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Wrinkles occur because all layers of the skin become progressively thinner with increasing age, due to exposure to the sun’s ultraviolet light. Some of the thinning is due to changes in the dermis, and with increasing age there is a progressive loss of the main support tissue, collagen, and damage to the elastin fibres in the skin. The upper layer of skin, the epidermis, also becomes progressively thinner with increasing age. It is these changes that lead to wrinkling. In addition, over the year, continuous contraction of the tiny facial muscles attached to the deeper part of the skin also lead to wrinkling, producing permanent ‘laughter lines’ around the eyes and frown lines on the forehead.
Laser skin resurfacing treatments can result in regenerative changes in the epidermis and an increase in the amount of collagen in the dermis. These changes are accompanied by a more favourable distribution of the pigment melanin and also by an increase in skin blood supply to the skin, which facilitates these beneficial changes. It has been claimed that the increase in skin collagen, following resurfacing laser therapy, is a permanent phenomenon.
Most facial wrinkling can be improved by skin resurfacing using the Erbium: YAG lasers. The effect of these lasers depends on the severity of the wrinkling. Patients with mild wrinkles may expect most of their wrinkles to go, whereas patients with severe degree of wrinkling will usually see a marked improvement in their wrinkles, but it would be unusual for them to disappear altogether. However, more than one treatment may be necessary to achieve the best results.
The Erbium: YAG lasers restructure the skin by applying very high laser power in very short bursts to the affected area. Because of the sophisticated technology involved, there is minimal damage to the skin and so the risks of scarring are very low.
Treatment with the Erbium YAG laser may only require a local anaesthetic, which is injected into the areas that are going to be treated. Sometimes an anesthetic called a ‘field block’will be used to freeze one of the main nerves to the fact to reduce any discomfort. Some patients may wish to have a general anaesthetic or deep sedation for the whole procedure and this will be discussed at the consultation. Paracetamol tablets taken one hour before the procedure, and six hourly afterwards, can be also be helpful.
Once the anaesthetic has worked, the eyes are protected with moist gauze and special goggles. The procedure itself may take from thirty minutes to two hours depending on the number of laser passes that are necessary. Around the mouth, two to five passes may be necessary, whilst around the eyes only one or two passes is usual. After each pass with the laser, the treated skin has to be cleansed before a further pass is carried out.
Treatment with the Erbium: YAG laser, usually only requires the application of a local anaesthetic cream or gel, one or two hours before the procedure. However, if extensive areas of the face are to be treated, a field block may also be carried out, or again a general anaesthetic. In addition to skin resurfacing, other treatments include L-ascorbic acid or a course of glycolic peels, which can commence six to twelve months after the resurfacing procedure if required.
It is very unusual to develop scarring following the use of the resurfacing lasers. The lasers have been designed to very exacting technological standards to try and ensure as far as possible that scarring is not a possibility. However, very rarely, a minor degree of scarring has been reported in small minority of patients, but this can usually be controlled with a steroid injection into the scar tissue itself.
The commonest post-operative complication is post-laser therapy hyperpigmentation. This increased pigmentation in the skin is much more common in people who tan easily. Hypopigmentation can also occur after laser resurfacing. In this condition the skin has less pigment and will look paler than previously. This is usually mild and best treated with sun blocking creams.