Pre-Operative Instructions for Laser Resurfacing

  • Notify your provider if you have a history of cold sores.
  • Avoid using products containing aspirin for ten days prior to appointment and two weeks after. Tylenol or Ibuprofen (Advil, Nuprin, or Motrin) is OK. You must inform us about medications you are taking before starting, and at each subsequent laser treatment. Some medications are contraindicated and must be discontinued before treatment.
  • Discontinue the use of Tretinoin, Retin-A, Glycolic, or Alpha Hydroxy Acid skin care products 24 hours prior to your scheduled laser treatment.
  • Wear comfortable clothes on the day of your treatment. Do not wear clothing which must be pulled over your head.
  • DO NOT wear makeup, creams or have moisturizer on your face when arriving for laser treatments.
  • No smoking of nicotine products a minimum of 2 weeks before the treatment. If you do smoke, please be aware that smoking increases the risk for poor wound healing and may delay your healing process.
  • Please remove your contact lenses the day of the treatment.
  • If you will be taking pain medication and a relaxant prior to the procedure, please plan for someone to drive you to the office and take you home. You may not drive yourself home.

 

Post-Operative Instructions for Laser Resurfacing

Post-operative care is very important.  Unnecessary pain and the complications of infection and swelling may be minimized if the instructions are followed carefully.  Sometimes the after-effects are quite minimal, so not all these instructions may apply.  When in doubt, follow these guidelines or call our office any time for clarification. The laser procedure has the ability to produce the most dramatic results in skin rejuvenation.  It also has one of the more formidable recoveries. This first week after laser skin resurfacing is challenging in terms of care. You will be swollen, covered with cream and not presentable to leave the house. This all begins to change at about day 5-6. After this the recovery is much easier. Just remember that the reward is at the end of the healing journey.

Laser resurfacing removes the outer layers of the skin. It is very important to manage this treatment to ensure proper healing. As with any burn, do not touch the treated area without washing your hands. Bacterial and yeast infections can occur.

Immediately Following Surgery:

  • You should rest with your head elevated in a recliner or with at least 2 pillows for the first 48 hours after surgery.
  • Take the prescribed pain medications before you begin to feel discomfort.  It is easier to prevent pain than control it.
  • Restrict your activities the day of the procedure and several days afterwards.  It is not unusual to require 7 to 10 days before you are feeling back to normal, and before you can resume strenuous physical activity.
  • The immediate post-laser treatment consists of covering the lasered skin with Cicalfate (provided in office) and using cold packs for discomfort and swelling.  

Bleeding

Mild oozing from the lasered skin is not unusual.  Mild pressure will control the bleeding that does occur.  The main reason bleeding occurs is from patients elevating their blood pressure by bending, lifting, straining, coughing, sneezing, straining on the toilet and other strenuous activities.

To avoid complications from bleeding you must absolutely refrain from activities that may increase blood pressure or bleeding for 10 days after your surgery.  We ask you to elevate your head for the first week and simply relax. You must also refrain from taking any drugs that may prolong bleeding.   Ginko, Garlic, and Ginseng, as well as high doses of vitamin E can increase bleeding.  If bleeding is heavy or prolonged call our office (561) 498-4407 immediately.

Swelling

The best thing to do is to continue applying ice packs to the treated area for 48 hours.  It is also extremely important to continue applying Cicalfate.

The swelling that is normally expected is usually proportional to the depth of the laser resurfacing procedure.

Swelling around the eyes and down into the cheeks and face is not uncommon.  This is the body’s normal reaction to the procedure.  The swelling will start the day of the procedure and will not reach its maximum until 2-3 days post.  Occasionally, the eyelids will swell completely shut.  The swelling will rapidly decrease after the 3rd day.

Pain

Generally, the procedure is not extremely painful, and feels more like a sunburn. The first 48 hours is the most uncomfortable and the discomfort should quickly subside. Some of our patients do not require pain medication but I would recommend taking a dose of your pain medicine about 1/2 hour before going to bed. By taking the pain medicine, you will be more comfortable.

For mild pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. Ibuprofen is generally not recommended for the first several days after the procedure.  This is because ibuprofen can cause increased bleeding and/or bruising.

For severe pain, take the narcotic pain medication as directed.  This prescribed pain medicine will make you groggy and will slow down your reflexes.  Do not drive an automobile or work around machinery until you are no longer taking any narcotic pain medications and your vision is clear.  Avoid alcoholic beverages as they will enhance the effect of the narcotic.  This is a dangerous combination.  Pain or discomfort following the procedure should begin to subside after the first two to three days.  If pain persists, it may require attention and you should call the office.  Do not routinely take Tylenol with prescription pain medications.  Many prescription pain medications already contain Tylenol.

Care for the treated skin

Your face will ooze and swell for the first 48 hours and then will quickly improve.  Generally, the procedure is not extremely painful, and feels more like a sunburn. Do not use overly hot shower water and only use the towel to blot dry, do not rub your face.   The goal is to soak and gently remove the dead skin and residue from the creams.  You want to keep all the “crusts” soft and do not let them dry out.  Your body will secrete serum in a normal response to the burn to the skin and this will tend to accumulate like a yellowish paste, especially around the lower lids and mouth.  It is “nature’s Band Aid” and help protects the healing skin.  Although it looks unsightly, do not aggressively attempt to scrub it off.  If some of the yellowish paste comes off in the shower, that if fine and it will all come off soon, but if you remove it and the underlying skin bleeds, you are being too aggressive.

Your skin will begin to wash or peel off about the third or 4th day and your face will become red over the first few days and remain red for a week, will then gradually fade to pink, and then over the next several weeks will normalize.  Some individuals progress quickly from red to pink, while others may take weeks or in some cases months.  The pinkness can be covered with makeup as soon as the skin heals.

