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Facial Resurfacing

Photo before carbon dioxide laser resurfacing
photos

Two different ways to decrease wrinkles and scars…
             leaving you with smooth, rejuvenated skin…

Dr. Bentkover has been resurfacing skin with various modalities for over 30 years. Having started with dermabrasion in 1979, he presently offers two major ways to resurface your skin…

Active FX® and Max FX® Carbon Dioxide Laser Resurfacing and Portrait® Plasma Skin Regeneration.

Both technologies give consistent results for the right patient. In the opinion of many facial plastic surgeons, the “gold standard” for facial resurfacing is still carbon dioxide laser resurfacing. Dr. Bentkover started using the Coherent Ultra Pulse® Carbon Dioxide Laser for facial resurfacing in 1995. His results achieved for wrinkle removal and acne scars are very predicable, with very high patient satisfaction. Recently, he upgraded to the newer version of this laser, the Lumenis Ultra Pulse® Carbon Dioxide Laser with the fractionated Active FX® attachment.In his opinion, this is the best of the fractional lasers on the market.

Many people talk about “downtime” as being an important factor in choosing an aesthetic procedure. In general, shorter downtime means a less invasive procedure. In many cases, this may be just fine; but in some cases the less invasive procedure may not adequately address your concerns. Both plasma skin resurfacing and carbon dioxide laser resurfacing can be done in less invasive modes with shorter downtime, 7-8 days. If you need a deeper treatment, however, the downtime may be as long as 10 days, still shorter than with the older lasers. Dr. Bentkover will have a thoughtful discussion with you about which procedure is best for you and try to customize the procedure to your particular needs. Active FX® is the less invasive fractionated mode of the laser. MaxFX® is the deeper, more invasive mode.

In 2006 Dr. Bentkover became one of the first surgeons in New England to offer new, viable alternative to laser resurfacing, Portrait® Plasma Skin Regeneration. There are only about 500 of these machines in the US.
This exciting new technology enables Dr. Bentkover to treat fine lines and facial discoloration with a quick office treatment that requires only topical or local anesthesia. By 10 days after the procedure the pinkness is generally mostly gone! We really like the overall textural improvement we see with the plasma treatment. If you have deeper lines or acne scars, however, you will probably need the carbon dioxide laser.

A comparison of the two treatments…

The Lumenis Ultra Pulse® Carbon Dioxide Laser

  • The standard to which all other resurfacing techniques are compared
  • Removes or improves fine and deeper wrinkles of the face
  • Removes layers of old skin and promotes growth of new, smoother, healthier skin
  • Requires skin preparation to prevent excess pigmentation after the procedure
  • Deeply treated areas can heal with a bit lighter skin color
  • The most significant stimulator of new collagen growth of all cosmetic lasers
  • Improves the appearance of acne scars
  • Removes brown spots from the face
  • Skin continues to tighten for about 6 months after surgery
  • Small areas can be treated with just local anesthesia; full face requires intravenous sedation or general anesthesia.
  • Less invasive mode is Active FX®. More invasive mode is Max FX®

It is used for deep wrinkles of the face, including crow’s feet, lower eyelids, upper lip (lipstick spill lines), lower lip, chin and other lines around the mouth. It is also used for whole face treatment of facial wrinkles and for acne and other scars. Dr. Bentkover uses this laser commonly for the lower eyelids and crow’s feet in conjunction with other eyelid rejuvenation surgery and for the upper lip, lower lip and chin area.

All procedures require, at least, local anesthesia; and some require general anesthesia or intravenous sedation. Procedures under local anesthesia can be performed in our office operating suite. Growth of new skin generally requires 7- 8 days, and we see the patients frequently during this period, providing ongoing skin care. You body will continue to produce new collagen in the lasered skin for about 6 months, continuing to tighten the skin. Some pinkness of the lasered skin can persist for 3-4 weeks, but is easily covered with make-up and often lessens quickly with some light steroid cream. Some lightening of the skin is possible, and your skin will need to be prepared for 4-6 weeks before surgery to prevent darkening (hyperpigmentation) of the skin. People with darker skin types are not good candidates for this procedure.

Portrait PSR3Plasma Skin Rejuvenation

  • Removes or improves some fine wrinkles of the face.
  • Removes layers of old skin and promotes growth of new, smoother, healthier skin
  • Removes brown spots and some benign skin lesions
  • Overall improvement in the quality and color of the skin can sometimes be better than with the laser.
  • Requires no significant skin preparation
  • Less risk of increased skin pigment or over lightening of the skin than with laser resurfacing
  • Skin continues to tighten for up to 1 year after surgery
  • Parts of your face or your entire face can be safely treated with just local or topical anesthesia in the office.

Portrait® Plasma Skin Regeneration from is a technology that utilizes a nitrogen plasma spray instead of a laser (Plasma is an electrified gas that is the fourth state of matter – solid, liquid, gas, and plasma.) Even in its higher energy mode, it is less invasive than the laser. Deeper wrinkles often require the laser, but the overall color and texture improvement with plasma can be as good or even better than with the laser. Some patients are treated in three short, low energy treatments; some patients are treated with one high energy treatment. The choice of type of treatment depends on the depth of your wrinkles and how much down time is reasonable for you.

