Laser Resurfacing, Day Five

Yesterday evening, I noticed some skin peeling off my nose, and decided to help it along. One thing led to another, and I ended up exfoliating my entire face! It was a thrill, as I actually got to look decent enough to go out for New Year's Eve. At this point, I have one or two tiny whiteheads, and a few drying blood spots, but otherwise nothing terrifying apart from the markedly pink tone (down from red yesterday). And yes, I can actually comb my hair gently now, without risk of disrupting the healing process. Have a look:

The shiny appearance, as usual, is due to the moisturizer.

By the way, I tried not to pick at the dead skin, which might have caused it to bleed. Instead, I just splashed it with water, and rubbed it off with my palms and fingers. It took about half an hour, but it all came off except for a few tiny patches of skin that needed more time. If you try this on day five, do so gently. Remember that you have different skin than I do, so you may require more time. Don't force it, and end up disrupting the healing process. Sooner or later, you'll peel. After I finished, I applied a layer of moisturizer to the newly-exposed skin. It stung painfully, but nothing that a burst from the fan couldn't fix after a few minutes.

As to the preliminary results, I could hardly be more satisfied. My forehead wrinkles, which I'd had for at least 10 years, are virtually indetectable. My feather lines at the bottom sides of my eyes are gone. Generally, bumps and dents are subdued to the point of inconsequentiality. The swelling is almost gone. And this time, the camera was honest: that's my exact shade of pink. We'll see how long it takes to fade back into my normal skin tone. I'll keep the photos coming.

Laser Resurfacing, Day Four

As has been my habit since getting lasered, I awoke in the middle of the night due to irritation. In this case, it was due to my stubble scratching against the pillow. On the plus side, this was the first night that my skin didn't really bother me; it was the nascent beard instead. On the other hand, there was only one way to fix the problem: shave.

Here's how I looked before the fact. You can see that I've started to peel all around my stubble, and quite thoroughly at the sides of my nose. The new skin is in excellent condition, which gives me some preliminary encouragement with regards to the final result. (I knew all those veggies I ate for years were doing me good! Their effects were just hidden behind decades of UV damage.)

I used lots of soap to shave, as I never use shaving cream on account of its weird effects on my skin (what do you expect from such synthetic crap?). I actually shaved in the shower in order to ensure maximum contact between my stubble and the soap. I knew that any air gap would cause very painful snags.

Granted, it still hurt like shaving a sunburn. But slowly and gently, I was able to remove almost all my facial hair. Immediately thereafter, I applied my prescription moisturizer, which stung sharply. A few minutes in front of the fan fixed that problem, so that I can type to you without shuttering in pain.

Here's what I look like now -- redder from the shave, but more more comfortable, and happily missing a few hundred yellowish skin flakes (which aren't really visible in stubble in the photo above):

As you can see, the sides of my nose and stubble area peeled first; I'm still waiting on the cheeks, forehead, and nose ridge.

By the way, whenever I've washed my face, I've been very careful to dry it using a paper towel. I press it against my face, then peel it away -- never wiping it. This minimizes friction damage and ensures that bacteria from my normal bath towel don't invade my fractured facial skin before it has time to heal. Otherwise, I might end up with one of the horrible breakouts that have occurred to other laser resurfacing patients.

In order to further guard against pimples, I avoid synthetic food. (I generally do so anyway, but especially now.) Vegetable oil -- including margarine, which might as well be motor oil -- is definitely off the list, as is white bread, and any other crap made in a factory which masquerades as food. Veggies, nuts, butter, sardines, and a bit of fruit is how I've been eating lately.

Finally, it occurred to me that if you have masks -- scuba masks, sleep masks, swimming googles, paint respirators, oxygen masks, etc. -- then you should give them a good soapy bath while you're recovering. It also wouldn't hurt to clean the parts of your reading or sun glasses which touch your face. Also, for men, I suggest disposing of the razor that you were using before the procedure. The reason for all this is simply to slow the rate at which bacteria and fungi from your "old face" will be able to corrupt your "new face". Of course, this isn't a perfect strategy, as the world is full of these creatures, and laser resurfacing isn't a sterilizing procedure, but you might as well take advantage of the situation to mitigate your acne or eczema problems, and in particular avoid the postlaser breakouts reported elsewhere on the Web. And by all means, keep unwashed hands off your face! Your skin is a critical component of your immune system, and as you can see from my photos, it will be several days before it's properly sealed and functioning again.

For my part, I don't seem to have acquired any acne at all due to this procedure, which I attribute to these diet and sanitation measures.

