Cosmetic Laser Surgery: A High-Tech Weapon in the Fight Against Aging Skin

Cosmetic Laser Surgery: A High-Tech Weapon in the Fight Against Aging Skin
May-June 2000
by Alexandra Greeley
FDA Consumer magazine

Vaporized.

Normally this is not a good thing where humans are concerned. In science fiction films the characters vaporized by a laser simply disappear. Patients opting for cosmetic laser surgery, however, suffer a less severe fate: Only their wrinkles and other skin imperfections disappear.

In recent years, lasers have shed their science fictional image to become a surgeon's and dermatologist's most promising weapon in the fight against aging skin. According to the American Academy of Cosmetic Surgery in Chicago, nearly 170,000 Americans, men and women, underwent laser resurfacing of the face in 1998, up from 138,891 in 1996--a 64 percent increase. That's nearly twice the number of the more traditional surgical facelifts performed in the same year.

Laser resurfacing is a very controlled burning procedure during which a laser vaporizes superficial layers of facial skin, removing not only wrinkles and lines caused by sun damage and facial expressions, but also acne scars, some folds and creases around the nose and mouth, and even precancerous and benign superficial growths. In a sense, the laser procedure creates a fresh surface over which new skin can grow.

While the Food and Drug Administration does not regulate how surgeons carry out these procedures, it is responsible for clearing lasers for marketing for the uses requested by the device's manufacturer.

Lasers in Cosmetic Surgery

Since their 1958 discovery, lasers have become a powerful industrial tool, but their applications in medicine have been truly revolutionary. One reason, says Richard Felten, a senior reviewer in FDA's Center for Devices and Radiological Health, is that lasers used as surgical tools can cut through tissue without causing excessive bleeding. In fact, lasers actually can coagulate tissue to stop bleeding. "That's something a knife can't do," Felten says. Also, for many internal procedures, surgeons can get the laser's energy to reach areas within the body more easily than with a scalpel. And finally, the wavelengths of the laser light itself lets surgeons use the device selectively on very specific types of tissues, such as port wine stains or hair follicles, without affecting nearby tissue. (See "Other Laser Treatments")

But using lasers for facial skin resurfacing was discovered almost by accident, Felten says. In the course of treating acne scars with a laser, surgeons noticed that after resurfacing the skin around the scar to make the scar less visible, small adjacent wrinkles were greatly diminished.

"Resurfacing is very appealing to people," says Stephen W. Perkins, M.D., president of the American Academy of Facial Plastic and Reconstructive Surgery and of the Meridian Plastic Surgery Center of Indianapolis, Ind., "because it is a way of refreshing the skin's surface and getting a new layer of non-sun damaged and more youthful skin."

Collagen is a key fibrous protein in the skin's connective tissue, and it helps give the skin its texture. Natural aging and such factors as sun damage and smoking help break down the collagen layer so that the skin's once smooth surface develops wrinkles. New, more youthful collagen actually forms after laser treatment, says A. Jay Burns, M.D., partner in the Dallas Plastic Surgery Institute and assistant professor of plastic surgery at the University of Texas Southwestern Medical School.

Laser resurfacing can often make patients look 10 to 20 years younger, and the results can last for eight to 10 years, says Tina Alster, M.D., director of the Washington Institute of Dermatologic Laser Surgery in the nation's capital. But she warns that after surgery, patients must avoid sunbathing and destroying their skin again. Patients can have a repeat treatment after one year, but usually the first procedure is so successful a follow-up is not needed.

Lasers cannot rejuvenate skin on other parts of the body nor can laser treatment lift or remove sagging jowls or smooth out "crepey" or sagging neck skin. These conditions only respond to traditional cut-and-stitch surgical methods.

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