The plasma does not remove skin. It works by heating the deeper layer of the skin, the dermis. This heat stimulates new collagen growth, which, over time, leads to tightening of the skin. Your skin peels on its own about 4 days after. You can continue to make new collagen for up to a year.

Dr. Bentkover will be able to recommend whether Portrait® Plasma or Carbon Dioxide Laser Resurfacing is the right treatment for you. We do not expect you to be able to decide which treatment is best for you just by reading on a website. That is neither practical and nor advisable. Education and decision making is the role of a consultation.


YOUR PROCEDURE

Before Surgery
Dr. Bentkover will carefully evaluate your skin and suggest which procedure he thinks will be most effective for you. Your choice of procedure may also depend on how much time you can take off from work or your regular activities. He will often recommend that you establish a routine of deep cleaning, manual facials from a high quality aesthetician before either procedure. This will help prevent infection and the formation of milia (small white cysts) after the procedure. If you do not have an aesthetician of your own, we can usually recommend one.

If you are having laser resurfacing, we will recommend preparing your skin for at least 4-6 weeks before surgery with a bleaching agent plus a retinol or one of our Obagi systems. Since the major risk of laser resurfacing is hyperpigmentation (increased brown pigment in your skin), these regimens are designed to protect your skin from this possible complication.

If you are having Portrait® Plasma Skin Regeneration®, there is no significant skin preparation. But if you are on a retinol like Retin-A™ and Renova™ or any kind of frequent fruit acid treatments to your face (like glycolic acid or vitamin C), we will ask that you stop using these about 3-4 weeks before the procedure. The reason for this is that your epidermis acts as what is called a “biologic dressing” after the treatment, and these products thin the outer most layer of the epidermis, the stratum corneum. 
For both procedures, we recommend washing your face with a hexachlorophene soap starting two nights before surgery.

Method of Surgery

For laser resurfacing under local anesthesia or plasma resurfacing in the office, you will be offered prescriptions to calm your nerves before the procedure. With the laser, usually we will only treat small scars, the lower eyelids, crow’s feet, upper lip, lower lip and chin under local anesthesia. A full face procedure will be done in the operating room at St. Vincent Hospital under general anesthesia or local anesthesia with sedation.  With plasma, we routinely do the whole face in the office.

Recovery: What to Expect

The recovery for both procedures is very similar. The treated area is usually covered with Aquaphor™ ointment for 7-8 days after surgery.  This is readily available at you local pharmacy.  It is important that you keep a thick layer of the ointment on your skin at all times until the skin has resurfaced, usually 7-8 days. This protects new skin and prevents the treated epidermis from coming off prematurely. We will show you how to use the ointment. Your skin may be pink for 2-3 weeks, fading gradually. Sometimes we will prescribe a mild steroid lotion to help this subside.  The skin may also be itchy.  Cotton gloves at night will prevent you from scratching off new skin.  You can usually wear a mineral make up in 8-9 days.  We stock ColorScience™ make-up for this purpose. Your skin will continue to tighten for a number of months as your body produces new collagen.   Collagen production does not even start significantly, however, for about 30 days.  Please be patient.  You will notice color changes in the first two weeks.  You will start to notice changes in the texture of your skin (e.g. wrinkles and smoothness) at about 3-4 weeks. Neither procedure should be very painful afterwards. You will feel like you have a bad sunburn the first night after surgery and might take a prescribed pain pill or extra strength acetaminophen. The next day you will usually not require any pain medication.


FAQ

What is Facial Resurfacing?

A peel with a laser or similar device designed to remove the damaged upper layers of skin and allow the growth of new healthier, smoother, tighter skin.

How long is the recovery?

For Fractionated Carbon Dioxide Laser Resurfacing or Portrait® Plasma Skin Regeneration  the initial recovery is about 7-8 days.  You may have some pinkness for 3 weeks or so after that.  You can cover this with make-up.

I heard that the recovery from laser resurfacing is painful.  Is that true?

Not usually. Our patients tell us that it feels like a bad sunburn the first night.  They rarely take significant pain medication after the first night, and many take no pain medication at all.  Our plasma patients take even less medication.

Will resurfacing treatments lighten my skin?

You can get some lightening with the carbon dioxide laser, but Dr. Bentkover usually dose a very nice job of “blending” the color.  He has been using this laser since 1995.  Portrait® plasma will even out your complexion by removing unwanted pigment but should not overly lighten your skin.

How do I know which is better for me, laser resurfacing or plasma?

The differences in outcome can be subtle or very significant, depending on the amount of energy used, the depth of your wrinkles and/or the amount of excess pigment in your face.  In a consultation Dr. Bentkover should be able to recommend which he thinks will be best for you.  He needs to see you in person.

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