By the way, I actually ventured outside yesterday. I didn't dare use sun lotion, though, whose chemical goop would no doubt soak deep into my damaged face, doing unpredictable cellular damage. As a result, I could only walk under heavy cloud cover, and otherwise spent my time inside shops or vehicles. I plan to start using SPF 50 once my face heals enough to tolerate the necessary evil of synthetic sun lotion.

Later edit: I narrowly escaped candlenut poisoning!

Laser Resurfacing, Day Three

Last night I woke up itching like crazy. The pillow fabric was chaffing my face. I ran for the bathroom and sprayed off all my moisturizer with a cold shower blast, which helped tremendously. As soon as I dried off (gently, with a paper towel), however, the itching returned.

With no prospect of returning to sleep, I sat in front of the fan. This cooled my itching. At the same time, I listened to some excellent hard rock, which helped me forget about it. Mercifully, the itching subsided sufficiently within an hour to let me sleep once again.

I'm happy about this, actually, as it suggests that I'll start peeling in a day or two. If I don't, then at least I'm assured a fortune in future income, starring in horror movies.

You might be able to see a few white flakes on my chin, where the exfoliating process appears to be starting. I do wish I could shave! Even combing my hair is a risk, however, as I might scratch my forehead. I already sliced open my nose, as you can see, by scratching it with a fingernail. I'd rather not push my luck.

The redness is giving way to more black dots, as the necrotic skin is starting to scab. Disgusting, yes, but at least the sallow yellow fluid appears to have run its course. The camera is exaggerating a bit: I'm more reddish-brown, than red.

My cheeks and nose are still puffy, but less so than yesterday, as I can tell from the fact that the former no longer cloud my lower field of vision. Pain is zero, but itching is annoying. It feels like someone has deposited a thin layer of wool over my face. Now if only I could peel it off from one of the corners...

Incidentally, I've been reading a lot online about the merits of various machines. I think it's safe to say that your machine of choice depends on (1) the condition you have, (2) the money you're willing to spend, and (3) your pain tolerance. I looked to the MiXto for the erasure of brown spots and faint lines, for which it is well suited and moderately priced, based on the many photos I've seen. However, if you have deep scars, for example from acne, there may be a better option for you. For one, Fraxel Re:pair is supposed to the state-of-the-art these days. For my condition, though, I was uncompelled by the photos I saw, compared to MiXto. So just remember to mentally filter the photos for your specific condition. And definitely read blogs like mine, so you know what to expect from the procedure and recovery. (I'm actually thankful that I couldn't find a MiXto blog. Otherwise, I would never have had the courage (blind ignorance?) to penetrate 300 microns!)

Today's glamour shot:

Laser Resurfacing, Day Two

This morning I felt very tired, on account of poor sleep. I finally accepted the fact that if I was to sleep at all, then I had to sleep on my side, meaning that I had to destroy the moisturizer layer on most of my face. I tried to make up for it by applying more as soon as I got out of bed.

On the plus side, my pain level is now down to mild itching -- no more suburn. On the other hand, I'm still puffy. I'm also redder than yesterday. My face is puddled with spots of blood and oozing yellow fluid, which I guess is moisturizer mixed with platelet cells. The laser tracks are obvious if you click to zoom, almost like rice terraces viewed from space! On my forehead, you can see how the bottoms of my horizontal wrinkles are mostly unscathed, while the surrounding flesh has been nicely grilled. I think this is the result of the dermatologist's attempt to flatten the neighboring plateaus in order to be more level with the depth of the wrinkles, thus diminishing the latter.

Laser Resurfacing, Day One

I've decided to post this blog about my experience with facial laser resurfacing using the MiXto SX fractional CO2 laser. (I looked at the label on the machine and verified it as a MiXto SX.) In all my web searches, I was unable to find a day-by-day photographic account of the treatment, particularly for the first week, when the skin changes are most radical.

I assume that you have basic familiarity with laser resurfacing, which is easily Googled.

Here's what I looked like a few days before the fact. As with all photos on this page, click to get higher resolution. I wasn't in particularly bad shape, although I did have feather lines flanking my lower eyelids (later edit: not visible in the photo due to the angle, but trust me), a few actinic keratoses (brown spots), and a few wrinkles and dents in the forehead.

I chose the MiXto SX based on a review of before-and-after photos I saw on many websites. In my opinion, it makes the best improvement of any technology available in my geographic area, although assuredly other machines will improve upon it in the future. It's not the cheapest; my treatment including ointments was about USD1000. And this fee must be paid every time I get a treatment.

