Thank you for your question. You stated in your question that you had CO2
laser done four months ago and you're concerned about persistent redness and discolorations.
You also mentioned that you feel like your skin is worse and that you are also a smoker.
Well certainly I can give you some guidance as to what my assessment of your situation
is. Of course this is in the absence of a physical examination or directly seeing what
you're describing. But certainly the photos give me some reference point to begin with.
A little bit of background. I’m a board certified cosmetic surgeon and a fellowship
trained oculofacial plastic and reconstructive surgeon. And I’ve been in practice for over
20 years and I’ve been using the CO2 laser since the mid-90s. And I can give you certainly
my perception of what I think was the desired treatment and what you're experiencing now.
So from the photos, it appears to me that you're young. And that the indication that
I would suspect you may have had forced you to laser would have been something like acne
scars or even some discolorations. Now without going it to my own philosophy on how I treat
people who are younger, I tend to be more conservative about the use of lasers on younger
people. But I would suspect that if you were treating acne scars – that the goal of the
laser is essentially to try to cause the scarred skin to less – look less obvious compared
to the adjacent skin. And invariably what that means is you have to generate a lot of
heat and you have to ablate or remove a decent amount of skin to allow the skin to kind of
feather in as well as to tighten over this time frame. The deeper and more aggressive
the laser, the longer the redness and the discolorations.
As part of a strategy, I think that your doctor probably gave you these possible outcomes
as part of the risks and benefits of doing this procedure. And I would be surprised if
we – if you didn’t see your doctor and the doctor didn’t recommend any type of
bleaching creams or skin lightening creams or things to deal with this. And sometimes
even steroid cream or something to help mitigate the redness and the pigmentation.
Something that I would also suggest that you as an action item is, of course, is to stop
smoking. People who smoke are unfortunately essentially addicted to the effects of cigarette
smoking which is basically in line with the nicotine effect. And what that basically means
is that in order to get the sense of well-being from nicotine, you're trading off the breathing
in of carbon monoxide formaldehyde and the generation of what’s called free radicals.
I’m sure you've heard this before but what that does is that it literally chokes the
oxygen away from your tissue. And one of the things that we always, always emphasize to
people who smoke is the actual limitations of what we can do in cosmetic procedures on
people who are smokers compared to non-smokers. People who smoke tend to have problems with
healing. People who smoke had tend to have longer periods of inflammation. And unfortunately,
it is hard for people to stop smoking. But in certain types or situations, I just won’t
do surgery on someone who smokes, such as in a face lifting operation. An exception
to that is something like eyelid surgery where, thanks to the dual circulation to the eyelid
area, even smokers are able to do well. In your situation, I don’t think you're
doing any good by smoking. So I would say, do the best you can. Maybe this will be the
reason to stop smoking. Fascinating thing about the human body is that in medical studies
done on the wound healing, people who smoke and then stop; that literally within 30 days
after stopping smoking, the body can heal in a way that’s comparable to someone who’s
never smoked in their life. So it’s just a remarkable aspect of the amazing machine
that is the human body. So that being said, I would also – for patients
who have come to us with similar situations from other practices, we’ve done – we
use things like platelet-rich plasma to help stimulate skin quality by improving circulation
and improving the collagen. You know, this platelet-rich plasma is derived from your
own blood and it’s a concentration of growth factors that stimulate new blood vessel formation
and the formation of collagen. This was revealed or developed first by oral surgeons who needed
that in the bone – in the mandible, in the jaw bone in order to be able to place titanium
posts for dental implants. So it can be of value. But the benefit of PRP can be outweighed
by the negative of smoking. So if you haven’t figured it out, I’m
really – I find – I think I can’t say enough about how bad smoking is for you. And
in particular when you're doing something that to improve your appearance, definitely
stopping the smoking is important. So that being said, I think you need to go
back to your original doctor who did this treatment and understand what that strategy
is and how to manage you. A lot of times people just stay, wait it out. And sometimes it’s
fine. It’s – because the pigmentation will fade and the redness eventually does
fade most of the time. So it’s not like just observation alone is not – you know,
it’s not okay. It is okay based on your doctor’s knowledge, experience, and assessment
of your situation. But at least you have some additional information to help guide you as
to what to do moving forward. So I hope that was helpful. I wish you the
best of luck. And thank you for your question.