Surgery Instructions – Skin Resurfacing

Download the Skin Resurfacing Instructions

RESURFACING THE SKIN: DERMABRASION/CHEMICAL PEEL/ LASER MEMORIZE THIS PAPER PRIOR TO SURGERY

WHAT IS SKIN RESURFACING?

Deeper chemical peels and dermabrasion are procedures best suited for individuals who have acne scars, moderate to severe sun damage or deeper imperfections of the skin. These procedures are performed by the doctor with the use of anesthesia.

Dermabrasion is a gentle mechanical scraping to resurface the skin by removing its upper layers. It is used for the treatment of facial scars and to help reduce the appearance of deep lines and wrinkles. Chemical peels are strong chemical solutions which smooth the texture of the skin by removing the damaged outer layers.

Another resurfacing technique uses a laser to vaporize the skins outer layers. Like other methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. Dr. Toledo will help you determine which resurfacing treatment is the best choice for you.

The Preoperative Visit

This visit will be scheduled approximately two weeks before surgery. It will give you an opportunity to ask questions you might not have asked previously. We will review your medical history, give you a preoperative examination, arrange lab tests, and discuss what to expect during surgery.  If you are over forty years of age or have a history of heart abnormalities, we will arrange for an electrocardiogram. We will also take preoperative photographs, which become a permanent part of your medical record, and remain strictly confidential. Your operative consent will be read and signed, preoperative instructions reviewed, and prescriptions given to you for the medications you will need. Payment of your fee will be due at this time.

Arrangements to facilitate overnight or postoperative care will be made to suit your individual needs. Facility and anesthesia charges are separate from the surgeon’s fee.

WHAT TO EXPECT DURING SURGERY

Resurfacing is usually performed at the Highland Park Plastic Surgery Center on an outpatient basis under twilight sleep sedation anesthesia. An anesthetist or nurse will be present to make you comfortable and unaware throughout the procedure.

Before surgery begins, you will be asked to change into a surgical gown and will be taken into a private operating room. An intravenous line will be inserted into a vein in your arm. This will make it possible for the anesthesia provider to administer fluids and to deliver the necessary medications to make you comfortable. Monitoring devices will be connected to you to assure your safety.

Dr. Toledo will talk with you and use a surgical marking pen to draw several lines on your face.  These will guide him during the operation.  Your face will be cleansed with an antiseptic solution and then covered with surgical drapes. At this point we will

proceed with the chosen resurfacing technique. The treated area is tapered at the outside edges, so there will be a blending of the treated and untreated skin after healing.

Immediately after resurfacing the top layers of skin, an antibiotic ointment will be applied to the treated area.

Resurfacing takes between fifteen minutes and one hour, depending on the area of skin to be treated. If performed in conjunction with other procedures, surgery will naturally take longer.

WHAT HAPPENS AFTER SURGERY

You will be transferred to a recovery room adjacent to the surgical suite, where you will be continuously monitored as you recuperate from the effects of the surgery and anesthetic. You will be allowed to go home after a recovery period of 30 minutes, or transferred by our nurses to an after care center for a planned overnight stay. You should feel fine, although it is not unusual to expect some minor discomfort.

If you are going home, the person taking care of you must stay with you for 24 hours and will be given instructions about your after care before you leave, or we can arrange for post operative care in an after care facility.

NOTE: If you live out of town, you must make arrangements to stay within a thirty minute drive of the Highland Park Plastic Surgery Center for the first twenty-four hours after surgery.

Preopertaive Guidelines

Bathe your entire body with CLn body wash the 2 nights prior to surgery and again the morning of surgery. CLn body wash is an anti-bacterial, antiseptic liquid soap. Sleep on clean sheets the night before surgery and wear clean clothes to your surgery.

