Before Treatment: 

• Cosmetic Consult - This treatment requires a pre-operative cosmetic consult, as not everyone is a candidate. It has some social downtime and can only be performed safely on certain skin types without significant risks of pigmentation issues.  Sometimes a customized skin care regimen must be adhered to before and after treatment to ensure even healing.
• Sun Protection is mandatory - We cannot treat recently sun-exposed or tanned skin.  When your melanocytes (pigment producing cells) have been recently "turned on" by sun exposure, there is risk of a suboptimal result.  
• Neuromodulator like Botox is recommended - If your goal is to treat wrinkles, at least 1 week before treatment a muscle "relaxing" treatment like Botox is recommended so that you are not "re-creating" your lines of motion while new collagen is forming.  This would be discussed in greater detail at your cosmetic consult.
• Topical numbing - You will typically be asked to apply a topical numbing medication to the treatment area 1 hour prior to your appointment time.  We will typically reapply the numbing upon arrival, and may also use lidocaine to perform nerve blocks.  
• Antivirals - All patients having resurfacing done are put on anti-virals (Valtrex or Acyclovir) at least 1 day before their procedure and are to continue it for at least 3 days after the procedure for a total of 5 days.  We will not treat if you have a cold sore on the day your laser is scheduled.
• Driver - Most patients arrange for a driver so we can give you medications to keep you comfortable.

During Treatment: Safety goggles will cover your eyes, and the topical numbing will be removed from the treatment areas one at a time. Most areas feel numb or barely noticeable, but there may be "hot spots" during the treatment.  Overall it is very well tolerated.

Immediately After Treatment:  Your skin will feel warm and there may be some pinpoint bleeding, but post-CO2 laser pain is very minimal.  A healing ointment will be applied and your skin may be soothed with cold air.  You will be released to your driver with post-laser care instructions.

Days following treatment:  Puffiness can get worse during the first 24-48 hours after treatment, and then it usually starts to fade.   You will be red and "greasy" with a healing ointment; and makeup is not to be used for the first 3-5 days until all areas have healed. Sun and excessive heat avoidance is a must as this can cause pigmentation issues. Puffiness can be minimized by: holding cool dilute white vinegar compresses or ZO Surfatrol astringent compresses on the treated areas (for no more than 3 minutes at a time, do not Rub), taking Tylenol (Acetaminophen), and taking Bendaryl (diphenhydramine) or another anti-histamine.  You will be provided with detailed post-laser instructions.  Usually you will have a followup appointment within a week of the treatment to make sure healing is going as expected.

Months following treatment:  Sun avoidance and protection is a must for at least 3-6 months after treatment.  In most patients, the redness dissapates within 7-10 days and is easily covered with makeup. Some patients have longer lasting redness, especially if more aggressive settings are used.  New collagen is formed for up to 12 months after treatment, so your final results will often look better with time.