Plastic Surgery - Erbium - Yag



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Plastic Surgery

Erbium - YAG - Laser

The ERBIUM YAG laser is one of the latest lasers for the treatment of skin disorders. Different from the ultra pulsed carbondioxyde laser, which causes a thermal injury, the Erbium-YAG-laser evaporates the epidermal cells more rapidly and the thermal impact is significant less. This gives a quicker healing and shorter healing phase with redness and risk for pigmentations. The collagenstimulation is also present but with a less cellular activity which has shown to beneficial when treating scars. A treatment of the surface of the skin does not replace a tightening of the skin where that is needed!

Principle: The cells of the skin or the lesion are layer by layer evaporated by frequent pulses until the desired depth is reached. The advantages between laser peels and chemical peels are that the depth is totally controlled with lasers. As no thermal impact is present, the wound will bleed as blood is not coagulated, just like excoriation, and it will heal within 5 days. The wound is left to open treatment with soap and water and Vaseline ointments several times daily There is a heavy discharge during the first 2 days which should be dried off continuously. A burning sensation is common during the first 12 hours. When smaller areas is treated local anaesthetics is sufficient and when the whole face is treated, intravenous narcotics is administered

What happens afterwards?

	Except for the burning sensation after the treatment, the course is almost painless.
	A very heavy swelling arises and this is normal even if it looks frightening.
	A light brown eschar is formed that should be kept moistened with Vaseline. This is gradually falling off with healing.
	The areas should be washed with soap and water twice daily and covered with Vaseline.


	If the surface feels hard or stiff it can be moistened with repeated applications of Vaseline.
	After healing the new skin is pink and it returns to normal colour gradually within 1-2 weeks depending of the depth of the treatment. The deeper the treatment is, the longer does the redness stay.
	Make up can be applied after healing, mostly after 7 days. Prophylactic anti herpes medication is prescribed and should start latest on the day of the treatment.

Complications
Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is set.

Scarring: A too deep treatment can cause scarring.

Infection: Acne and pustules can arise under the eschar. Cleaning with soap and water or applications of hydroxyperoxide is mostly sufficient to cure this. Deeper infections are seldom but can occur. Herpes can burst out and spread over the treated area. Therefore antiherpestreatment is mandatory.

Hyperpigmentations: Too early exposure of wounds to sun or solarium causes permanent redness or hyperpigmentation. Sun blocker should after all skintreatments be used for half a year. Spontaneous hyperpigmentation can also occur and this might disappear spontaneously. Bleaching creams are not routinely prescribed but can be used if needed.

Hypopigmentations: Lasertreatment peels off the superficial cells of the skin and their pigmentation. A transient difference of colour to untreated skin is unavoidable, especially if there is a sun tan. A permanent bleaching can very rarely occur.

Smoking: Smoking does compromise bloodcirculation and healing. Smoking should be abandoned prior to a planned operation

This text is edited and controlled by Dr. Per Gunnar Opitz, Opitz plastikkirurgiska klinik i Malmö Sweden