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, Dr. Coverman 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. (Even the Fraxel:restore laser can't do this.) This is a huge advantage of the carbon dioxide laser. In addition, the color of the skin is evened out, and age spots, pre-malignant lesions, 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 are more difficult to correct than routine wrinkles, but it is definitely a worthwhile treatment.
This procedure is not intended to treat redness, "broken blood vessels," or other vascular problems.
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.
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® Cosmetic, Restylane, peels, FotoFacial and microdermabrasion might also be discussed if appropriate. A treatment plan will be outlined.
It is critical to start bleaching creams and Retin A one month prior to your procedure. 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 six days after your treatment. 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.
You should not have any laser or any light based therapy if you have any photosensitive diseases such as lupus erythematosus, porphyria, or albinism. You must stop any photosensitive medicines at least two days before your treatment unless your prescribing doctor told you not to. Always check! These include anti-arthritis drugs such as gold or methotrexate: any antibiotic from the tetracycline group including Tetracycline, Minocycline, Doxycycline, Vibramycin, Doryx, Solodyn, and Dynacin; acne medicines including Accutane, Cipro, or any of the "quinolone medications"; oral antifungals including Griseofulvin; anti-arrhythmia drugs including Chlorpromazine; NSAIDs including Naprosyn, Advil; St. John's Wort; diuretics.
Prior to the procedure, you will be given 5-10 mg of oral Valium and an intramuscular shot of Demerol (meperidine). Please let us know if you are allergic or have any specific problems with these medicines.
Dr. Coverman 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 laser treatment 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. Please make sure we have their cell phone number.
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 at least the first week or two. 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, most 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 should look no worse than a sunburn.
Plan your work, school, travel, and social activities accordingly.
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. We recommend Elta MD UV Physical SPF 41 sunscreen. This is chemical free and won't burn, sting, or run. It is very adhesive to your skin. 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.
For normal post-operative pain following most of the procedures that we perform in our office, we do not recommend nor prescribe any of the stronger pain medicines including hydrocodone (Lortab; Darvocet N100; Mepergan Fortis; Ultram). We feel that a combination described below of over-the-counter medicines will be enough. This is what we recommend:
If you have any liver disease or potential liver problems, do not take the Tylenol. Do not take Tylenol if you are allergic to it or acetaminophen. DO NOT DRINK ALCOHOL WITH THIS REGIMEN! Otherwise, follow the schedule below:
The Benadryl is a great idea. It is the main component of most over-the-counter sleeping pills. (Tylenol PM), and is not addicting. Never drink alcohol before or with this, and plan on going right to sleep and sleeping 8 hours. DO NOT take with any other sleeping pill, anti-depressant, MAO inhibitor, or anti-anxiety drug (Xanax, Valium, etc.). Do not drive or operate dangerous equipment.
Thus, in any given day you should never take more than the total of four Advil or Aleve or eight Tylenol total (two every four to six hours).
Normally you should be able to safely do this for one to three days - but never more. If the pain ever worsens or this fails to control it - call our office during normal office hours or the medical exchange (458-1121) after hours.
This combination of Aleve or Advil plus Tylenol is safe, covers you around the clock, and allows you to take two different pain medicines whose side effects don't cross react with each other assuming you are not allergic to either.
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, scarring, 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 those scars or wrinkles. 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 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 skinned people this will be less obvious. Nonetheless, this remains a risk which is impossible to avoid or predict. There may be hair loss in the treated areas. This may be permanent.
Because the superficial layers of skin are removed, sebaceous glands (oil glands) may be inhibited or destroyed. After healing, the skin may feel and be drier than usual. This could be permanent, but the glands tend to regrow. Dr. Coverman has NEVER had a patient mention permanent dryness.
We typically perform this procedure on a Monday. Dr. Coverman will see you each day that week. 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 Thursday of the second week after your procedure, and the following Monday and Thursday again at the third 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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