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.