Laser Skin Resurfacing (LSR)
Copyright @ 2002, Lynn Conway. All Rights Reserved
[version of 3-22-02]
I enhanced the results of my earlier FFS and FLS surgeries by undergoing full-face Laser Skin Resurfacing (LSR) surgery by Jeffrey Dover, M.D. in Chestnut Hill, MA (near Boston) in early 2002. This surgery was done to rejuvenate the final appearance of my facial skin by removing fine wrinkles, age-spots and other accumulated sun-damage.
Although my overall facial appearance looked pretty good after FFS and the face-lift, my skin tone wasn't as youthful as I wished it to be. There were some age-marks and a lot of little tiny wrinkles, along with a sort of "stiffness" to the skin in some areas.
These things just don't show up in most photos, especially if a gal has had a face-lift. However, they are still sure "tells" of age. All you have to do is reflect on the countless TV ads for Retinol-A "wrinkle-removing creams", and the very widespread use of such creams and treatments by millions of pretty women in their forties and beyond, to realize that these subtle aging effects are a real concern even in otherwise attractive women.
I had seen the truly remarkable before/after results that several women friends had gained from expertly-done full-face laser resurfacing surgery. The results of LSR surgery are subtle but powerful, especially when seeing the skin up-close and in motion, i.e. in "4-D", as when speaking and making various expressions.
When performed by a top laser surgeon such as Dr. Dover, LSR can have a truly rejuvenating effect, not just by removing defects but also by making the skin much softer, smoother, plumper and more "rubbery". This is especially true when your face is seen up close, in intimate situations, i.e., inches away where the detailed tecture of the skin can be fully seen. The result is a far greater "age-reduction-effect" than you can get from the face-lift alone.
In many older TS women, especially those who have a lot of sun damage to their skin, laser resurfacing can be an important follow-on to FFS and FLS. This sequence of surgeries can produce dramatic overall results, making them not only look more feminine, but very much younger too. In younger TS women, LSR can be applied to eliminate scarring from electrolysis or markings from acne earlier in life.
I hope that the information below is useful to women contemplating laser resurfacing following FFS and FLS. While not "fun", laser resurfacing is only moderate in impact compared to the ordeal of FFS. However, the recovery is a bit messy and one's appearance is temporarily pretty weird (you look like a "burn victim" for at least four or five days). Thus LSR can be a bit more of an ordeal than face-lift surgery. However, it is generally less expensive than the face-lift, and can produce dramatic results in those who are good candidates for this type of surgery.
What is done in Laser Skin Resurfacing Surgery?
CO2 UltraPulse and Er:YAG lasers are used for resurfacing aged and photo-damaged skin, and eliminating lip lines, crows' feet, and facial wrinkles. The lasers can also reduce and smooth scarring caused by electrolysis, acne, past surgery or chicken pox, and reduce some of the skin-damaging effects of excessive smoking. In skilled hands, the laser is used to vaporize very thin successive layers of outer skin. If this surface removal is done just right (just enough, but not too much - as a function of location on the face and of the damage to be corrected), it can lead to a dramatic elimination of defects after recovery. The procedure is done under a general aneasthetic, and takes on the order of one hour or so.
The recovery phase is similar to recovery from a large-area moderate burn: It is awkward, messy and requires continual attention for many days. The first few days are spent within a protective "skin covering". Then for many days one needs to do ice-water soaks every three hours followed by application of a protective lotion. Recovery is gradual, and although one can use makeup and get out and about a bit after about 8-10 days, it takes many weeks for redness to completely dissipate and several months for the full improvement to become fully visible. However, unlike a burn injury, the laser resurfacing actually improves the health and robustness of the skin after recovery. The resulting increase in build-up of collagen makes the skin feel much softer, smoother and more "rubbery" and makes it appear much younger-looking. For details of technology and surgical procedures, and many photos of before/after results, see Dr. Dover's textbook, Illustrated Cutaneous & Aesthetic Laser Surgery.