TED Hose: The Hose we instructed you to buy and wear is for the prevention of deep venous thrombosis (blood clots). Deep venous thrombosis affects mainly the veins in the lower leg and the thigh. This clot may interfere with circulation of the area, and it may break off and travel through the blood stream. This clot can then lodge in the brain, lungs, heart, or other areas, causing severe damage to that organ or even death. Any surgical procedure that will inhibit your activity post operatively there is a risk of blood clots. You will be required to wear your TED Hose during surgery and keep them on for 2 weeks after.

Medications: Take the medications we’ve prescribed according to the instructions on the bottle. You may feel a little drowsy, so have someone help you. If you need a refill, call the office and give us the telephone of your drugstore or pharmacy. Do not take aspirin for four weeks before surgery and two weeks after.

Hormone replacement therapy and birth control pills increase the incidence of blood clots. STOP 2 WEEKS BEFORE AND AFTER SURGERY.

Smoking: Smoking or nicotine use (chewing tobacco, nicotine gum, snuff) can have a severe detrimental effect on wound healing. The nicotine decreases the vital blood supply to the skin and can cause poor healing or even skin death. STOP ALL NICOTINE PRODUCTS 2 MONTHS BEFORE AND AFTER SURGERY.

Caffeine: Excessive use of products with caffeine such as coffee, tea, or soft drinks, especially Diet Coke, can have similar effects as nicotine. STOP ALL CAFFEINE PRODUCTS 2 WEEKS BEFORE AND AFTER SURGERY.

POSTOPERATIVE GUIDELINES

You should expect:

Raw scabbing and red skin that slowly turns pink in several weeks. Moderate swelling that lasts about two weeks.

Sensation of tightness and itching—this subsides over several weeks.

Development of milia (whiteheads)—these are small blocked pores that occur in many patients and will subside over three to four months. They will be treated in the office.

Call (214) 363-4444:

Severe pain that doesn’t respond to medication.

Persistence or increase in redness after five to ten days can signify an infection or allergic reaction.

Any other problems or questions not answered in this paper.

Activity: You should “take it easy” the day of your operation and the following days.

By keeping your head elevated above your heart, swelling can be minimized. Because of your medications, you may need assistance getting to and from the bathroom for the first day.

Facial Care: Keep a thin layer of polysporin ointment on the resurfaced areas at all times. This will form soft mushy scabs that wash off in several days. Keeping the resurfaced skin lubricated with the ointment will prevent infection and enable the new skin to grow back quickly. The deeper the resurfacing the longer you will have new red scabbing skin and need to use Polysporin ointment – usually five to ten days. DO NOT USE NEOSPORIN OINTMENT.

Pain: Most patients feel that the discomfort from the surgery is minimal. The greatest period of discomfort usually lasts about 24 to 48 hours. Thereafter, you should have less discomfort and less need for medication. Occasionally, it lasts a little longer, as different people have different pain tolerances. As long as your face doesn’t dry and stays lubricated, the pain is minimal.

Alcohol: Do not drink alcohol for five days after surgery or when taking pain medication.

Diet: Start with liquids the first few hours and then progress to your regular diet as you desire.

Hair: You may wash your hair 24 hours after surgery. You may blow dry your hair with a warm hand dryer, or sit under a cool dryer, but do not use a hot dryer.

Ice packs: Our staff will explain how to make simple, effective ice packs, which should be placed on your face for two days following surgery. This will decrease discomfort, swelling, and bruising.

Makeup: May be applied when the skin no longer has raw areas or scabbing, usually around the seventh to twelfth day. You will probably want to use special cosmetics, such as Dermablend, to cover the reddened area. Do not use any cosmetics that require hard rubbing for application or removal.

Sun: Do not sit in the sun at all for six months after surgery. For at least a year after surgery, be sure to apply a strong sunblock (30-40SPF) under your makeup base if you have to be in the sunlight.

Sports: Strenuous sports, such as tennis, swimming, jogging, or aerobics, may be resumed after two weeks. For two weeks after surgery, refrain from any activity that significantly raises your body temperature and/or blood pressure.

Work: Depending on the kind of work you do, you may return to your job as soon as you’re comfortable. It will be approximately three weeks before you are comfortable to be seen in public without makeup.