After all the crusts are gone and the skin is no longer oozing, the “greasy” creams will be stopped, and you will begin using a hypoallergenic moisturizer. The moisturizer is applied generously to the lasered skin and since it is less greasy than Vaseline, you need to apply more moisturizer and use it more frequently.  The whole idea is to hydrate the skin, so it does not dry out during the healing process.

Day 1 –Vaseline and Cicalfate (provided by our office).

Day 2 to 5 – Continue Vaseline and Cicalfate. Sterile gauze (provided by the office) can be utilized to blot and reapply cream. Do not get face wet until Dr. Feinstein has given authorization to do so. You can bath during this time, but cannot get the face wet.

Day 5 to 7 – Continue with Vaseline and Cicalfate (depending on depth of laser). You can shower and wash your face with Cetaphil cleanser using the pads of fingers, gently dry off and then reapply Vaseline or Cicalfate. Stay out of the sun!

Day 7 to 14 – Continue with face washing and moisturizer, makeup can be applied when skin is smooth and pink, without crusting.  Begin using fragrance free sunscreen by day 14 or earlier if outside or riding in car.  Stay out of the sun and use sunscreen anytime you are outside.

Your laser resurfacing is a safe and predictable procedure but is reliant on multiple medications to prevent viral and bacterial infection, reduce swelling, control discomfort, and assist in sleeping if necessary. It is imperative that you understand the prescription regimen and take the medicines as directed by Dr. Feinstein and his associates. Some of the medications are patient dependent. You may not receive all of them. Ask Dr. Feinstein if you have any questions.

Acyclovir (anti-herpes medication given to all patients) – all laser patients are susceptible to herpes outbreak after their laser treatment. This medication is very important, as a herpes outbreak can cause permanent scarring. This medication is started on the day of the procedure and taken three times per day for 10 days.

Doxycycline (antibiotic medication given to all patients) – this medication will protect your healing skin from bacterial infection. In the case of allergy, we will prescribe you a different antibiotic. This medication should be taken the day of the procedure twice per day for 10 days.

Flucaonazole (prevent fungal infection) – this medication will protect your healing skin from fungal infection. This medication will be taken on Day 4 after the procedure (day of procedure is consider day zero).

Benadryl – Many people will complain of itching as the skin heals.  It is important not to scratch the treated areas.  Benadryl may be used to help with the itching.  Take one 25 mg tab twice a day as needed for itching.

Discomfort Medication – you will receive a prescription for discomfort if needed. You only need to take this medication if you have discomfort. If you wish, you may take Tylenol instead.

Sleeping Medication – (only given if needed) If you are having trouble with restful sleep, please contact our office.

Sunscreen – Keeping sun off the face is very important and important for proper healing.  All patients should avoid direct sunlight for 4-6 weeks after surgery.  Using sunscreen, sunglasses, and a wide brimmed hat are necessary.  It is also important to protect your healing skin from sunlight that comes through car or office windows.  Using a high quality sunscreen with at least SPF 30 is recommended. This should be applied several times per day, every day during the healing period.

If you have been using Retin-A, or other skin care products before your laser, you need to stop them until your healing is complete. We like to have all patients on Retin-A and skin care products before and after their skin resurfacing. We generally begin the post laser skin care 4-6 weeks after the laser procedure. Your new skin is sensitive and requires gentle care. You will love the changes, but it takes some time to get to that point.

Discoloration

If you had laser your skin will be pink. Some patients will only be pink for several weeks and other patients will be pink for months. The pink skin will eventually resolve and is generally easily covered with makeup. Do not apply make-up over the treated skin for at least 10 days.

About 30% of laser patients will experience hyperpigmentation after skin resurfacing. This usually occurs about 4 weeks after the procedure. This is a temporary blotchy tanning or darkening of the lasered skin. It is a reversible situation and generally responds quickly to bleaching creams. Any irritation to the healing skin such as hot air from hair dryers, car defrosts, sun exposure, and bright overhead lights can contribute to hyperpigmentation. Again, it is always temporary.

Nausea and Vomiting

In the event of nausea and/or vomiting following the procedure, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on flat coke, tea, or ginger ale.  You can also purchase coke syrup over the counter which can have a soothing effect on the stomach.  You should sip slowly over a fifteen-minute period.  When the nausea subsides, you can begin taking solid foods and the prescribed medicine.  Please call if the nausea does not subside within 3 hours.  There are medications we can call in to your pharmacy that work very well to control nausea and vomiting.

Additional Information:

  • Numbness of the skin surrounding the surgical site is normal and there is no cause for alarm.  As stated before, this is usually temporary in nature although in some instances, it can be permanent.
  • Slight elevation of temperature immediately following the procedure is not uncommon.  If the temperature persists, notify the office.  Tylenol should be taken to reduce the fever.
  • Your case is individual as no two people are alike.  Do not accept well intended advice from friends. Discuss your questions and concerns with either Dr. Feinstein or a member of our staff.
  • If you are involved in regular exercise, be aware that your normal nourishment intake is reduced.  Exercise may be much more difficult.  We recommend that you take at least 14 days off from any vigorous physical activity.  When you do resume your exercise regimen, start with a light to moderate workout and gradually increase your regimen over several sessions.  Stop exercising if you get light headed.
  • You should wear clothing that fastens either in the front or at the back rather than the type that must be pulled over the head for one week.
  • An appointment will be made at the front desk to check the procedure site.  If you did not receive an appointment, please don’t hesitate to call our office so we can see you.

If you have any questions regarding your condition, it is best to call the office at 561-498-4407.  Follow-up visits are provided as a courtesy at no charge.  If you have a true emergency, Dr. Feinstein or his assistants can be reached 24 hours a day, 7 days a week.