser that they gave me. The directions are to wash, but not to wash off the Hydrobalm ointment, and then to re-apply more ointment. I could see some skin coming off already. I’m a little itchy in places. I keep touching my face and getting ointment on my fingers.

My assistant was here and said that it wasn’t as bad as she expected—I guess I over-prepared her. I haven’t seen anyone else yet, although I sent a picture to a friend and she also thought it didn’t look so bad. I look exactly like I remember Dr. Zimmet looking in the pictures he showed me after his Active FX procedure, so I’m sure this is all par for the course. I’m seeing him two days from now so that he can gauge my process.

The thing that has surprised me most is how tired I was yesterday. I guess it was unrealistic to think that I’d come home and get right to work as if nothing had happened. It makes sense that your body might be somewhat fatigued from working to heal. I’ve been eating very healthy stuff—a “green” smoothie with spirulina, some kombucha, a raw broccoli salad. Tomorrow I’m going to make the raw cheesecake and raw corn chowder. I have watched MANY episodes of CSI (I rented the first two seasons, which I’ve never seen) and read some of my book.

Still Tuesday, July 27

See the Active FX Laser Resurfacing Video, part 1.

It’s the evening of the procedure day and I want to give a quick recap. First we shot some “before” pictures. At about an hour before the actual procedure began Dr. Zimmet’s aesthetician, Hadley, covered my face with a topical anesthetic and gave me a Xanax (mild tranquilizer) and a Vicodin (pain reliever). After about 30 minutes my face started to feel quite numb. After 60 minutes, Dr. Zimmet came and in and administered shots (nerve blockers) to my forehead, near my eyes, and near my mouth. The shots weren’t too bad; Dr. Zimmet “shakes” the area so the shot doesn’t pinch much. And by this time I was feeling the Xanax, which tends to make everything easier. I tied my hair back and Hadley gave me a headband to get all of my hair off my face. They started the chiller—chilled air was blowing on my face the entire time, which felt really good, because the primary feeling from the laser was heat.

Dr. Zimmet started the laser treatment around the edges of my face—he called that “feathering,” I’m not sure why. I think he starts there because the sensation is the least strong. The most sensitive place was around my mouth. It reminded me a little of the sensation with Thermage, which is kind of like being zapped with something hot. He did my eyelids last, and I think using a different tip. I expected that area to be the most sensitive but it wasn’t bad at all. The whole procedure took maybe 30-35 minutes. Afterwards, they gave me a mirror. My face was already kind of brown with little spots all over my skin. We took some more pictures, and then Hadley covered my face with ointment. Dr. Zimmet had told me that it would feel like a major sunburn, and having had some bad sunburns in my teens I remember what that feels like, but I think this may have been even hotter. They gave me some ice to hold to my face, and I did so all the way home. (I went through P. Terry’s–best veggie burgers in Austin!–drive-through on the way home, and I’m sure the guy thought I looked freakish, but I was starving and didn’t really care).

When I got home I felt very sleepy, probably from the Xanax. (And I’m still sleepy now, so will post the recovery directions tomorrow.) When I woke up it felt like most of the ointment had soaked in, so I put some more on and took a close look at my face. It’s pretty puffy, which is normal for the first couple of days. It’s quite brown, like someone with really terrible sun damage. You can see the little dots created by the machine. I took a few pictures. I don’t really feel pain unless I touch my face; the right side feels a little bit sore. I’m supposed to put the ointment on four times a day and not let my face get dry, and I think I might need to apply it even more than that because it feels like it’s soaking in. It still feels kind of hot, and tight. All of which I expected. Can’t wait to see what I look like when I wake up in the morning!