SKIN RESURFACING

SKIN

“With a thorough understanding of the important principles of skin resurfacing and wound healing, the management of complexion improvement becomes straightforward, complications become manageable, and patient satisfaction is excellent”.

Chemical Peel and Dermabrasion are two procedures, which up to the present moment of time have been used to refresh the appearance of your skin by causing it to regenerate.  Information on the skin-resurfacing laser follows later in these notes.

A Chemical Peel achieves this through a controlled burn, which causes an exfoliation of the outer layers of the skin while Dermabrasion causes an effect similar to “sandpapering”.  The skin removed can be superficial or deep.  Superficial techniques are employed to give the skin a “fresh, clean” look.  However, they will not remove wrinkles.  The deeper methods may remove wrinkles, such as those around the lips but the deeper the technique, the greater is the chance for complications such as altered pigmentation of the skin and scarring.  You should discuss with your surgeon what you hope to achieve by these techniques so that he may determine which technique is best suited to your requirements.

There are limitations to both Chemical Peels and Dermabrasion.  When used within the parameters for which they were designed, both are effective.  Problems start when these methods are required to undertake work for which they are not suitable.  Chemical Peels, Dermabrasion and the skin resurfacing laser do not substitute for a Facelift (Rhytidectomy) but may well be used either in conjunction with one, or if employed early enough, to avoid one.  If you are to allow anyone to carry out this treatment on you do so on the bases that these techniques are complimentary to surgery rather than an alternative.

A consultation with a fully experienced Plastic Surgeon is the first step in considering any of these treatments.  You should ensure that he has a full understanding of your requirements, which should be realistic and achievable.  Discuss your goals and expectations, and remember, if you have a passive personality and contribute little to your consultation, the result you end up with is almost certainly going to be that favoured by your surgeon.  If your requirements are specific in any way you must make them known.

DERMABRASION

Dermabrasion is carried out under with local or general anaesthetic.  A high speed rotating devise is used to which is attached a small, rotary wire brush, or an abrasive metal, or stone cylinder.  Dermabrasion removes the upper layer of skin and depending on the extent of the treatment, the face may be left exposed, or covered with a dressing for a few days.  Under no circumstances are you to go into direct sunlight, or even areas of brightly lit shade.  Sunbeds are out for at least 6 months, perhaps more.

CHEMICAL PEEL

Chemical peeling is simply a matter of applying an acid solution to the face.  At the discretion of your surgeon, the face may be left exposed, covered with ointment, or protected with a mask with layers of zinc oxide tape, or similar with openings for eyes and mouth.  The chemical “burns off” the upper layer of the skin, which then regenerates during the normal healing process, producing new, younger looking skin.  As with Dermabrasion, sunlight must be avoided.

Post-treatment your doctor may prescribe creams, which contain Retin-A, and hydroquinon, which are Vitamin A derivatives.  Certainly, once the healing process is complete you will be advised to apply Retin-A for the month following, as a boost to your treatment.

Both Chemical Peeling and Dermabrasion may be carried out as a day case treatment but occasionally a short stay in hospital is necessary.  Your surgeon will advise you of his requirements on your consultation.

Treatment carried out under local anaesthetic may still prove to be painful, or at least uncomfortable.

Following treatment, the skin will crust over and this will last between 5 and 10 days depending on the depth of the treatment.  The deeper the treatment, the more dramatic the results, but recovery times are proportional to the severity of treatment.  When all traces of crustiness have gone you will be left with a pink skin, which may last for several weeks, rarely longer.  As with Chemical Peeling and Dermabrasion, sun protection is necessary for several months.

As with all forms of peeling, be it chemical, mechanical, the deeper the treatment, the better the result.  However the more major the treatment the more likely are problems.   These may be temporary, or permanent alteration of skin colour, areas of scarring due to delayed healing and infection.  If you were to contract an infection, you would need to take a course of antibiotics.  However, in most cases, problems if they do occur, are minor, healing usually progresses to a natural conclusion.

For the first two weeks you should not go to work.  In truth, you won’t want to.  After this period of time establishing your normal activities and routines is an individual matter.  Your surgeon will advise you as he sees fit and you are expected to follow his advice.

TUMESCENT DERMASANDING WITH CRYOSPRAYING

This is a new treatment, which has shown to have remarkable results.  Unlike any of the treatments mentioned above (for which a place exists for all) tumescent dermasanding has proven not only very effective, but also very safe.

Basically a theme on Dermabrasion it differs in that no machinery is involved.  Instead the surgeon uses simple sand paper of varying roughness.  This is sterilised prior to use and is wrapped around a dental roll (as used by your dentist in keeping the cheek off the gum) and used to plane away rough or wrinkled skin.

