Laser skin treatment - how do I care for my skin before and after?

Care for your skin is important both before and after laser skin resurfacing. When patients undergo ablative laser skin resurfacing (such as CO2 and Erbium:YAG laser skin resurfacing), after care is more involved and lengthly. As a result, many patients are opting for fractionated skin resurfacing, which usually requires multiple treatments and has less dramatic results. The great thing about fractionated skin resurfacing is a lower incidence of side effects and much less, if any, downtime.

Proper skin care is important before your procedure. Here are guidelines I recommend:

• Patients should stop use of retinoic acid products (e.g., Retin-A, Tazorac, Differin, Renova) for at least 2 weeks before their procedure.
• Patients must not have taken Accutane, which is used for acne treatment, for at least 1 year prior to treatment.
• Avoiding the sun is best. Untanned skin is easiest to treat, and less likely to encounter side effects from resurfacing.
• If possible, it’s best to stop aspirin therapy at least 1 week prior to skin resurfacing to reduce risk of bruising. To a lesser degree, ibuprofen (Motrin, Advil), naproxen (Aleve), other Non Steroidal Anti-Inflammatories, Ginkgo, St. John’s Wort, and Vitamin E can increase risk of bruising.

After patients undergo fractionated laser skin resurfacing, many doctors recommend the following:

• Moisturize your skin at least twice daily. For the first 7-10 days after treatment, skin may be particularly dry. If skin is dry, using a moisturizer up to 4-5 times daily will help keep moisture in your skin.
• Use sunblock! Even if you’re not out in the sun, a sunblock with an SPF of 30 or higher should be applied once in the morning and once mid-day while your skin is red.
• Avoid the sun! If you’re skin is already red, sun exposure will just make skin redder, more irritated, and more likely to blister, hyperpigment, or even scar. Stay in the shade, and wear a wide brimmed hat.

If you have been treated with an ablative CO2 or Erbium laser, there are more steps you’ll need to take to protect your skin and allow it to heal:

• Oozing, weeping, crusting, and scabbing often occur after CO2 laser skin resurfacing. To minimize this, you may be directed to wash your face with a vinegar and water solution. After the vinegar wash, you may be advised to use an antibiotic ointment.
• Your doctor may want you to take Valtrex or a similar antiviral to reduce the occurrence of cold sores. Your prescription may be for seven to ten days.
• Swelling of the treated area is normal. Ice 20 minutes at a time for the first few days helps to decrease swelling.
• You need to avoid sun exposure if there is significant redness to the treated area. If there is scarring from a deep resurfacing, you may be advised to avoid sun exposure for up to 12 months. If you can’t avoid the sun, sunblock with an SPF of 30 or higher is best, and should be reapplied every 2 hours. Stay in the shade, and wear a wide brimmed hat.
• Don’t pick at crusting or scabbing- this can result in a scar.
• Oil free make-up is best after the early healing phase has passed. Avoid makeup use when there’s oozing, crusting, weeping, or irritated skin.
• Expect redness to last for months with a CO2 ablative laser. Redness can last for up to 6 months. The duration of redness is usually less with an Erbium ablative laser.

Always make sure to consult with and receive treatment from a medical doctor who’s experienced in laser skin resurfacing for best results!

Keep in mind that all laser skin treatments work by causing a controlled amount of damage to your skin. It is the healing of this controlled damage that provides the desired effect: skin rejuvenation. In order to help your skin heal, you need to avoid things that make it harder for your skin to heal, and do things that make it easier for your skin to heal.

Based on that understanding, here is what I advise:

• Avoid sun exposure as much as possible before and after your treatment. UV from sunlight causes skin damage and makes it harder for your skin to heal. There is NO SUCH THING as a healthy tan!
• QUIT SMOKING!! I can not over emphasize the importance of quitting smoking. Smoking damages skin and makes it harder for skin to heal. Smoking is so bad that some doctors won't treat smokers at all.
• Avoid any products that make your skin inflamed or light sensitive. This includes Accutane, Retin-A, retinols and tetracyclines. Always check with your doctor before stopping any mediication.
• Avoid any medications that increase bruising and bleeding. This includes aspirin, Aleve, Motrin, Ibuprofen, Vitamin E, St. John's wart, and others. If you are not sure if your medication causes bleeding, ask your doctor. If you are on coumadin, you may not be able to safely stop the coumadin. People who need to take coumadin may not be candidates for laser skin surgery.
• Keep your skin moist after your procedure. Ask your doctor what moisturizer he wants you to use after your procedure and get it before your surgery. You don't want to have to go shopping the day after your laser skin surgery!
• I also recommend that patients use a product that contains tetrahexyldecyl ascorbate before and after surgery. Tetrahexyldecyl ascorbate is a fat soluble product that is converted into Vitamin C in your skin. Saturating your skin with Vitamin C may help you heal faster.

Before and after any series of laser treatments, maintaining skin integrity is the essential ingredient for success. Too many patients believe that lasers are a cure-all - a panacea - but ongoing maintenance is essential.

• Proper moisturizers (for your skin type)
• SPF45 Sunscreen every day (that’s right, every day)
• Facials every 2 months to exfoliate, express your pores and rid you of nasty oxidizing porphyrins

A full 10 days before treatment, discontinue any photosensitizing medications (ask your doctor), antibiotics and all retinol-like products. There’s no reason to risk burning oversensitive skin, or damaging areas irritated by retinols.

This is a good question but the answer would be contingent on what treatment the patient is undergoing. Your practitioner should provide you with verbal and written instructions for pre and post treatment skin care. For example, if a patient is undergoing laser hair reduction, the instructions would be quite different than an acne patient.

Despite which treatment is being rendered, good sun protection is always critical when receiving laser treatments. Also, maintaining proper pH balance and minimizing skin irritation is important. Compliance with these easy instructions will compliment any treatment program.

I think the best laser resurfacing results can be obtained by doing your homework.

• Read about what you think you want
• Talk to your doctor about realistic expectations because that’s what you have to establish right away

People come in and say “I want these gone” and I say, “Well I can make them a little better. And I don’t know if that’s going to be 20% better or 80% better, but it’s not going to be 100% better.” And we have to try combination treatments-avoiding the sun, using the right sun creams, getting a series of laser treatments, and maybe doing some microdermabrasion to maintain your skin, Botox, and Restylane or another filler substance.

To hit it from different angles will achieve the optimal results.

1. Stay out of the sun before and after treatment plus appropriate skin protection.
2. Use constant application of gentle moisturizers every couple of hours after treatments.