Zapping Your Way To A Younger Looking Face

Despite his fair complexion, Jeff Baraban used to run to the beach whenever he

got the chance. Not surprisingly, the sun took its toll on his face, leaving it red, blotchy, and wrinkled. So last summer, the 50-year-old Walnut (Calif.) trial attorney went to Dr. Bruce Achauer, a plastic surgeon in Orange, Calif., for help.

To repair the damage, Achauer recommended laser resurfacing, an increasingly popular alternative to dermabrasion or chemical peels. Baraban submitted to a 90-minute procedure one Friday morning, then spent the weekend alone in a darkened house, his swollen face wrapped in surgical bandages. Does he regret the ordeal? No way. "I look like a totally new person," he says.

SKIN DEEP. Are you a candidate for the laser? Speedy recovery times and impressive results are the reasons U.S. doctors performed 46,253 laser resurfacings last year, surpassing chemical peels as the most sought-after nonsurgical method of rejuvenation. Facial resurfacing is a favorite of 35- to 50-year-olds, who aren't as much concerned with sagging skin and deep wrinkles as with surface damage from sun and cigarettes. In 1996, this group accounted for 41% of all laser resurfacings, according to the American Society of Plastic & Reconstructive Surgeons. The procedure can be painful and lead to facial discoloration. But with proper skin care, a resurfacing can be good for up to 10 years--and you can repeat the procedure, if you're inclined.

Lasers have been used in cosmetic surgery for more than 20 years, primarily to remove birthmarks, port wine stains, and tattoos. But in 1994, when the Food & Drug Administration approved carbon dioxide lasers for facial work, doctors turned their high-intensity light beams to erasing moderate wrinkles, freckles, and blotches. The latest technology features erbium YAG lasers (named for their components--erbium, yttrium, aluminum, and garnet). The results of erbium YAG treatment may not be as dramatic as those from CO2 lasers, but they promise shorter and less painful recoveries.

TOAST. CO2 and erbium YAG lasers work by emitting short bursts of high-energy light that vaporize skin cells. The first pass with the laser turns the epidermis, the top layer of skin, to a gray ash, revealing the dermis. The laser removes part of the dermis on the second pass, causing the remaining layers to tighten. Wrinkles such as smile lines may require a third treatment.

If you're thinking of laser resurfacing, be prepared to invest considerable money and time. A full-face resurfacing costs around $2,500--and insurance is unlikely to cover it unless you can demonstrate the procedure was needed for medical reasons, such as removing precancerous lesions. Resurfacing is done in an outpatient setting, rather than in a hospital. The procedure is less expensive than a facelift, which costs around $4,400. The cheapest alternative is a chemical peel, which uses acid to burn away layers of skin. A peel goes for $1,500, but it's not as effective as the laser for smoothing wrinkles.

For best results with laser treatment, you must be diligent before and after resurfacing. Achauer often refuses to treat patients who don't follow through on their preoperative routine, which includes two or more office visits for blood tests and preliminary facial scrapings. You'll also need to apply Retin A lotion daily to speed cell turnover, and clean your face regularly with medicated soap. Achauer figures unless you do the pre-op work, you'll really be in trouble afterward, when the most common complications may occur.

Careful post-op care is also crucial. After a resurfacing, expect to spend a few days at home with your face in bandages or slathered in ointment. As you heal, you'll need to follow a rigorous routine of cleaning the skin and keeping it moist with petroleum jelly or other lotions several times daily. An erbium YAG resurfacing will heal more quickly--3 to 7 days, vs. 10 to 14 days for CO2 procedures. With both, regular visits to your doctor are a must: A trained eye is more likely to catch infections or scars.

UNEVEN? One possible complication of laser resurfacing is hypopigmentation, or loss of color, which can occur as long as a year after treatment. You might also end up with an uneven complexion if the doctor doesn't blend the resurfaced area with untouched skin. Fortunately, both problems can be corrected with more laser work. Scarring occurs in only 1% of patients, but uneven pigmentation is more common, at around 10%.

Once you've healed, you'll have to apply sunscreen (30 SPF or higher) whenever you venture outside, and stay out of the sun. Paradoxically, because lasers also produce heat, patients come out looking badly sunburned. "The first three days after surgery, I looked like a burn victim," says 68-year-old Vivian Turner of Anaheim, Calif., who had a partial resurfacing performed in September to erase crow's feet and lip-area wrinkles.

The redness and swelling from the heat is painful enough so that most doctors administer a local anesthetic to minimize discomfort. But the heat is a key part of the treatment. For reasons not completely understood, heat tightens skin and stimulates collagen production for up to a year after a procedure. As the top two layers of skin grow back, they appear younger-looking and less wrinkled. Erbium YAG lasers cause less pain and burning, which means less post-procedure redness. One drawback: Skin doesn't grow back quite as tightly and smooth as with a CO2 laser. Another notable difference is that CO2 lasers have been around longer, so more is known about possible long-term side-effects, such as loss of pigment. The Erbium YAG is so new that few studies of complications over time have been done. Short-term problems, such as infection or burning, are less frequent than with the CO2 lasers, though.

As both types of lasers are relatively new, few doctors have used the machines on a range of patients and skin types. Many doctors are still learning about resurfacing--usually by attending weekend conferences sponsored by laser device makers or professional associations, such as the Plastic Surgery Educational Foundation. Typically, the first day is filled with classroom instruction and practice sessions, where students test their technique by skinning eggplants and tomatoes. The next day features demonstrations on live patients by trained doctors. But no certification is required. "Any type of doctor can do it. All you need is a medical license, a business, and a check to cover the cost of machinery," says Dr. David McDaniel, a Virginia Beach dermatologist in who has done hundreds of resurfacings.

HOMEWORK. In the end, your new appearance will depend on "the surgeon's skill, artistic eye, and knowing the best equipment to use," says McDaniel. So you'll want a doctor with a good reputation and a substantial amount of cosmetic surgery experience. Two sources for referrals are the American Society for Dermatologic Surgery (www. or 800 441-2737) and the American Society of Plastic and Reconstructive Surgeons (www. or 800 635-0635). Once you've found several physicians, ask them about their training and experience (table). Also seek out people who have had resurfacings. Speak to recent patients for details on pain and post-op care, as well as those whose surgery took place a while back for an idea of long-term results.

Bear in mind that laser resurfacing may not be the best solution for your aging woes. If you want to hitch up a sagging chin, a facelift might be the answer. Resurfacing often works on surgical scars, but if they are deep, cosmetic surgery might be preferable. And resurfacing won't erase bad acne scars. Nonetheless, laser resurfacing can turn the clock back. "It makes your skin look better and fresher," says attorney Baraban. But before you go under the beam, consider your options carefully. Once your old face is gone, you can't get it back.