Prior to any treatment being carried out the surgeon will inflate the area with a combination of local anaesthetic and saline in order to make the area very firm.  Having done this he can now commence to sand the area staring off with a 150 grit paper then moving to a finer 400 grit, finally finishing with a smooth 500.

Bleeding from this technique is minimal but where it persists cryospraying may be used to bring it under control.  Cryospraying may also be used to help firm the area prior to sanding.  Only when the treated area is smooth as it can be will the surgeon dress the areas and the operation be over.

Post operatively you will feel sore and treatment is virtually the same as for Dermabrasion.  If you suffer from cold sores your surgeon will need to know in order that he may prescribe medication, which will prevent the virus from being spread during your treatment.  Recovery times are remarkably quick, results are usually quite predictable and problems relative minor.  In the United States, the current hottest topic in Dermatological Surgery is CO2 Skin Resurfacing.  In answer to the question of how well does Dermasanding compare with the Skin-Re-surfacing Laser?  The jury is still out.  Both procedures are constantly being refined and it may be some time before it can be said with any degree of certainty which of these two treatments produce the better result.

However Dermasanding procedures constantly gets good results, offers little in the way of pain and discomfort and for these reasons alone it will continue to be sought after by patients seeking a permanent way to refresh their complexion.  We now carry out far more treatments for Dermasanding than for any other method of skin resurfacing and believe that this relatively recent treatment will continue to grow in popularity as more surgeons and patients appreciate its efficiency.

Regardless of the method of skin resurfacing which is suited to your particular requirement, it will be necessary for you to have an anaesthetic of one type or another if the procedure is to be without serious pain and discomfort. 

GENERAL ANAESTHETIC

After you have discussed your operation with the surgeon, it will be necessary for you to consider your anaesthetic requirements.  In order for the operation to be performed painlessly, it will be necessary for you to have an anaesthetic of one type or another.  Although we try and avoid the use of full-blown general anaesthetics wherever possible, in many cases, for reasons of your absolute comfort and safety they are required.  Modern general anaesthetics are safe.  You need not fear them.  They are even safe for the type of patient seeking elective surgery because of their fitness levels.

If a GA has been selected as being appropriate in your case you will meet your anaesthetist before the operation but, because your operation is not urgent in a medical sense, it is sensible for you to be as fit and healthy as possible, prior to the anaesthetic.

In order to avoid unnecessary disappointment, this leaflet has been prepared describing some common problems, which can result in the operation being postponed.   If you are in any doubt, please contact the hospital prior to leaving home.  If it is essential to postpone your operation you will then be spared the journey, when a new date can be arranged.

Most people have never had an anaesthetic.  The latter part of these notes describes what will happen before, during and after your anaesthetic.  The description is quite detailed, in the hope that it will take away some of your anxieties.  Your anaesthetist will be taking care of your all through the operation, although you will only be aware of his presence before and after the operation.

Coughs, sore throats, colds and influenza, or any infection in the breathing passages, can be made much worse by a GA.  For this reason you should be symptom free for at least two weeks before an anaesthetic.  Important symptoms include a fever, sore throats, runny nose or cough.

It is very important that your stomach is empty before you have a GA.  For this reason you should not eat, or drink anything, for at least 6 hours prior to your operation.  This will be advised to you on the day of booking your operation with the Patient Information Officer.

Most medical conditions do not cause difficulties for your anaesthetic, providing that they have been adequately treated beforehand.  If you have a problem such as diabetes, chronic bronchitis, or asthma, which deteriorates from time to time, it is best to have your anaesthetic during a good period.

If you are worried that you may not be fit enough for an anaesthetic, ask yourself this question: “while I have suffered from this problem, have I ever been fitter?”  If the answer is yes, please phone the hospital before leaving home, so that we can advise you on the desirability of having an anaesthetic at that particular time.  It may be necessary to delay your operation for a few weeks so that your medical condition can be improved.  This may be a disappointment at the time, but is done for your comfort and safety.

If you suffer from high blood pressure, you may like to ask your GP to check it for a few weeks before your operation.  If your blood pressure is unacceptably high, your GP will be able to read it before your have your operation.  You will appreciate that your GP will already have cared for you during your medical illness.  He is, therefore, in the best position to advise on treatment, which will return you rapidly to full fitness.

Many people do not want their GPs to know that they are having a cosmetic operation.  This is because they believe that he will be unsympathetic.  This is very rarely the case.  We prefer to involve your GP in any treatment, prior to your operation, as his advice can be immensely helpful.  We will always ask your permission before contacting him and will only do so if you agree.  We hope that you will agree for the reasons just given.

It is important that you bring with you all pills and medications that you are currently taking.  It is important that your anaesthetist knows what you are taking, so that he can give you an appropriate anaesthetic, which will not interact with your tablets.

