Archive for March, 2011
Sedation Not Needed for Laser Resurfacing
Question:
Can I get laser resurfacing without sedation? I do not want any sedatives as I don’t need any. I heard a doctor around here wouldn’t even do it without the patient being sedated. However, I have heard of some that just use local anesthesia with an OPTION for sedative or iv sedation. Please let me know if this is absolutely necessary. I really don’t need to be sedated in my opinion (as long as I am pain free with the local).
Answer:
You can definitely get laser resurfacing without sedation. The local anesthesia used for laser resurfacing should be 100% effective so that there is no pain during the actual treatment.
The type of local anesthesia varies with the type of laser that is used for the resurfacing. In most of my cases resurfacing with the erbium laser, which is most often used to treat specific regions of the face, can be done using only a topically applied anesthetic. After each “pass” of the laser, additional anesthetic solution is applied, so that the numbness persists even into deeper layers of the skin. The carbon dioxide (CO2 ) laser, on the other hand, requires an injected anesthetic. This is true for both conventional and fractional CO2 laser resurfacing. In most cases the CO2 laser is used for resurfacing the entire face. Even for full-face CO2 laser resurfacing, most of the anesthetic injection is nearly painless (this is because tumescent local anesthesia is used). Most patients require no sedation with either type of laser.
Please keep in mind that I developed my methods of anesthesia over the past 16 years of performing laser resurfacing, with the goal of maximizing patient comfort during this procedure. Not all laser surgeons use similar methods of local anesthesia.
Erbium laser before filler for lower eyelids
Question:
I am scheduled for erbium laser resurfacing on lower eyelids in two months. If I wanted to get filler done under the eyes should this wait until after the resurfacing? Or how long after resurfacing would you recommend getting the filler injected if it can be done at all?
Answer:
It probably makes the most sense to first undergo the erbium laser resurfacing. Most likely you are considering injection of a filler to help fill in the tear trough between the lower eyelid and the nose. The erbium laser resurfacing will help smooth the wrinkles on the lower eyelid and may result in some improvement in the tear trough. Because there is some tightening of skin resulting from the erbium laser resurfacing, you may see modest improvement in the tear trough, which would enable the use of less filler.
The standard fillers including Restylane, Juvederm and Radiesse can be used to improve the tear trough but must be used with caution to avoid a visible lump or discoloration of the treated area. These fillers are usually placed deep beneath the skin, just above the bone. The results are temporary.
The best filler for the periorbital area, including the lower eyelid, is autologous fat. Fat is the only substance that can be evenly distributed throughout this area (it should be placed beneath the orbicularis muscle) and is also the only filler that gives permanent improvement. Fat grafting in the periorbital area is an advanced technique that must be done with care in this delicate area. Restoring lost volume in this area re-creates a youthful appearance and also reduces wrinkles because the skin has greater volume beneath it.