PHOTOS: A complete set of photographs should be taken, preferrably by using a digital camera including close-up views of the periorbital and perioral regions, any scars to be treated and full-face exposures taken with changes in wrinkles and scars.
PRE-PROCEDURES CONDITIONING OF THE SKIN:
The pre-procedure and post-procedure skin conditioning programs are applied for both laser and chemical resurfacing. These programs have revolutionized and improved the outcome of the author’s resurfacing procedures leading to better results, happier patients, less complications and safer procedures. Skin conditioning has significantly reduced the postinflammatory hyperpigmentation, erythema and scarring. The skin’s conditioning enhances epithelization by increasing the mitotic activity, activates dermal fibroblast for greater collagen and elastin production, increases the well-hydrated keratinocytes and increases dermal hydratin. These reduce postoperative dryness, erythema and increase permeability. The preconditioning regulates the melanocyte function which reduces the post inflammatory pigmentation and reduces the inflammatory process such as acne, comedones and folliculitis.
THE PRE-CONDITIONING PROGRAMS:
The pre and post-condition programs were best described by Obagi and S. Kilmer.
Sunscreens: Many commercial products are available. Sunscreen should be used every morning for six weeks before the procedure and continued for six months after the laser or chemical resurfacing. Remind the patients that the UVA is a strong stimulus for melanogenesis and it penetrates through the skin via for example, the glass of a car window.
Hydroquinones: Pretreatment of patients with an increased risk for hyperpigmentation with topical hydroquinones will decrease the incidence of post inflammatory hyperpigmentation. All patients with type III skin or greater or those with a tendency to hyperpigment even after a minor scratch should be pretreated. Any of the various preparations can be used twice daily for at least two weeks, but preferably four to six weeks before the procedure. The recommended application is Hydroqiunones 4%, 1g twice a day to reduce or stop melanin production. Best continued for up to six months or more following the procedure. Kojic acid 2% can also be used.
Retinoids: Retin-A (tretinoin) is of most benefit for laser resurfacing, as it enhances collagen regeneration. The recommended application is Retinoic acid cream 0.025%, or 0.05% every night for four to six weeks before the procedure and continues for up to six months after the procedure.
Alpha Hydroxy Acids: Alpha hydroxy acids (AHAs) are known to affect the stratum corneum, and somehow also have an effect on the dermis. Corneocyte adhesion is diminished, which increases permeability and may allow for better diffusion into
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Fig. 18 – 19. Preoperative laser resurfacing planning program.
the dermis. AHA appears to activate RNA which is mitogenic for keratinocytes and fibroplasts which in turn increase collagen production. AHA in concentration of 10% or less partially removes the stratum cornema, leaving the skin feeling smooth, in concentration 10-20% AHA will completely remove the stratum cornema leaving the skin smoother but irritated and sensitive.