Depending on condition and penetration depth, I've heard of people doing anywhere from 1 to 6 treatments in a year. After that, your skin is permanently behind schedule, i.e. you continue to age, but you're aesthetically anywhere from 3 to 15 years younger, depending on your level of preexisting damage, and extent of treatment. As to preexisting damage, obviously, the more you have, the more treatments will likely be needed to address it as well as possible. Second, the more pain you can tolerate, the more penetration depth you can do per treatment, and thus the fewer treatments you'll need in order to remove a given skin depth. Some people remove as little as 10 microns per treatment. 50 microns appears to be a baseline level for meaningful aesthetic effect, in which case one would need up to 5 treatments at 10 microns.

In my case, the dermatologist set the MiXto to penetrate 300 microns into my skin. Note that this doesn't necessarily mean that he peeled off 300 microns in one go (although it sure as hell felt like it). Why? Because the deeper the laser penetrates, the weaker the beam becomes. It's just like swimming in the ocean and looking up at the sky: the deeper you go, the dimmer the light beams from the surface. So I can't say exactly how deep the ablation was, even though I know that the penetration was 300 microns, as programmed into the MiXto. Nevertheless, he made it clear to me that his strategy was to use maximum pain, meaning minimum number of sessions. Clearly, this could save me a lot of money. And potentially, the results are cleaner when you do all the ablation in a single session, as opposed to multiple ones which allow some level of intervening degradation and sunburn to occur.

At least, this is one of those rare medical procedures in which one has a choice between physical and financial pain, for essentially the same result!

I've heard laser resurfacing be described as a "lunchtime peel", on account of the brief amount of time required for the procedure. I assure you that there is nothing "lunchtime" about it! Although my full facial procedure took only 30 minutes or so, I had a preop photo session (for research and legal purposes, I guess) and about 90 minutes of anesthetic lotion absorption. After the procedure, I had to blast my face with cold air for another 30 minutes, in order to alleviate the intense burning sensation. I've had some nasty injuries in my life, but I've never felt more pain (during the operation), or more burning pursuant to any sun exposure, than with this 300-micron penetration. In my case, though, I could tolerate it (barely), so it saved me thousands of dollars. If you can't, then scale waaaaaay back on the power level, and go for several sessions. I'm told that on lower settings, the laser feels like a rubber band hitting your face (annoying, but not excrutiating). In my case, it felt like multiple dental drills penetrating into my cheeks simultaneously.

Now... what can you do to deaden the pain, besides allowing the nurse to apply topical anesthetic? (That is, assuming you've got neither steel nerves nor a fat wallet, and aren't willing to do multiple sessions.) In theory, you could go under general anesthetic. However, the added cost and hazard might not be worthwhile. In my case, I drank a soup made from shiitake mushrooms and turmeric an hour before my appointment, taken with 800IU of vitamin D. All these components are powerful antiinflammatories. After the procedure, they gave me 1000mg of paracetamol, which I chewed and swallowed with water. (Chewing both accelerates absorption and protects the stomach.) But still, for half an hour after the fact, it felt like I was having a face-to-face argument with a flame thrower. Sunburn, my ass! At times, the pain was so intense that I wanted to vomit. (I didn't know that pain could do that... on second thought, maybe it was just the "burger" odor of my own skin getting grilled.) I tried my best to sink into a trance, which I managed for a few merciful seconds here and there. Remember, you can always turn down the power!

One thing that did bother me was the prospect that the intense heat from the target area might conduct through my skull and into the prefrontal cortex of my brain. But for one thing, all MiXto procedures seem to involve an assistant blowing cold air on the target area. Additionally, I must confess that I experienced no obvious lack of mental faculty after the fact, apart from a mild headache, no doubt related to the pain. So probably, this isn't an issue -- particularly at low power. But it's something to investigate if you're paranoid.

Do not leave the dermatologists's office until you can stand 5 minutes without a fan blowing in your face. Otherwise, you're not likely to handle the journey home. And please don't even think about going to work for the rest of the day, if not the next several. You'll be very uncomfortable, and might scare the wits out of your coworkers!

Here's what I looked like an hour after the procedure. I still have some anesthetic cream on my face. The laser "weaving" tracks are evident if you click for higher resolution. I also have blood spots, and some places where the skin is oozing fluid. I'm wearing a clear moisturizer as instructed by the dermatologist. The pain level has subsided to that of a bad sunburn. I'm starting to swell; hence, my facial contours are distorted:

Later edit: Notice how my eyelids have curled downward. Don't worry if this happens to you! As you can see in my later entries, it's a temporary effect due to skin tightening. Later, my skin will reconform to my facial contours; it will feel less tight (but still firm), and my eye shape will normalize.