Square by tiny square, Dr. Theodore Golden points a beam of light at a 59-year-old Livonia, Mich., woman’s face and zaps off years of wrinkles.
The high-intensity laser lightly burns the top layer of the skin, leaving one white, dry patch after another. Little wisps of smoke drift upward. Golden takes a damp gauze pad and literally wipes away the lines.
“Take a look,” he says. “You can’t tell me that’s not a miracle.” Fresh, pink tissue replaces older, worn skin. Deep lines look fainter; the fine ones are gone. Overall, the skin looks clear, taut and unlined.
“We can’t stop the clock,” Golden says, “but maybe we can turn it back a little.”
Painfully aware they aren’t looking any younger, thousands of women and some men are lining up in doctors’ offices for laser skin resurfacing, the latest revolution in wrinkle repair. Interest soared last year, doctors say, after talk show host Geraldo Rivera underwent the procedure to have his crows feet removed on live television.
Now the machines are popping up in hospitals, walk-in surgery centers and physicians’ offices, promising help for skin damaged by age, sun and smoking — the three major culprits of facial wrinkles.
“I don’t want to look like my mother did when she was in her 60s,” patients tell Birmingham (Mich.) plastic surgeon Dr. William Vasileff. Indeed, genetics and changes in weight — up or down — also contribute heavily to how facial characteristics change with time.
The laser procedure is promising enough that some doctors are abandoning other such wrinkle treatments as dermabrasion and chemical peels. Other physicians are sticking with the older techniques, especially if they’ve had good results.
Laser resurfacing has drawbacks. Not everyone can afford the $3,000-$5,000 cost for a full-face procedure, and insurance usually does not cover elective cosmetic procedures. Nor can all patients afford a week or two at home to bathe their faces in petroleum jelly, prescription creams and Crisco.
Also, resurfacing can’t work miracles on deep lines that smokers develop around the mouth. Nor can lasers eliminate sagging.
“A laser can’t do what an eyelift or facelift can do,” Golden says. Like other facial peels and sanding techniques, lasers may leave permanent scars and redness.
“It fascinates me that all these experts who style themselves as gurus at lectures always have the complication slides,” says Dr. Joseph Mark, of Rochester Hills, Mich., who has been doing laser resurfacing since November. “There is no button on the machine that says `Stop,’ ” Mark says.
Mark tells patients, “If we need to do a touchup, let’s do it. I’m sorry you have to go through a procedure a second time, but I’d rather do that than to try to nurse you through a complication on the first.”
It’s also not well known whether laser resurfacing is a good choice for darker skinned people, although Dr. Hashim Alani, a Southfield, Mich., plastic surgeon, says it worked well on three of his Indian patients.
The concern is that lasers, like chemical facial peels, may cause darker skin to lighten or get dark spots. Dr. Lorna Thomas, a Detroit dermatologist with many African-American patients, says she’s not jumping on the bandwagon.
Many facial procedures, except for milder glycolic acid facial peels done in beauty salons and health spas, “are risky on people of color,” she says. Nor can many people afford the cost of laser techniques, she says.
“I’d advise people not to immediately rush to their closest laser-treatment center.”
The procedure itself is quick, bloodless and usually uncomplicated.
After a patient is put to sleep with general anesthesia or numbed with local injections, a doctor holds a wandlike device over the person’s face and pushes a floor pedal, releasing a burst of energy. The heat comes in pulses, at one-thousandth of a second, vaporizing the surface of the skin. The short bursts of energy give the machine its name — the ultrapulsed laser.
The Coherent brand, used by Golden and several other doctors in the Detroit area, uses a computer to guide the laser to certain depths, regardless of where the laser wand is held.
“This machine takes every variable out of the procedure but me,” says Golden. At William Beaumont Hospital in Troy, Mich., he instructs his operating team to program a pattern that emits laser energy in squares.
They can also create straight lines for wrinkles above the ridge of the nose, or circles for use around the eyes. He uses a feathered pattern for touchups.
“It’s like painting a picture,” Golden says. “You use a big brush for the big spots, smaller brushes for smaller spots.”
“Laser off,” he asks, stepping back from the patient. Two registered nurses, credentialed as laser nurses, program the computer that guides the machine.
“This is where caution comes in,” Golden says. “We can’t get rid of every wrinkle. We can get rid of 80 to 90 percent of them, but not the deep, deep wrinkles. You’d burn her if you did.”
A nurse asks, “Don’t wrinkles give you character?”
Golden replies, “Let’s get serious.”
She asks again, “So this takes 10 years off your age?”
Golden says, “I can’t say that, but it makes you look a hell of a lot better. If you see what she looked like, and what she’ll look like six months from now, you’d have no doubt.”
Noticing several deep wrinkles over the mouth, he tries a last pattern with the laser. The procedure ends in exactly an hour.
For another hour, the patient rests in a recovery room. Then she goes home with a package of creams and instructions.
Over the next few days, she may feel post-operative burning similar to the pain of a sunburn. She will bathe her face repeatedly in vinegar solutions, prescription antibiotic creams to fight possible infection and Crisco. That brand is even mentioned specifically in medical literature.
She schedules an appointment with Golden for two days later, to check her progress. He plans to see her twice a week for a few weeks.
For 10 days to two weeks, patients’ faces are red, sensitive and sometimes itchy, like a sunburn. They can’t wear makeup. Then they’re advised to wear a green-tinged makeup to cover redness and protect them from sun and wind.
The fairer the skin and the more wrinkles, the longer the recovery. For fair-skinned people it may last six months.
