Thank you for your question!
You submitted a single photo which shows the eye area the right eye and you’re describing
your photo and you’re asking is your skin ruined forever.
You described that this is now 4 weeks after you underwent erbium and CO2 laser around
the eyes and you feel like the skin is leathery and shiny and bumpy and you want to know what
is going on.
Well I can certainly give you my perspective with limited information.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
And I have used the CO2 laser, the erbium laser and fractional CO2 laser.
In my practice over this time with the intention as I suspect your intention was to improve
the appearance of fine lines and wrinkles and discoloration around the eyes.
So one thing that I would have been probably helpful is whether or not at 4 weeks, you’ve
seen your doctor and has your doctor given you any guidance as to what to do.
You see, a challenge very often when you see photos is that photos very often look much
worse than the person does in person.
It just seen that the nature of photography that the reds tend to be more intense and
look more vivid than they do in real life and that’s just part of reality.
Just to give you an overview of just basic wound healing and what can account 4 weeks
is that there are basically 4 phases of wound healing.
There is the hemostatic phase, inflammatory phase, proliferative phase and wound remodeling
phase.
So right now at 1 month, you’re at a phase called proliferative phase.
The proliferative phase is phase where you have a lot of blood supply and collagen being
formed.
Now if there is any suspicion and again this is the art of medicine is that to one doctor
looking at your eyes at this point, it might seem that it’s excess redness, excess bumpiness
and to another doctor who may have more experience with that particular combination of laser
then they feel that this is what’s expected at this point and make it better on its own.
Sometimes it’s important just as a strategy to modulate some of that inflammation by the
use of topical steroids or other modalities such us you may want to consider platelet-rich
plasma(PRP) but it’s hard to say whether or not it’s going to be it for you.
Back in the mid 90s when the CO2 laser was first introduced, it was not unusual for someone
to have redness that was fairly intense for months and months and months.
Now it might have been that the indication for you had to be aggressive that’s why
you have a more aggressive combination ablation type of procedure.
I think that you have to meet again with your doctor who performed this procedure and ask
about this and get a sense whether or not you feel comfortable and confident about the
way it looks.
Since I’m looking at a two dimensional picture and I’m not seeing you in person, there
is a certain amount of feel that I would not be able to have by just looking at you in
person.
If there is unusual inflammation for this stage of your procedure, then steroid use
of some kind is often indicated.
If this is normal, then your doctor can probably tell you this is normal.
I think that submitting a photo like this, you will get a lot of conflicting opinions
and you have to be sure that there isn’t “being over treated”.
In rare cases, redness can also be a sign of infection but it’s not necessary the
case because if someone watching you every week to two weeks to watch your progress then
other questions will need to be answered before giving you definitive answer to this question.
So again my recommendation is to consider possibly that this may be inflammation or
is normal healing but meet again with your doctor to confirm what’s going on and get
a sense of what to expect over the next few weeks as time goes on.
As I tell my patients, I say that we do fractional CO2 laser routinely and combine it with platelet-rich
plasma(PRP).
I found in my practice that I can actually diminish a lot of that initial redness and
so I feel that this is not typical in my practice in terms of intensity and that leathery feel
but I can say from my experience with more ablative procedure that there is some potentially,
just norm to this experience but I again you have to meet with your doctor to really understand
what’s going on.
So I hope that was helpful, I wish you the best of luck and thank you for your question!