Pre-surgery and post operative care with laser treatment

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Acne Laser treatment pre-surgery postoperative care

Whether you are a candidate for CO2 laser treatment as an anti-aging solution for your severely photo-damaged skin or ErYAG lasers for an acne laser treatment for acne scar removal, pre operative care is a must. The care before the surgery depends very much upon the skin type.

Recent evidence has suggested that there is no need for the use of hydroquinone, retinoic acid, or glycolic acid before the acne laser treatment or laser treatment for photo-damaged skin in people with light skin.

But clinical experience has shown that pretreatment skin care with retinoids and glycolic acid is important for successful treatment of darker, more pigmented skin. A topical hydroquinone regime is followed by a large number of laser surgeons, particularly in countries where the population has mostly darker skin types.

The usual pretreatment regimen includes tretinoin cream 0.025% or 0.05% nightly, or alphahydroxyacids and a broad-spectrum sunscreen during the day.

Anesthesia

Most patients have been found to be tolerant to acne laser treatment with the use of a regional nerve block or local infiltration with lidocaine and this is used for most cases of acne laser treatment. This is a big advantage for the patient. General anesthesia is usually considered only when the treatment area is extensive i.e. a full facial peel. But general anesthesia can be offered for patients who are very sensitive to pain. Post operative care after laser treatment

Postoperative wound care with laser resurfacing surgery is generally straightforward, as the laser produces less bleeding, oozing, and crusting than other techniques, such as dermabrasion. Acne laser treatment with Er:YAG laser requires very little post operative care as compared to C02 lasers. A typical post operative care process is shown below, but the specific protocol varies depending on the surgeon and the specifics of the treatment undertaken. Make sure to consult with your surgeon about post operative care procedures.

Immediate care

A layer of emollient (e.g., Vaseline®, Aquaphor®) is applied to the treated surface, and a fan is generally used for cooling the burning sensation, which is usually most pronounced in the first 20 minutes after the procedure.

Once the heat sensation has calmed down patient is told about the postoperative instructions and is instructed to follow them thoroughly, they are also given a written copy to take home.

Bactroban® ointment is often applied to bilateral anterior nares for prophylactic treatment of nasal colonization with Staphylococcus aureus.

Care between 2-3 days after the laser treatment

As the majority of infectious complications associated with this procedure are related to herpetic outbreaks, it is a general belief and standard of practice to have all patients started on antiviral therapy 1-2 days prior to the procedure (continued for 10–14 days until complete re-epithelialization), regardless of the previous history of herpes simplex.

Significant oozing and swelling of the skin occurs during days 1–3 which reaches it peak during the first week, and the patient should be told about it before hand.

Swelling may be reduced by elevating the head during sleep with two to three pillows or sleeping in a recliner and using ice packs. Since the postoperative erythema, is generally most striking during the first postoperative week, diluted acetic acid water soaks (5 ml white vinegar in two cups of water) can be applied to the treated areas to ease the patient. Following the soak, the skin should be gently patted dry with a soft, clean towel. Vaseline® or Aquaphor® is then reapplied. Emollient should be kept on these areas continuously for 7–10 days when not soaking.

If the patient is having dry or scabbed areas appear on the skin, they should be soaked more frequently. The patient should be advised against picking or scrubbing the skin. Vinegar water can be also be sprayed on the skin periodically between soaks.

Faster healing has been shown in patients given antifungals (i.e. fluconazole) to prevent the overgrowth of yeast (one dose on the day after the procedure and another dose after 1 week).

Dressings

Semiocclusive dressings (“closed” technique) or petrolatum-based ointment (“open” technique) are used until full skin re-epithelialization. But the “closed” technique has obvious advantages over the “open” technique because of faster re-epithelialization and less pain and burning.

However, since the risk of infection is greater with closed dressings, a semiclosed technique, combining the advantages of both open and closed techniques, is often adopted. The wound is kept occluded (covered) for 48–72 h after which an open technique of applying moisturizing creams is generally preferred.

Some surgeons also prefer an open dressing system. A variety of petrolatum-based products can be used in the open dressing technique (i.e., Aquaphor®, Vaseline®). A plain vegetable oil-based product is also an excellent choice to avoid contact dermatitis in these dressings. If contact dermatitis to the petrolatum-based products is seen to occur quite frequently during the healing process, vegetable oil-based shortening is a good substitute.

Any topical antiseptic cream that produces local irritation needs to be avoided as this may delay the recovery time and increase the risks of adverse effects, such as erythema and hyperpigmentation.

In order to minimize postoperative hyperpigmentation, a bleaching ointment with 2% hydroquinone and 15% glycolic acid in a lotion base is introduced only after full re-epithelialization occurs, and the patient is advised to avoid the sun and prolonged exposure to fluorescent light and unfiltered computer screen light.

Care after 1 week

At 1 week, the patient begins use of a mild cleanser and transitions from the application of heavy emollients to a bland cream such as Cetaphil® or Vanicream®.

But if in any case a contact dermatitis is suspected, the application of makeup should be delayed to avoid contactants that may exacerbate the dermatitis.

After a follow up consultation with the surgeon to confirm successful wound healing, the patient is allowed to use a topical regimen, sunscreen, and wear makeup. The patient is also able to resume his/her normal activities after on week of care.

Proper post-operative care is the key to good results and avoiding serious side effects due to the surgery. Laser resurfacing surgery offers good results and a high degree of satisfaction to most patients. Even peole with pigmented skin types III and IV can be well-treated with this laser resurfacing technique without a risk of depigmentation if all the pre-operative and postoperative treatments are used properly.

References:
  1. E. Papadavid,and A. Katsambas, “Lasers for facial rejuvenation: a review”, 2003, The International Society of Dermatology, 42, 480–487
  2. D. Railan, and S. Kimlmer, “Ablative treatment of photoaging”, Dermatologic Therapy, Vol. 18, 2005, 227–241


   
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