Consultations and Scheduling:
The practice of laser surgery is relatively new, being widely applied only in the early 90's. It is VERY important to go to a top expert in this new field of surgery. There have been numerous tragic results from laser surgery performed by inexperienced and/or unskilled surgeons. Furthermore, not all people are good candidates for the surgery: Some women may not get much of a result at all, while others have skin conditions that are likely to lead to unwanted side-effects.
Dr. Dover is nationally known as a top expert in this field, and has done over 1000 full facial laser resurfacings. I highly recommend him as the first choice for a surgeon to do your LSR. Remember that your LSR results will be forever visible to everyone. This is one of those surgeries you want done only by the very best surgeon. If you are considering going to someone else, be sure to do a very thorough evaluation of that surgeon's skills and results via personal and web contacts with a number of earlier patients.
No matter what laser surgeon you might be thinking of going to, you should consider going for a consultation with Dr. Dover to get his expert opinion about whether you will (i) benefit from LSR and (ii) are not likely to have side-effects. If you are not a good candidate, he will tell you. If you are a good candidate for LSR, he can ease your mind by confirming that.
For appointments, contact his office at Skincare Physicians of Chestnut Hill, 1244 Boylston Street, Suite 302, Chestnut Hill, MA 02467. (Phone:617-731-1600). The Skincare Physicians of Chestnut Hill website contains further information about that clinic, their facilities and their many surgical treatments.
Regarding scheduling of LSR: If you've had a face-lift, you'll need to wait for the facial skin tightness to relax before undergoing laser resurfacing. This is necessary in order to insure good healing and the best result. Be sure to consider this in your overall planning, allowing has much as a 6 months to one year delay per your surgeon's instructions. It also might be a good idea to undergo LSR during the winter time, since that will make it far easier to totally avoid sun-exposure during the early months of recovery. Dr. Dover is always booked some months into the future, so do contact him for a consultation early enough to arrange convenient scheduling for surgery.
Surgery and Recovery Period:
- - - TBD - - - plan carefully, since this is NOT something you are going to want to do "on your own in a motel" - - - if at all possible, try to stay with a friend, or have someone go with you who can help you thru at least the first five to seven days postop - - -
- - - I stayed in the Boston area at the home of a friend, Nicki (e-mail: hamilton@hamiltonlabs.com), who had also herself previously undergone FFS and then had undergone LSR by Dr. Dover (see the LSR surgery and recovery photos on Nicki's LSR page). Nicki was able to pick me up at the airport, and drive me to/from the surgery and follow-up visits at Dr. Dover's office, and assist in my recovery. - - - if you were to travel to Boston for this surgery, it would be a big advantage to be able to similarly stay with someone in the area who could assist you - - - you could compensate them well for their help, and it would still be a bargain for you in terms of costs, convenience and peace of mind - - -
- - - Dr. Dover provides a handout with very detailed instructions for postop care - - - along with his follow-up instructions during postop office visits, these instructions (if followed VERY carefully) should enable a friend to assist your recovery quite well - - - the main issues are staying reclining in bed, and having someone to help with ice-water soaks, helping with food, and running any errands that might need to be done - - plus helping you get to/from Dr. Dover's office for follow-up visits - - -
- - - some details of surgery and recovery - - - TBD - - -
- - - medications are prescribed that you'll need to bring with you - - - an antibiotic and a specific anti-viral medication - - - plus meds to help you sleep - - - follow-up visits - - - there is a lot of variation in healing time of skin from one person to another - - - thus the recovery time before you can safely fly home varies quite a bit from one person to another - - - the minimum time is about a week - - the likely time about 10 days or so - - - but some people may need about two weeks - - - you should plan accordingly, and be sure you could stay in the area a bit more than 10 days if your skin heals slowly - - - etc.
