Lasers have been around since the 1950’s and were introduced into ophthalmology and dermatology at about the same time,in the 1970’s; in ophthalmology for treating diabetes and in dermatology for removing tatoos.  Over the years many types of lasers have been developed for applications in medicine and industry.  In this blog I would like to discuss the applications in skin resurfacing; treating acne scars, sun damage and wrinkles.

To understand how lasers work to resurface the skin you should know something about the structure of the skin.  There are basically two layers, the outer epidermis and the underlying dermis.  Think of the dermis as the steel work upon which a building is constructed.  Once the steel work is in place it is then possible to apply the facade of the building.  The facade can not support the weight of the building, it must have the steel superstructure.  Similarly, the epidermis needs a healthy dermis for its support.  When the dermis becomes damaged as it does with sun exposure, smoking, poor nutrition and/or genetics, the epidermis will crumple, that is, become wrinkled.  The element in the dermis that gives it structure is collagen.  Collagen is adversely effected by free radicals from the degrading forces mentioned above.

There are several types of lasers used for skin resurfacing, Erbium, Neodymium and carbon dioxide.  They all work on the same principle, they heat the dermis which stimulates the collagen to remodel itself.  The revitalized dermis leads to an improvement in the health and appearance of the overlying epidermis.  The technical difficulty is how do we design a laser that will heat the deep dermis without pain and without damaging the epidermis.  Until relatively recent years, this was not possible and patients undergoing skin resurfacing had their procedures in the operating room  with long recovery times.

Enter the Fractional Carbon Dioxide Laser which has been on the scene since 2007.  This laser delivers enough energy to stimulate collagen while sparing the skin surface.  The result is rapid healing and the discomfort is minimal and the procedure can be done inthe office setting.  Folks can return to work in three days if necessary.

If you have acne scars, wrinkles or sun damage that you are not happy with, give me a call at the Miami Eye Center and we can discuss your situation  and plan an approach with the fractional carbon dioxide laser.  You will be pleased to know that the procedure is far less expensive than you might anticipate.

This may seem like an absurd title but when it comes to understanding how the various technologies can improve and alter your appearance, there appears to be a widespread lack of knowledge among my patients here in Miami.  I’m referring to the modalities such as Botox, fillers like Juvederm, lasers for skin resurfacing and facelifts.

The key to understanding is determining whether the wrinkles are fixed or dynamic.  Botox will improve dynamic wrinkles, that is, wrinkles that arise from facial expression.  When we smile the lines around the eyes suddenly appear or the frown brings out the lines in the brow.  These are dynamic wrinkles and are treatable with Botox.  In general, the region of the face that can be managed is from the nose up to the hairline.

The fixed folds in the facial skin are the smile lines that radiate down from the nose area to the lips.  The lines that start at the outer edge of the mouth and angle down to the jaw are fixed.  This type of facial dynamic is treatable with fillers.  The deeper and longer the fold the more filler is required to give a nice contour.

Laser skin resurfacing is usually a full face treatment designed to reduce or eliminate wrinkles where the collagen of the facial skin has degraded and the overlying surface has lost its vitality.  The laser leads to collagen rejuvenation and secondary smooting of the surface.  Sun damaged skin is readily improved with this technology.

Lastly, facelift surgery is an operating room procedure whch can lead to major changes in the appearance but requires a substantial commitment of time and money as recuperation takes weeks and fees are often prohibitive.

When properly applied, Botox, Juvederm and laser skin resurfacing can be combined in a sequential manner with minimum down-time and with dramatic results.  I will be happy to discuss these options with interested folks.

Scientists are beginning to unlock the mystery of aging.  In 1900 average life expectancy was 47 years.  We are now pushing the average toward 80 years.  But there is far more to just racking up the years, in my view it is about quality of life; we want to live well for as long as we can.  I see myself as dying at 94 while standing on the bow of my fishing skiff wrestling a 110 pound tarpon. 

Part of feeling well is looking good.  As we age, it takes an extra effort to accomplish that goal.  Gravity is at work, body fat is relocating, collagen (the scaffold supporting our skin) is degenerating and our genetic predisposition begins to play out.  If you are in your forties, just look at the quality of the skin of your parents and get a glimpse into your future.  All of these factors  have an effect on the appearance of our face.   Perhaps the most important feature of the face is the eyelid area.  Upon meeting a person, this is the first region that is considered and we are programmed to make numerous decisions about that person at the instant of “the first encounter.”  By creating small alterations in the appearance of the eye area, one can send a whole new set of information at the moment of the encounter. 

62 year old prior to upper eyelid surgery

Following surgery

The only thing that was done in this case was to create a lid crease by removing skin.  You have a more youthful appearance and you notice the sparkle in the eye.  The key to surgical success is to do the minimum necessary to create the desired effect.

This procedure, known as blepharoplasty or cosmetic eyelid surgery is a 20 minute outpatient procedure which we do in our adjacent ambulatory surgery center.  It is done with local intravenous anesthesia from which the patient awakes immediately and leaves the operating room under their own power.  For reasons that remain unclear to me, there is no pain  following the surgery.  Folks can be up and about on the next day provided that they make an effort to apply ice to the surgical area.  The issue of bruising always comes up.  If you tend to bruise then expect that with the surgery, otherwise localized swelling is the norm.  The sutures are removed in one week. 

In many instances, health insurance companies including Medicare and Medicaid provide full coverage for this surgery.  When a patient meets the criteria, we take photographs preoperatively and submit them for review by the insurance companies.  Many people are surprised to learn that they are covered.

Age alone is not a factor; your state of health and your motivation to look as good as you can are the driving forces.  Call the office and I will meet personally with you and review your candidacy for blepharoplasty.