The study included 27 patients - both men and women - who were queried at various stages within 30 months after their laser surgery procedure, designed to help smooth wrinkles around the eyes and mouth, minimize scarring from acne and correct uneven skin tone resulting from sun damage.
Though much has been written on laser resurfacing from a clinicians' perspective, the study is thought to be the first to focus on after-the-fact patient perceptions, said Sonia Batra, MD, chief resident in dermatology at Stanford and first author on the study which appeared in the October issue of the Archives of Dermatology. "We found that while patient satisfaction overall remains quite high, it's important to note that the percent of patients who felt it met their expectations declined over the 30 months," Batra said.
Within three months of the procedure, 23 patients (85 percent of the study group) said it met their expectations. By 30 months, however, only 13 patients (54 percent) said they felt this was still the case.
Laser resurfacing is a common procedure popularized in the last decade with the advent of the carbon dioxide and more recently, the erbium:YAG lasers. During the outpatient procedure, doctors apply short bursts of laser energy to remove the top layer of skin and stimulate the underlying cells, or collagen, that provide support to the skin. Patients are sedated though remain awake during the procedure, which requires about a two-week recuperation period, Batra said.
Batra became interested in patient satisfaction with the technique while a medical student at Harvard, musing one day with a mentor, Jeffrey S. Dover, MD, about the high expectations cosmetic surgery patients often have, particularly after they've traveled some distance and spent thousands of dollars on an elective procedure such as laser resurfacing.
"We definitely encountered patients who never expected to get a wrinkle again," she said. "There was a perception that rather than reset the clock, the procedure should halt the clock. That was just unrealistic."
She decided to design a study with Dover to examine patient experiences and their perception of results. The patients included 25 women and two men who were treated with both the carbon dioxide and erbium:YAG lasers between August and November 1999 in a Boston-area clinic. The average age of the patients was about 50. Roughly half the patients were being treated for wrinkles and sun-damaged skin, while the other half came in for treatment of acne scarring.
The researchers queried the patients about their experiences one day, three days and one week after the surgery and again at three weeks, six weeks, 12 weeks and 30 months.
On the day of the procedure, 37 percent of patients reported being very worried about the outcome and 11 percent considered laser resurfacing a "terrible experience"; 26 patients (96 percent) said they experienced discomfort and 20 (74 percent) said they experienced pain during the procedure, though pain and discomfort subsided within an average of six to 12 days.
While patients initially reported being satisfied with the results, the responses became less favorable as time progressed. After three months, all 27 patients said they felt they looked better than they did before the procedure. By 30 months, however, just 21 patients said they looked better. When asked after three months if they would have the procedure again, 89 percent said they would; by 30 months, this figure had dropped to 71 percent.
The researchers noted that "the decline in satisfaction between three and 30 months may represent a real reduction in clinical improvement over time." Previous studies suggest that clinical results don't always hold up over time, particularly in areas of the face, such as around the eyes and mouth, where movement and expression may impact the quality and appearance of the skin, Batra said.
She said the researchers had expected patients with acne scarring to be less satisfied with results overall, as these patients "often have many more psychological issues related to their appearance." However, the satisfaction levels for these patients were comparable to those who came in for treatment of wrinkles, she said.
Batra said the study should help prepare clinicians and patients on what to expect with laser resurfacing. "The goal is to help the patient and the practitioner have shared realistic expectations regarding the possible outcome," she said.
Batra's co-authors on the study are Carolyn I. Jacob, MD, at Northwestern University Medical School; Lori Hobbs, MD, at Charles Drew University of Medicine and Science in Los Angeles; Kenneth A. Arndt, MD, who has affiliations at Harvard, Yale and Dartmouth medical schools; and Dover, who has affiliations with Yale and Dartmouth medical schools.
Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.
PRINT MEDIA CONTACT: Ruthann Richter at 650-725-8047 (richter1@stanford.edu)
BROADCAST MEDIA CONTACT: M.A. Malone at 650-723-6912 (mamalone@stanford.edu)