- - - ongoing recovery after returning home - - - TBD - - - be sure to always use effective sunscreens during first 3 to 6 months of recovery - - - and always use sunscreens of face, neck and hands to protect from further long-term sun damage (see next section) - -
- - - An important make-up tip: You can hide residual redness by using very thin amounts of green-tinted concealer underneath regular foundation make-up (Estee Lauder Maximum Cover Green Corrector #02) - - -
Avoid further damage by protecting your skin from the sun:
Sun damage is the major cause of unnecessary premature aging of the skin, even in otherwise very healthy people. Most of the damage is caused by early in life, when the long-term effects are not at all obvious. However, the insidious effects of the accumulating damage eventually show up in one's forties, fifties and sixties - just at the time other negative effects of aging are kicking in (wrinkles, sagging and loss of flexibility of the skin, etc.). Although a face-lift can dramatically reduce the wrinkling and sagging effects, it cannot eliminate the fine wrinkles and "leatheriness" and loss of flexibility caused by sun-damage. Only laser resurfacing can reduce or eliminate those sun damage effects.
Thus there is an important lesson here: Avoid sun damage by all means possible. Although a "nice tan" may seem healthy and sexy-looking when you are younger, you will greatly regret having the effects that emerge later-on in your forties, fifties and beyond. To convince yourself of these effects, compare the softness and texture of the skin on your face, hands and neck with that of skin in areas of your body that have almost never seen the sun (for example, your 'buns' and your lower-abdomen). As you get older, the differences can be dramatic, and you'll wish you hadn't gotten so much sun exposure.
Therefore, ALWAYS use sunscreen on your face, neck and hands when out in bright sunlight, and cover with clothing any areas unprotected by sunscreen. If possible, also wear a wide brimmed hat when out in bright sunlight to shelter your face and neck from long periods of direct sun exposure. Those who do not now need laser resurfacing may be able to avoid needing it in the future by consistently using sunscreens. With a suncreen in place you can slowly get a nice light tan if you are out in the sun a lot, but without accumulating excessive sun damage.
It is very important to use a sunscreen following laser surgery, in order to thoroughly protect your "new skin" from any further sun damage, especially during the first months when the skin is rebuilding its structures and is very sensitive to sun exposure.
Fortunately, there are wonderful modern sunscreen products available that are not greasy or smelly, and which are PABA-free and thus do not irritate sensitive facial skin (or the eyes). For example, Neutrogena makes a fine skin moisturizer (Nuetrogena Moisture SPF 15) that is a wonderful moisturizer and ALSO an SPF 15 sunscreen. Your skin will benefit greatly from routine use of this product on your face, neck and hands, especially on any days when you might be outdoors in the sun. You can use this product alone, or apply your foundation over it. Neutrogen also makes a tinted version (Neutrogena Moisture SPF 15 Sheer Tint) that provides a light tanning effect without any foundation over it. If you will be outdoors in very bright summer sunlight, I recommend using an even stronger PABA-free SPF 25 moisturizer-sunscreen made by Eucerin (Eucerin Face Protective Moisture Lotion SPF 25).
Some examples of excellent, PABA-free, combination moisturizer-sunscreens:
What kind of results can one expect?
The results of LSR are difficult to fully capture in photos, and I didn't specifically take before/afters of my LSR surgery. However, I'll try to take some 'afters' soon, and compare them with other photos on my site - especially to show how the LSR removed many of fine wrinkles. Meantime, here are some before/afters from Dr. Dover's textbook that will give you a good idea of the remarkable improvements that are possible. These are both older GG women who have lots of sun damage and who underwent full facial LSR. The rejuvenation effects are very dramatic even in static 2-D photos of these women. The effects in person, and with the skin in motion, are undoubtedly even more obvious - especially the removal of the "leathery effect" from sun-damaged skin (Note: the overall effects would be even more dramatic if these women had had face-lifts that were followed 6 months to a year later by the LSR):
LSR before/after photos from Illustrated Cutaneous & Aesthetic Laser Surgery, by Jeffrey Dover, M.D., et al

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Reset on 2-22-02