Excessive consumption of alcohol can cause bleeding during and after the operation.  It is better not to drink at all before the operation but if you feel the need, please do not have more than one pint of beer, or one short, on the evening before your operation is carried out.  If you smoke, you are more likely to develop a chest infection after your operation.  Any reduction in cigarette consumption is helpful. 

Ideally, you should stop smoking completely from the time of your first consultation or for that period of time advised by your surgeon.  Smoking has an adverse effect on the outcome of many surgical procedures.

Your anaesthetist will ask you for details of your teeth.  What he wants to know is whether or not you have any crowns, bridges or cosmetic dentistry, which will require him to use a different technique.  Teeth can be and often are, damaged by failure of the patient in informing the anaesthetist that crowns or bridges are present.

The possibility of damage to teeth during anaesthesia is remote, if you have given full dental information prior to your anaesthetic.

Your surgeon will tell you when you can expect to go home after your operation.  If you are discharged on the day of your operation, it is dangerous for you to drive, operate appliances, or machinery.  Long journeys by public transport can be exhausting, even after a minor operation.  It is therefore advisable for you to arrange to be collected by a friend or relative.  You may also find it helpful to stay with someone overnight.  You should not drink alcohol for 48 hours after your anaesthetic or for that period of time advised by your surgeon post operatively.

Each anaesthetist uses a slightly different method.  It is not therefore possible to describe precisely, what will happen.  The following description, will however, give you some idea of what to expect:

Before your operation your anaesthetist will wish to see you.  He will discuss your medical history and will examine your heart and lungs.  A nurse will already have taken your temperature and blood pressure.  Some patients may also have a heart tracing taken (ECG).

The anaesthetist will decide whether this is necessary on the basis of your age, medical history and the examination.

Conversely so, you should not worry if your anaesthetist does not take an ECG reading.  This simply means that your obvious good health obviates its necessity.  An ECG is taken as an added precaution, and you should not assume that the anaesthetist thinks you are ill.  Before an ECG is taken, he will explain why he thinks it is necessary, and afterwards will tell you what it shows.  You will then have a chance to discuss you anaesthetic.  Many people worry unnecessarily because they have head “dreadful stories”.

Modern anaesthetics are extremely safe, and we hope that you will feel free to ask as many questions as you like so that we can set your mind at rest.  You may also be written up for some sleeping tablets, which are optional, but are often helpful the night before an operation.

Before your operation you may be given a pre-med.  This is usually a tablet, but in certain circumstances may be an injection.  The pre-med will make you pleasantly drowsy and reduce your anxiety.  Although you will have been starving in preparation for your operation, it is perfectly in order for you to drink a small amount of water to help you swallow the tablets.  At about this time you will be asked to put on a theatre gown, and to remove all jewellery, except your wedding ring, which will be covered with tape.  You should only wear the gown and your lower undergarment.

About ten minutes before your operation, you will be asked to get onto a trolley and taken to the anaesthetic room, which is next door to the theatre.  The anaesthetic nurse will confirm with you the operation you are having, and will then put on you a blood pressure cuff, and small stickers, which will allow your anaesthetist to monitor your heart beat whilst you are sleeping.

You will then be anaesthetised.  This will involve a small injection in your hand, wrist or below.  You probably will not feel the injection at all, but if you do, it will be no worse than scratching yourself.  You will be asleep within twenty seconds after the injection.

Some people feel a little dizzy just before they fall asleep, others fall asleep instantaneously.  Each person reacts differently, but the majority of our patients do not find our anaesthetic procedure either disturbing or unpleasant.

Whilst you are asleep your anaesthetist will be looking after you all the time.  His sole duty is your safety and welfare.  Several sophisticated electronic monitoring devices are used to assist your anaesthetist.  These constantly monitor your heartbeat, blood pressure, and the quality of anaesthetic being given.

All the machines are fitted with alarms to give your anaesthetist early indication of the very rare occurrence when an abnormality may arise.  This allows the abnormality to be corrected.

When the operation is over, your anaesthetist will wake you up.  By the time you become aware of your surroundings you will be in a special recovery room.

A nurse will be with you until you are completely awake.  You will still be having your heart rate and blood pressure measured at regular intervals by automatic machines.  When you are fully awake (usually about 15 minutes) you will be lifted back into your own bed where you may drift back into natural sleep.  Even though you will not be allowed out of the recovery room until we are confident that your anaesthetic has worn off, it is quite common not to remember anything until you wake from this natural sleep.

Most of these operations are not nearly as painful as your might imagine.  Often the pain can be relieved by simple tablets such as Paracetamol.  Stronger painkillers are always available should you need them.  The nurses will ask you at regular intervals if you are feeling discomfort, or pain, but you may ask for painkillers at any time.