Anesthesia needed for CO2?

Question

I have a surgeon telling me he will only do CO2 under anesthesia for best results. He said he cannot go deep enough unless I am under anesthesia. Is this the case? He wants to charge me almost 10K.

Timothy M. Greco, MD, FACS · Answer

I perform all of my CO2 laser cases under conscious sedation (twilight anesthesia) for the purpose of maintaining comfort and safety for the patient.

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

co2 can be done under local topical creams and injections, we do this in our office daily, see our IGTV today.  ensure you prep your skin before and treat after its very important.

at home peels like cosmelan, enlighten and aerify along with dermarolling (Emerageskin roller with anteage MD AERIFY ampules weekly) should be started now (see link to emeragecosmetics).

if you have post inflammatory hyperpigmentation/melasma/discoloration that needs cosmelan or enlighten peels at home which we can do virtually and send to your home along with aerify peels regularly, vivatia foam, restorsea 10x, faith essence serum, and cosmelan 2 cream.

Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, halo, maxi, pro fractional laser/erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer.

Brian K. Machida, MD, FACS · Answer

Some doctors opt for general anesthesia and it is their custom and practice to do so.  It may be that in his hands and experience, local anesthesia is not comfortable enough.  Topical anesthesia alone is not enough for a CO2 resurfacing so don't let providers in a med spa setting convince you otherwise.  However, i do 100% of my cases with oral sedation, no IV, and a combination of topical plus local anesthesia injection in the form of nerve blocks and some regional low concentration tumescence.   My laser procedures never require general anesthesia in my practice.  It sounds as if your doctor needs to do these procedures in a surgery center and uses an anesthesiologist so that may be factoring into your cost estimate.  I do not need an anesthesiologist nor charge for a facility fee.

William Groff, DO · Answer

Hi- I perform laser resurfacing almost every day for the past 20 yearsand I can assure you that general anesthesia is totally unnecessary. I typically use the light IV sedation in combination with topical anesthesia and nerve blocks to make patients very comfortable during the procedure. Please feel free to review my before and after‘s on real self and Instagram. You will see that you can get amazing results and you never need to go under general anesthesia for this procedure.. I hope this helps.

Amrish Patel, MD · Answer

I have done several of these with topical anesthetic only, it smarts, but it does not require anesthesia. The only reason to use Anesthesia is so you can do the procedure and not worry about patient comfort while doing the procedure. It would make it faster for the person doing the procedure, but in my honest opinion, it is not necessary.

Anshul Gambhir, MD · Answer

Thank you for your question! We do many different depths of CO2 laser but none of them require being put under general anesthesia. We offer the option to do "oral sedation" in the office where we give a Percocet and a Valium and a driver would be required but you are never "put under." We also offer injection numbing and always do topical numbing for 2 hours prior to the procedure. The most expensive CO2 procedure we do is just under $5,000 for a "full depth" procedure. Hope this helps!