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Laser Surgery
The word "laser" conjures up images of something technologically advanced and almost magical. Lasers are depicted in the media and in popular literature as being able to do amazing things and to some extent, they do. It is important to remember, however, that lasers are simply a very specific type of light. Laser light is monochromatic, that is, it has a single wavelength (sunlight has a broad spectrum of wavelengths). Laser light is coherent which is to say that the light does not diverge as it travels. The beam remains focused so the spot of light is the same size whether it is a foot away or a mile. Lasers exert their effect in only one way: the laser light is absorbed by an appropriate target and the laser energy is converted to heat. Because lasers are very powerful, targets get very hot, very fast. A laser can literally cut through metal.
Lasers have many applications in medicine. They are used in many procedures in the eye, for example. They have a number of wonderful applications in plastic surgery. We have several lasers. One is the pulsed carbon dioxide (CO2) laser. Electricity is passed through a chamber containing carbon dioxide gas and this produces a very powerful laser beam that targets water. It is a bit more complicated than that you get the idea. When a CO2 laser beam hits water it is so powerful that the water is instantaneously vaporized. Pulsing means that the laser light hits the target only for a tiny fraction of a second. This allows great precision. Because cells contain water, CO2 lasers are very effective for destroying skin lesions, such as warts, moles, tags, and even skin cancers. They are also excellent for "resurfacing the skin" (also called a "peel") to remove or smooth wrinkles in the skin. We use a Luxar pulsed CO2 laser in our practice and it remains the "gold standard" for smoothing wrinkled skin.
A recent addition to our laser armamentarium is the fractionated erbium laser. Erbium lasers also target water, even more efficiently than CO2. Fractionation means that instead of a single beam of light, the laser hits the skin with many tiny beams. This leaves intact skin between the laser "hits" and this speeds the healing process significantly. Resurfacing with a fractionated erbium laser heals in half the time as with the CO2 laser. The results, however, are not as dramatic. One trades off a lesser degree of improvement for less, expense, less risk and need for anesthesia, and less "down" time after the procedure.
Skin resurfacing is a wonderful procedure, either alone or as an addition to other procedures. The resurfaced skin will look and feel more youthful, it will be smoother, and even sun damage can be improved. Our consultation will help patients determine what procedure is best for them.
We also have a laser called a "non-ablative" laser. This interesting laser penetrates the skin without damaging it and exerts its effect below. It is the only laser approved by the FDA as a treatment for stretch marks. It is also used for scars, including acne and surgical scars, for the purpose of softening and flattening them. This laser can also be used for wrinkles but is not as effective as the two above.
We also several IPL devices. IPL stands for Intense Pulsed Light. Unlike a laser, IPL is not monochromatic but it is fairly coherent. IPL's are very good for getting rid of brown spots on the skin that result from aging and sun exposure. "Liver spots" (which, really, have nothing to do with the liver) and freckles on the backs of hands and arms, on the chest, and face respond beautifully. Strict attention to avoiding unnecessary sun exposure is important or the spots can return fairly promptly. IPL can be used for blood vessels, such as the capillaries that give the cheeks and nose a red "W.C. Fields" look in those who have Rosacea. It can eliminate the visible vessels often seen alongside the nose. Finally, IPL can be used for very effective hair reduction on the face, arm pit, and bikini line.
While laser and IPL lights are very precise, their effect on individuals can vary greatly. Some skin types respond better than others. Genetics, degree of sun damage, natural skin pigmentation, overall health, other medical conditions, and more can all play a role in the outcome of a laser treatment. A consultation is very important to help you determine if one of our lasers or IPL's are right for you.
While lasers are very useful devices when properly used, they are often over used and over hyped. In many procedures, there is no advantage in using lasers over more traditional techniques and, in fact, in some cases, the laser procedure is not as good.
We also have a new laser, the Lifesculpt laser, for liposuction procedures. Read more about that in our liposuction section.