Postoperative visits: You will be seen at our center three to five days after surgery.

Subsequent visits will be determined according to your progress, usually weekly for one month, and then less frequently.

You will feel more comfortable using the private postoperative waiting room for your initial postoperative visits. Park in the handicap spot in front of the Sherry Lane door. Press the doorbell and we will let you in from the inside.

Please feel free to call us at any time during your healing period. THE OUTCOME OF YOUR SURGERY IS IN YOUR HANDS AS WELL AS THE DOCTOR’S. IT IS YOUR RESPONSIBILITY TO FOLLOW ALL INSTRUCTIONS GIVEN TO YOU.

Possible Problems and Complications

No surgical procedure is without risk. Most complications associated with skin resurfacing, however, are minor. Here are some possible problems:

Decrease or increase of sensation in the treated area. If this occurs, it will usually return to normal in time.

Soreness and itching in the treated area. If these sensations occur, they will soon disappear.

Discoloration of the skin. There may be darker or lighter pigmentation or areas of blotchiness. This may diminish with time or it may remain permanently. This complication is more likely if you go out in the sun without a sunblock during the first six months after surgery.

Depression. With aesthetic surgery, as well as with other surgical procedures, this sometimes occurs postoperatively. This is generally attributed to the normal response of the body to surgery and anesthesia.

Asymmetry. No patient is identical from side to side. Small differences exist in all patients. In the occasional patient with a major difference, this can usually be improved with a secondary procedure.

Persistence of the original problem.

Potential but unlikely complications: Infection:

Poor healing.

Loss of small area of skin (necrosis).

Scarring can result from any operation, including skin resurfacing. Scars can be raised or red, and usually fade with time. This complication is rare.

Allergic reaction to antibiotic ointment or facial creams. Complications of severe nature, which could be life threatening.

The deeper the resurfacing procedure whether it be chemical peels, dermabrasion, or laser, the greater the likelihood of permanent discoloration and scarring.

Deep venous thrombosis (blood clots) affects mainly the veins in the lower leg and the thigh. This clot may interfere with circulation of the area, and it may break off and travel through the blood stream. This clot can then lodge in the brain, lungs, heart, or other area, causing severe damage to that organ or even death. This is the reasons we have you stop hormones, wear TED hose, and walk every 3 hours the night of surgery.

Infection Alert

There is evidence of an increased incidence of MRSA (methicillin-resistant Staphylococcus aureus) and other antibiotic resistant bacteria in our community. In the past, these resistant bacteria were typically found only in hospitals, but they are now found everywhere. Frequently people can be a carrier of the bacteria without their knowledge. An infection with this bacteria can cause severe damage to the skin and even death. We are diligent in cleaning and sterilizing our facility and try to limit the exposure

of outside bacteria from patients into our surgery center. We therefore have implemented the following hygiene steps to help prevent the contamination of our facility and therefore decrease your post operative infection risk.

Bathe your entire body with CLn body wash the 2 nights prior to surgery and again the morning of surgery. CLn body wash is an anti-bacterial, antiseptic liquid soap. Sleep on clean sheets the night before surgery and wear clean clothes to your surgery.

YOU MUST ENTER INTO YOUR SURGERY FULLY UNDERSTANDING NOT ONLY THE BENEFITS, BUT ALSO THE POSSIBLE PROBLEMS. ON RARE OCCASIONS, MINOR REVISION MAY BE NECESSARY TO ENHANCE THE FINAL RESULTS.

WHAT YOU WILL SEE IN THE MIRROR

Initially, your face will be swollen, red and raw, with oozing scabs and covered with a thin layer of Polysporin ointment. During the first two weeks the scabs come off with facial washings and the new skin begins to resurface. This skin will be bright red and slowly turns pink, then fades within several months, leaving a smoother, tighter skin appearance.

The instructions above are general and some portions may not apply to all patients. Changes in the instructions depend on your medical history, number and type of procedures and type of anesthesia.