Laser Resurfacing - Ultra Pulse CO2 Laser

ULTRAPULSE™ CARBON DIOXIDE CO2 FOR LASER RESURFACING

Laser resurfacing is basically dermabrasion using a laser. There is minimal if any blood, the operative field is clean and dry, and the depth of ablation is precisely controlled by the laser settings. Using exact parameters, the laser surgeon can control the depth, width, and pattern of penetration. Unlike other methods of dermabrasion such as the traditional wirebrush, diamond fraize, or even the Erbium laser, the CO2 laser will not only smooth down the elevated "shoulders" of a wrinkle, but it can tighten and firm up the underlying collagen. These other methods only buff down the surface, but they don't tighten up what is underneath. This is a huge advantage of the carbon dioxide laser for wrinkles. In addition, the color of the skin is evened out, and age spots, freckles, and chronic sun damage is either eliminated or vastly improved.

This laser is also used to treat scars, particularly acne scars on the face, for the very same reasons. The elevated edges of the scar can be smoothed down while the underlying collagen can be tightened up. Generally scars are more "bound down" at the base and may be a little more difficult to correct than routine wrinkles, but it is definitely a worthwhile treatment.

FEES

Full face -$3500 per treatment session

This is an all inclusive fee that includes pre-operative care, the treatment itself, and extensive, close, and careful post-operative monitoring. All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No "verbal" quotes are accepted.

SCHEDULING

A visit with Dr. Coverman is required. There is a fee for this visit. At that time Dr. Coverman will discuss your wishes and needs. He will review prior treatment of your scars or wrinkles. He may suggest ongoing therapy to precede, compliment, and augment your laser resurfacing, and give you a plan for long term care. Other options for correction of your wrinkles such as Botox, Collagen, peels, FotoFacial and microdermabrasion might also be discussed if appropriate. A treatment plan will be outlined.

There is a $500 non-refundable fee for missed appointments without a 24 hour notice.

PRETREATMENT

It is critical to start bleaching creams and Retin A one month prior to your surgery. Dr. Coverman will discuss this with you. Prescriptions will be written and an extensive written "cookbook" of pre and post-operative care will be given to you. All items on this will be discussed with you.

If you have ever had herpes or think you may have (cold sores or fever blisters), inform Dr. Coverman or our staff prior to scheduling your appointment. We will give you a series of anti-herpes pills to take the day before the treatment, the day of, and the day after. This should help to suppress or prevent herpes from flaring, but there are no guarantees. A herpes flare could cause pain, pigment, infection, and scarring.

Dr. Coverman strongly recommends that a numbing cream be applied prior to the treatment. Although this won't block all discomfort, often it can improve this by at least 50%. You may purchase some of these over the counter (Ela-Max) but we recommend Betacaine LA. This is a patented product that is compounded by Medical Center Pharmacy in Tampa, Florida. We have tried almost all other similar products on the market, and this is by far the best. By law, this must be dispensed directly to the patient, and this will be shipped directly to your home. For your convenience, we will fax the prescription for you. We will need your credit card information in order to do this but we immediately SHRED that information and do not save it anywhere.

Please apply this one hour prior to your intended procedure. It will work even better if you place saran wrap over the cream and then tape all of the edges airtight. Some patients don't want to come to the office with cream or plastic on their face, so if you bring the cream with you, we can apply it for you just prior to your treatment. Although it won't be on as long, a little bit is always better than nothing.

SAVE the numbing cream! It can be used again for this treatment, other treatments like it, or for waxing, hair removal, even insect stings and sunburns. You will always find a use for this cream. Never put on a fresh burn, infected skin, inflamed skin, or ANY weeping, open, or oozing skin. Never apply to any undiagnosed rash. For any questions, always ask Dr. Coverman.

TREATMENT DAY

You will arrive at our office hopefully with the numbing cream on your face. Prior to the procedure, Dr. Coverman will give you 5-10 mg of oral Valium and an intramuscular shot of Demerol. Please let us know if you are allergic or have any specific problems with these medicines.

