Tag Archives: Active FX

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

Taken with iPhone, day 7.


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).

Continue reading

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.

Here's one of my "before" shots.

Another "before."

The first "after." Dr. Zimmet took this one in his office.

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!

Tuesday, July 27

Today is the day! I woke up at 4 a.m. with that pre-vacation sort of anticipation. I was happy to have time to walk my dog, since he probably won’t have a walk for the next four days unless I can get a friend to walk him. I remembered to wear my glasses instead of contacts, since they’ll be putting the disc things in my eyes before the treatment. I’m here now at Dr. Zimmet’s office, early to meet Julia who is going to interview me and Dr. Zimmet, and possibly Lydia. He went over the entire procedure with me again and asked several times if I had questions. They are very, very thorough here with preparations and checking in. Hadley called yesterday to make sure I’d gotten my prescriptions. I’ve remembered not to wash my face with anything but mild soap (not exfoliating) the last couple of days and I also remembered to take the Valtrex twice yesterday and once this morning. I’m a little nervous . . . curious what it will feel like and will be happy when the actual procedure is over. Dr. Zimmet told me again that I’ll look sunburned and possibly puffy at first and that in the days to come it might feel like the getting-back-to-normal process is taking a long time. I think that will be one of the valuable things about this diary. There are lots of before-and-after pictures online, but I haven’t seen any of the in-between pictures. I plan to post a picture or two every day so you, my readers (I hope there will be some readers!) can see the whole process—the good, bad and the ugly.

Monday, July 26

Tomorrow is the day. I’m excited.  Yesterday I bought some inexpensive blue pillowcases at Target. Dr. Zimmet suggested old pillowcases but I don’t have any of those (except some that I used to cover up plants during winter freezes).  This evening I am planning to go grocery shopping and to the movie store.

Dr. Zimmet’s office called in two prescriptions for me and I picked them up at Walgreen’s on 45th and Guadalupe. Continue reading

Dr. Zimmet called me on Friday to discuss the pre-op instructions, and I took these notes.

“Basically, I wanted to tell you what to expect on the day of your appointment. And there are a couple of medications we might want you to take. We prescribe Valtrex to everyone whether or not you have a history of fever blisters, as a precaution; and a painkiller in case you have trouble sleeping the first night. You come in an hour before your appointment, we take some photos, you’ll review the consent form, and we’ll apply a topical anesthetic. After 30 minutes we’ll administer a local anesthetic nerve block and, if you’d like, we can give you a Xanax.” (Yes, please!) “If you do elect to take the Xanax we’d want someone to drive you home.” Continue reading

Thursday, July 22

Four days away and have to admit, I’m getting a bit nervous. Will it hurt? Will I be totally grossed out by what I look like? Will I look OK when I finally do venture out on the sixth day after the procedure? It has been challenging to keep all meetings and social activities off my calendar for five days without disclosing why. I made the mistake of telling a couple of people that I was going out of town. It just seemed easier than coming up with another excuse for people I didn’t want to tell. Now I’m worried that I won’t remember who I said that to, and that I’ll slip up later. “What a tangled web we weave . . . “ Also, as I’m pretty active on social media and it’s conceivable that they could wonder where my vacation pictures are. OK, that’s probably going too far with the worrying. Continue reading

by Clare Sargent

Wednesday, June 21

Today I arranged for a videographer to shoot my procedure. Dr. Zimmet had someone in mind who couldn’t do it on the day I wanted the procedure, so we got my colleague and friend Julia Hilder. I waited until after I’d lined her up and explained the project (filming for two hours and a couple of interviews) to tell her that I am the actual patient. I was quite surprised when she emailed back that she “knows it well” referring to laser resurfacing. Her main issue was sun spots—she’s blond and has fair skin. She said that her spots faded and her skin tightened—she described the effect as subtle. I’m counting on a lot more than subtle. I should have asked what kind of equipment was used when she did it, as according to Dr. Zimmet that can make a big difference.

When Dr. Zimmet had one of his staff perform the procedure on him, he used two different kinds of anesthetic, one on each side of his face, so that he could tell which was more effective. I’m not worried about the pain, in part because I’ve had a number of things done now and imagine that this won’t be too different. Back when I had the series of photofacial treatments I remember Dr. Zimmet saying that it would feel like my face was being snapped by a rubber band. Some of the zaps were uncomfortable but at the same time I always thought that it had to hurt a bit to be really effective.

Now that I think about it I have no idea what this will feel like and I haven’t really asked. I’ll definitely be taking a Xanax to take the edge off. The only thing I’ve had done that hurt kind of a lot was the shots in my lips, which I guess are harder to anesthetize. I still got it done a second time, though, because I liked the results so much. One thing I really, really appreciate about Dr. Zimmet is that you wouldn’t look at me and think “Oh, she had her lips done.” He even cautioned me the first time I had it done that he would be somewhat conservative. (When you have a few hours to waste, check out www.awfulplasticsurgery.com for some hideous celebrity examples of way overdone lips—Lindsay Lohan, Melanie Griffith and Carson Kressley are two that come to mind and there are many, many others.)

Skin Vein