Carbon Dioxide (CO2) laser treatment can be used to treat skin lesions such as raised blemishes and flat, pigmented blemishes, and to remove the thick surface tissue of a rhinophyma. Carbon dioxide (CO2) lasers work by sending out a concentrated beam of light which can remove raised, uneven or scaly areas of skin. Used properly, it is an excellent alternative to traditional surgery because it can remove the top layers of skin very evenly to leave a smooth surface without the need to sew up a wound which may heal as a linear scar.
The laser is also used to remove verrucas and warts effectively, particularly those plantar warts (verrucas on the sole of the feet) which other treatments have failed to shift. The laser seals the tiny vessels which would otherwise bleed when the lesion is removed, and allows the treated area to heal more quickly, so that even deep verrucae which have become painful to walk on can be treated without impairing mobility. The restriction of blood supply to any virus-infected tissue which remains may be the reason that recurrence after laser removal is higher than with other methods.
Another use for the CO2 laser is the treatment of Pearly Penile Papules, small bumps or lumps on the glans of the penis, occasionally barbed in appearance, which are a normal variant, and which do not imply disease, but which sometime cause distress and embarrassment.
CO2 laser resurfacing is a particularly useful treatment technique for fine wrinkles and is a useful treatment for acne scarring. It is less successful at minimising deep icepick scarring and such pits should generally be excised first (three months before laser resurfacing). The scars which result from such excisions can then be included in the formal resurfacing procedure which follows. It is very unusual to restore acne-scarred skin to normal. The deeper the laser resurfacing is taken, the greater the likelihood of pigmentary changes. This takes the form of either a loss or an increase in the skin’s pigmentation, which may be patchy. Nevertheless, a worthwhile improvement can often be achieved.
CO2 laser treatment can change the colour of the skin, often making it lighter or, if you do not stay out of the sun for 6 weeks after the treatment, marking it dark. Certain skin creams
can be used to reduce this risk.
Laser treatment can be performed under a general or local anaesthetic.
If you choose to have a local anaesthetic, you can choose to have no sedation, mild sedation (using a tablet under the tongue), or heavy sedation (using an intravenous injection). Local anaesthetic procedures without sedation or with mild sedation can be performed as an Out-Patient. Local anaesthetic procedures with heavy sedation require at least a day case stay. Mild sedation does not require an anaesthetist to be present, whereas heavy sedation does.
Alternatively you may have laser treatment under general anaesthetic either as a day case patient or stay overnight. As a general rule, the greater the area to be resurfaced, the more advisable is a general anaesthetic.
Fees for laser treatment vary with the area to be treated, the type of anaesthetic and the hospital stay. There is no guarantee that a single treatment will be sufficient for your needs, and repeat treatments may be necessary.
Carbon dioxide laser treatment is available at the Wellington Hospital, London.
The cost of treatment starts at around £1695, including local anaesthetic and one follow-up.
The prices quoted above are for a single treatment. There is no guarantee that this will be sufficient for your needs, and repeat treatments may be required.
Laser Treatment - Patient Instructions
Below are examples of the instructions that you should follow before and after your laser procedure if it involves the full face, or a large area of it. The instructions are simple, but it is important that they are dutifully followed.
One month before the procedure:
You should begin to apply Isotrex to the areas to be treated, in accordance with the manufacturer’s instructions - that is, using a pea-sized amount once a day at night. The skin may initially become reddened or scaly - this is a common reaction.
After the procedure:
The treated area may look like a graze, may be red, swollen and raw and may ooze a clear or yellow fluid for 3 - 7 days.
You may be prescribed:
Acyclovir (Zovirax) on the day of your procedure and for five days afterwards
Paracetamol for pain; take two regularly every 4-6 hours after the surgery
Antibiotics for five days
• It is important that all treated areas are kept moist to prevent scabs or crusts from forming. Any treated areas which are not covered by the dressing should be covered with a layer of Vaseline which should be re-applied five times a day.
• To minimise swelling, you should use two pillows under your head whenever you are lying down.
• DO NOT PICK the skin.
• When you bathe do not allow your bath water to wet the treated area or the dressing.
• It is absolutely essential to avoid sun exposure for at least four months after the procedure.
Day 1 Mild swelling and discomfort
Rest and take plenty of fluids
Day 2 - 7 Maximum swelling and oozing
Perform daily dressing changes
Week 1 - 2 Gradual fading of redness, oozing stops, new skin feels dry and itchy
Week 2 - 3 Redness continues to fade
Make-up may be applied
Use sunscreen SPF50 EVEN when indoors
Apply Hydroquinone 2% twice a day as soon as the skin is completely healed (that is, no longer oozing, and completely unbroken). If redness or irritation results, you should amend this to alternate days.
Week 3 - 12 Gradual return of normal skin colour
Week 13 Stop Hydroquinone and use Isotrex once weekly for maintenance
If the laser involves other parts of the body, such as hands or feet, for example, for warts or verrucas, the treated tissue may leak a small amount of fluid, but CO2 laser treatment normally seals any blood vessels, so that there is no bleeding. The treated areas usually look raw, and you are generally requested to leave the bandages on and keep these dry. Please do not pull off the dressings on your own, if they are stuck, as you may inadvertently pull off the healing tissue and set the wound back or make it ooze again.
LONG TERM SKIN CARE
Three weeks after your surgery, you can begin return to your usual skin care regime of cleansing, toning and moisturizing morning and night. Avoiding the sun will prolong the improvement in your skin that your surgery has achieved and prevent premature ageing, so you should always wear a good sun-blocking moisturiser before applying your make-up. The importance of staying out of the sun after laser treatment cannot be overemphasised. It is not enough merely to sit under a parasol or to wear a sun hat; the sun’s rays are reflected onto your face whenever you are outside, and you must wear a COMPLETE sun block.