Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The consultation is a rigorous medical assessment, not merely a scheduling appointment. The surgeon evaluates the patient’s skin type, medical history, and specific goals. The primary objective is to determine whether the patient is a safe candidate for laser surgery and to select the appropriate wavelength and modality that matches their pathology.
During this phase, the surgeon examines the area of concern under magnification and possibly with special lighting (such as a Wood’s lamp) to assess the depth of pigment or the extent of damage. This diagnostic accuracy is crucial for preventing complications like burns or pigmentary changes.
Plastic surgery is a diverse surgical specialty dedicated to restoring, reconstructing, or altering the human body. The term is derived from the Greek word plastikos, meaning “to mold” or “to form.” Contrary to popular belief, the field is not solely focused on cosmetic enhancements. It is broadly categorized into two main disciplines: Reconstructive Surgery, which corrects defects to restore normal function and appearance, and Aesthetic (Cosmetic) Surgery, which focuses on enhancing the appearance of structures that are functioning normally. A Plastic Surgeon is a specialist trained in the complex manipulation of skin, muscle, bone, and soft tissue to achieve these goals.
The most critical safety factor in laser surgery is the accurate determination of the patient’s Fitzpatrick Skin Type. This scale classifies skin from Type I (very fair, always burns) to Type VI (very dark, never burns).
The amount of melanin in the skin competes with the target chromophore for the laser energy. Darker skin types (IV-VI) have more epidermal melanin, placing them at higher risk for burns and hyperpigmentation. Settings must be precisely calibrated based on this classification to ensure the laser hits the target without damaging the surface skin.
For many patients, especially those with darker skin tones or undergoing aggressive treatments, a test spot is performed. The surgeon treats a small, inconspicuous area with the proposed settings and observes the tissue interaction.
The patient is then sent home, and the area is evaluated after 24 to 48 hours (or longer for darker skin). This delay allows any adverse reactions, such as blistering or hyperpigmentation, to manifest before the entire face or body is treated. It is the ultimate safety check.
A comprehensive review of the patient’s medication list is mandatory. Many common drugs, including antibiotics (tetracyclines), diuretics, antidepressants, and acne medications (isotretinoin), make the skin hypersensitive to light.
Treating a patient on photosensitizing drugs can result in severe burns or scarring from settings that would generally be safe. The surgeon must identify these agents and determine if a washout period is required before surgery can proceed safely.
Recent sun exposure is a strict contraindication for most laser procedures. Tanned skin contains activated melanocytes and increased melanin in the epidermis. This extra pigment acts as a target for the laser, absorbing heat meant for the deeper target.
Patients must avoid the sun for at least 4 to 6 weeks before surgery. Treating tanned skin dramatically increases the risk of burns, blisters, and permanent white spots (hypopigmentation). The surgeon assesses the skin for tan lines and recent UV damage.
To optimize results and safety, patients are often placed on a pre-conditioning skincare regimen for several weeks before surgery. This typically involves using retinoids to accelerate cell turnover and hydroquinone to suppress melanocyte activity.
This “priming” of the skin ensures that the melanocytes are quiet and less likely to react to the laser heat with hyperpigmentation. It also thins the dead outer layer of skin, allowing the laser to penetrate more evenly and effectively.
Laser resurfacing around the mouth can trigger a reactivation of the herpes simplex virus (cold sores), even in patients who have not had an outbreak in years. Thermal trauma acts as a stressor that awakens the dormant virus.
To prevent a widespread viral infection on the raw, healing skin, patients with a history of cold sores are prescribed antiviral medication (such as valacyclovir). This prophylaxis typically begins one day before surgery and continues until re-epithelialization is complete.
Laser surgery offers profound results, but it is not magic. The consultation includes a frank discussion of the technology’s limitations. For example, a laser can tighten skin, but it cannot replicate the lifting effect of a facelift for severe sagging.
The surgeon explains the recovery timeline, the expected number of treatments, and the potential for temporary side effects like redness or swelling. Aligning the patient’s expectations with the clinical reality is essential for post-operative satisfaction.
Advanced clinics use digital skin analysis systems (such as VISIA) to photograph patients under different lighting conditions. These systems reveal subsurface damage, vascularity, and pore size that are not visible to the naked eye.
This objective data establishes a baseline for the patient’s skin health and allows for precise tracking of improvement over time. It transforms the consultation from a subjective discussion into an evidence-based planning session.
Hydrated skin responds better to laser energy. Water is the target chromophore for ablative lasers. If the skin is dehydrated, the ablation may be less efficient, or the heat may conduct differently than expected.
Patients are encouraged to hydrate well in the days leading up to the procedure. Topical moisturizers may be recommended to ensure the epidermis is supple and the tissue’s water content is optimized for the specific laser interaction.
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Generally, no. We avoid elective laser procedures during pregnancy. Hormonal changes can cause pigmentation issues (melasma) that make laser treatment unpredictable, and we always prioritize the safety of the developing baby by avoiding unnecessary stressors.
Yes, you must shave the area 24 hours before your appointment. If the hair is long, the laser energy will burn the hair on the surface of the skin, causing pain and burns, rather than traveling down the shaft to kill the root.
You need to avoid direct sun exposure and tanning beds for at least 4 to 6 weeks before your laser session. Your skin must be your natural, pale color. If you have a tan, we will likely have to reschedule to avoid burning you.
If you are taking isotretinoin (Accutane), you must stop taking it for at least 6 months before having any ablative laser resurfacing. This medication affects how your skin heals and can lead to severe scarring if laser surgery is performed too soon.
Yes, for many laser procedures, especially if you have a darker skin tone or are treating a sensitive area, we will perform a small test spot during your consultation or a few days before the complete treatment to ensure your skin reacts safely.
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