Rejuvenation of the Neck (Neck 101)
Neck rejuvenation "comes in many sizes". For some, a simple course of Intense Pulsed Light (IPL) is all that is necessary to remove age spots. More aggressive topical lasers can reduce worsened pigmentation and wrinkles, as can a variety of chemical peels. LifeSculpt, our newest laser addition, can improve neck contour when loose skin accompanies extra fat in the neck. For those necks that need more, a "Neck Lift" can be performed. Neck lifts are known as "Cervicoplasties". A "Direct" Cervicoplasty simply removes the excess tissue from the central neck (the infamous "Neck Waddle" or "Turkey Neck") by cutting it out and closing directly, though this leaves a midline scar that really hides best in the male bearded skin. A "Full" Cervicoplasty leaves all scarring behind the ears, so scars are covered by hair and seldom seen. This procedure does require general anesthesia and still takes some time to fully recover from, but gives a nice neck tightening with minimal visible scarring. However, it cannot be done alone if the patient has large jowls, for then the jowls hang down on the tightened neck and the procedure doesn't give the improvement the patient needs. For the patient with jowls, a full Facelift must be performed. The Cervicoplasty is part of a routine Facelift.
Brow Lift
A brow lift, also known as a forehead lift, minimizes the creases that develop across the forehead, or those that occur high on the bridge of the nose. It improves what are commonly referred to as frown lines; and repositions a low or sagging brow. A brow lift:
- Minimizes the creases that develop across the forehead, or those that occur high on the bridge of the nose, between the eyes
- Improves what are commonly referred to as frown lines, vertical creases that develop between the eyebrows
- Repositions a low or sagging brow that is hooding the upper eyelid
- Raises the eyebrows to a more alert and youthful position
If you are bothered by expression lines or other signs of aging in the brow region, a brow lift may be right for you.
A brow lift is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image. Brow lift surgery is a good option for you if:
- You are physically healthy
- You don’t smoke
- You have a positive outlook and specific, but realistic goals in mind for the improvement of your appearance
Chemical Peels
Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers and facial blemishes, wrinkles and uneven skin pigmentation. Phenol, and trichloroacetic acid (TCA) are used for this purpose. The precise formula used may be adjusted to meet each patient's needs. Although chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process.
Chemical peel is most commonly performed for cosmetic reasons to enhance your appearance and your self confidence. Chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. In certain cases, health insurance may cover the peel procedure.
Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel. With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin.
Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it's applied to the neck or other body areas.
With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan). This means that not only will the skin be lighter in color, but you'll always have to protect it from the sun. Certain modified phenol peels are gentler and may be preferred in some circumstances.
Eye Lift (Blepharoplasty)
Also known as blepharoplasty, eyelid surgery improves the appearance of the upper eyelids, lower eyelids, or both. It gives a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert.
Treatable conditions:
- Upper eyelid surgery can remove excess fatty deposits that appear as puffiness in the upper eyelids.
- Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision, can be treated by eyelid lift surgery.
- Lower eyelid blepharoplasty can remove excess skin and fine wrinkles of the lower eyelid.
- Bags under the eyes can be corrected by blepharoplasty.
- Lower eyelid surgery can correct droopiness of the lower eyelids, showing white below the iris (colored portion of the eye).
Is it right for me?
A blepharoplasty procedure is usually performed on adult men and women who have healthy facial tissue and muscles and have realistic goals for improvement of the upper and/or lower eyelids and surrounding area.
You should undergo blepharoplasty surgery for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.
Good candidates for cosmetic eyelid surgery are:
- Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
- Non-smokers
- Individuals with a positive outlook and specific goals in mind for blepharoplasty
- Individuals without serious eye conditions
You must tell your doctor if you have any of these medical conditions:
- Eye disease such as glaucoma, dry eye or a detached retina
- Thyroid disorders such as Graves’ disease and under or overactive thyroid
- Cardiovascular disease, high blood pressure or other circulatory disorders or diabetes
