Light Years

For facelifts and skin resurfacing, doctors are abuzz about lasers.

Bursting with the type of machismo that lands him in televised slugfests with neo-Nazi skinheads, Geraldo Rivera is an unlikely poster boy for laser facial surgery. Still, last year, when "crow's feet" began to undermine his own special brand of rough and tumble male beauty, Rivera took the plunge. On air, of course. "I would never, ever have the guts to have plastic surgery unless it was on television," he said at the time, "because I know somebody would find out about it and then they'd put it on their show instead of my show."

Thus, the floodgates were opened; thanks to the flashy journalist, millions of somebodies found out about the miraculous aesthetic powers of light beams that day. Performed by San Francisco based dermatologist Alan Gaynor, MD, the quickie skin-rejuvenator was, per the famous patient, "not even as bad a going to the dentist"

The dentist analogy is one that is deployed with great frequency by laser plastic surgery patients. And indeed, as compared to the traditional routes to facial freshening - cut and paste facelifts, chemical peels and dermabrasion - it is deemed less painful. That's due to the fact that doctors performing laser surgery operate in what they refer to as a "bloodless field."

Rather than perforating the skin with a scalpel, burning it with acid, or abrading it with a wire brush, practitioners pierce a computer-determined amount of tissue with the laser. The severed skin is immediately "vaporized", leaving behind a whitish crust that is easily wiped off with a bit of damp gauze. The intensity of the heat in effect cauterizes the blood vessels, making for a considerably less gruesome tableau.

That said, this is still surgery. No matter how you slice it.

"It's not a panacea," says John Sherman, MD, assistant clinical professor of surgery at New York Hospital Cornell Medical Center. "I can tell you that unequivocally. There is less bleeding and less swelling, but six months later the end result is the same."

"It's a turf war, definitely," says Karyn Grossman, MD, a dermatologist specializing in laser work who works with Patricia Wexler, MD, skin doctor to New York's chic set. "Plastic surgeons don't want us to do work that is cosmetic, whether it's with lasers or it's liposuction or collagen injections." Despite the ill will, Grossman's business, which encompasses resurfacing and the zapping of dilated blood vessels, is booming.

And she picks her laser patients extremely carefully. "I, myself, wouldn't be a candidate because I'm dark-skinned," Colen says. "And I hate to wear makeup."

Trust that if you do have laser facial work done, particularly a resurfacing, you'll need to wear makeup. Unless you don't mind zipping through your day's activities with the equivalent of a fairly bad sunburn. Post-laser redness is notoriously long-lived, lasting for up to five months in some cases. It seems the beleaguered epidermis has a hard time bouncing back from all that thermal activity.

"Patients have to be psychologically prepared for this treatment," says Fredric S. Brandt MD, clinical associate professor of dermatology, University of Miami School of Medicine. "They'll be red for two to three months and they have to be able to accept that.

"It's not for everyone," Brandt adds. "It's best limited to fair-skinned individuals, the type that burns before it tans."

On the plus side, at least in the short term, patients recovering from laser resurfacing will generally have an easier go of it than those who opt for a peel or a dermabrasion. What little crusting does occur can be even further lessened by keeping the wound moist during the healing process. "That way," says Brandt, "the new skin doesn't have to migrate up and under the crust."

What some practitioners see as an advantage of laser eyelifts - minimal scarring - others pooh-pooh. "In the hands of a competent surgeon,'' says Sherman, "that shouldn't be an issue anyway."

Skepticism aside, Sherman does in fact own, and use regularly for a wide variety of procedures, an UltraPulse carbon dioxide laser. But he's eager to dispel the notion that laser surgery is a cakewalk devoid of any real recovery period. He also doesn't view lasers as an automatic replacement for a scalpel or a bottle of trichloroacetic acid. "In some modalities," Sherman says, "lasers are an improvement."

-DANA WOOD