Dr. Coverman himself will perform a series of nerve blocks down the center of your face, to give profound numbing in that area, and then his staff will inject a dilute numbing solution into the rest of your face. This should take about 1/2 hour.

Dr. Coverman will perform the surgery himself in the operative suite. Metal eye cups will be inserted under your eyelids to protect the eyes at all times. You will be lying down, and the procedure will begin. You shouldn't feel anything. If you do, more local numbing medicine can be used which will work instantly. The actual procedure takes about one hour.

You will be wide awake but perhaps a bit groggy. You can talk to Dr. Coverman during the procedure.

At the conclusion, you may relax in one of our examination rooms, and family members may join you. Most patients leave the office one hour after the procedure is finished. It is imperative that someone drive you home.

POST TREATMENT

Adequate oral pain medicines will be prescribed, and you will probably want to take those during the first day after the local anesthesia wears off. A stronger pill can be used for the first few nights, mainly to help you sleep. Usually after the first night, there is not much discomfort.

There will be weeping and oozing and your face will be red and swollen for the first week. You will want to stay indoors. You will be wide awake, functional, and you can pretty much do what you want. You just won't look very pretty. Extensive and detailed instructions for care will be discussed and you will receive written confirmation.

By the end of the second week, at the 14th day, virtually all female patients are able to go back in public wearing full make-up. They are usually able to attend all work and social events. There may be persistent redness (not much worse than a weekend sunburn) which may last several weeks or months afterwards, but that is usually fading every day. With the make-up off in the evening, it will look no worse than a sunburn.

DO NOT PLAN ANY EXTENDED TIME OR VACATIONS IN THE SUN FOR AT LEAST THE FIRST TWO MONTHS AFTER YOUR PROCEDURE.

Although you will be healed, and you will of course be wearing sunscreens, we wouldn't want to take any chances. Specifically do not plan trips that would involve visits to the coast or the beach or activities such as snow skiing. If you are just going out of town for business or routine pleasure, that is fine. Once your skin is healed and you are back wearing sunscreens, you will of course be using common sense and wearing broad brimmed hats as you should anyway. Normal activities can be resumed.

COMPLICATIONS

This laser treatment is ablative. There will be a "burn" to the superficial layers of your skin. With any ablative procedure there can be pigmentary changes (whether lighter or darker), mottled pigmentation, scar, flare of underlying herpes, or infection. There is no guarantee what percentage of wrinkles or scars will be removed whether per lesion or overall. This will be variable due to the depth of any individual treated area. There can be a line of demarcation where the laser treatment stops and normal skin begins. Normally we try to "feather" this so that it becomes much less apparent if at all. At the hair line we try to soften the laser beam and spread it out a bit such that it blends into your hairline, and along the angle of the jaw we try to do the same thing. We also try to "tuck" the treated area underneath the jawline so the area of demarcation doesn't show. In lighter skin people this will be less obvious. Nonetheless, this remains a risk which is impossible to avoid or predict.

If you have ever had herpes or think you may have had herpes (cold sores, fever blisters) in the treated areas, this treatment could flare that. Please inform our staff prior to your treatment date and we can prescribe a series of anti-herpes pills that usually should prevent this. Nonetheless, rarely the herpes could break through and you could have another attack. If you have never had herpes, this cannot cause herpes. Other potential complications and alternatives will be discussed at the time of your visit and on the consent form.

FOLLOW-UP

We typically perform this procedure on a Wednesday. Dr. Coverman will see you that Thursday and again that Friday. You will have his cell phone number in hand, and he is available to see you at any time. He will then see you the following Monday, Wednesday and Friday of the first week after your procedure, and the following Monday and Friday again at the second week. There is no charge for any of these visits as long as other medical problems are not discussed. By your last visit he will prescribe a maintenance program for you, often involving typical treatments to prevent further aging such as Retin A, sunscreen, vitamin C serum, and alpha hydroxy acids. All visits after that will be at normal office visit charges.

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