Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Patient comfort is a priority during laser surgery. For superficial treatments, a high-potency topical anesthetic cream (lidocaine/tetracaine) is applied for an hour under occlusion. This numbs the skin surface effectively.
For deep ablative resurfacing, topical anesthesia is supplemented with regional nerve blocks (injections that numb the entire face) and oral sedatives or analgesics. In some cases, twilight sedation is used. This multi-modal approach ensures the patient remains relaxed and pain-free throughout the procedure.
Safety in the operating room is strictly controlled. Everyone in the room, including the patient, wears wavelength-specific protective eyewear. Laser light can cause permanent retinal damage instantly if proper protection is not worn.
Wet drapes are used around the treatment area to prevent any accidental ignition of dry materials. Oxygen is turned off or minimized during facial treatment to eliminate fire risk. These protocols create a secure environment for the delivery of high-energy light.
Vaporizing tissue produces a plume of smoke containing biological particles and a distinct odor. A specialized smoke evacuator a high-powered vacuum with HEPA filtration is held adjacent to the laser handpiece.
This device captures the plume instantly, keeping the air in the room clean and maintaining a clear visual field for the surgeon. Efficient smoke evacuation is a standard of care to protect the respiratory health of both the patient and the medical team.
The surgeon delivers the laser energy in a precise pattern. For fractional treatments, the laser lays down a grid of microscopic channels. The surgeon controls the density (the number of channels per square centimeter) and the energy (the depth of the channels).
Passes are often overlapped to ensure uniform coverage and prevent “checkerboard” patterns. The surgeon constantly assesses the skin’s reaction, looking for clinical endpoints such as pinpoint bleeding or tissue shrinkage, and adjusts the settings in real time to optimize the result.
To protect the epidermis from excessive heat buildup, cooling is applied before, during, and after the laser pulse. This may involve a chilled sapphire tip on the laser, a spray of cryogen, or a continuous stream of forced cold air (Zimmer cooler).
Cooling allows the surgeon to deliver higher energies to the deep dermis without burning the surface. It also acts as a potent anesthetic, numbing the nerve endings and significantly improving patient comfort during the procedure.
Immediately after the laser passes are complete, the treated area is covered with cold compresses to extract residual heat. Once the skin is cool, a thick layer of an occlusive ointment (such as petrolatum or a specialized balm) is applied.
This occlusion is vital. It creates a moist wound environment, which speeds up re-epithelialization by up to 50% compared to dry healing. It also significantly reduces pain by covering the exposed nerve endings.
The first 3 to 5 days after ablative surgery are the re-epithelialization phase. The skin will be raw, red, and moist. It may ooze serum. This is the period during which stem cells from hair follicles migrate to cover the open surface.
Patients are instructed to perform vinegar soaks (diluted white vinegar and water) multiple times a day. This gently cleans the skin, removes debris, and creates an acidic environment that inhibits bacterial and fungal growth. No scrubbing is allowed.
Swelling is a predictable and significant part of recovery, peaking around 48 to 72 hours. In severe cases, the eyes may swell shut. This is a normal inflammatory response to the thermal injury.
Patients must sleep with their head elevated on two or three pillows to use gravity to drain the fluid. Systemic corticosteroids may be prescribed to blunt the swelling response. Ice packs can be used intermittently on the non-treated surrounding areas.
Around day 3 or 4, the skin will begin to darken and feel rough, like sandpaper. This is known as “bronzing.” It represents the microscopic columns of dead skin (necrotic debris) being pushed out by the new skin underneath.
Over the next few days, this bronzed layer will crack and peel off. Patients must allow this to happen naturally. Picking or peeling the skin prematurely can cause scarring or infection. Keeping the skin moisturized helps the debris slough off gently.
The raw skin is susceptible to infection during the first week. Patients are often prescribed antibiotics to prevent bacterial superinfection. If the patient has a history of cold sores, antiviral medication is mandatory.
The patient is taught to monitor for signs of infection, such as increased pain, yellow discharge, or fever. Keeping the wound clean with soaks and covered with ointment is the primary defense against pathogens.
As nerves heal and skin dries, itching (pruritus) is very common. It can be intense. Scratching the healing skin is strictly forbidden as it can cause scarring.
Oral antihistamines (like Benadryl or Zyrtec) are often recommended, especially at night. Keeping the skin moist with ointment also helps relieve the itch. In some cases, a mild topical steroid may be prescribed to calm the sensation.
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For the first few hours, it feels like a severe sunburn. The throbbing can be intense but usually subsides by the next morning. Most patients find that Tylenol and cool compresses are enough, though prescription pain medication is available for the first night.
You must sleep on your back with your head elevated on at least two pillows. This is crucial for reducing swelling. Putting a towel over your pillow is a good idea to protect it from the ointment and oozing.
You can shower and wash your hair 24 to 48 hours after surgery. You should let the shampoo and water run gently over your face, but do not scrub the treated area. The steam from the shower can also feel soothing.
Pinpoint bleeding is normal during the procedure and immediately after. If you spot bleeding at home, apply gentle pressure with a clean gauze soaked in cool water. Do not rub. If it persists, call your surgeon.
The intense redness fades to pink once the skin peels (around day 7). This residual pinkness can last from a few weeks to a few months, depending on the depth of the laser treatment. It can usually be covered with makeup after the first week.
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