Biomedical Engineering Reference
In-Depth Information
reason, it is recommended that conservative energies and
densities are used when treating the neck (45). Patients with a
history of scarring or postoperative wound infection are at
greater risk for scarring complications (46,47). Early interven-
tion when scarring occurs may involve the use of PDL, topical
and intralesional steroids, and/or 5% 5-fl uorouracil injections
and topical silicone gels (Hybrasil, Crescendo Therapeutics,
Inc., San Diego, California, USA) or silicone sheeting (46,47).
with a decreased density of ablative spots and/or the use of
postoperative topical corticosteroids has also been found to be
helpful, especially in the Asian population. One advantage of
fractional lasers is the absence of long-term hypopigmentation
(so long as no skin textural change associated with overtreat-
ment has occurred). This side effect was a major drawback of
confl uent resurfacing, was frequently observed particularly
after multiple pass treatments, and was the primary reason for
the CO
2
laser's waning popularity in the late 1990s.
Pigmentation
Postinfl ammatory hyperpigmentation with ablative fractional
treatment is more common among patients with darker
skin phototypes. Darker-skinned patients should be advised of
the potential risk for PIH (Fig. 7.14). In addition, they should
be counseled to avoid sun exposure for several weeks before
and after treatment (48). Sun avoidance and protection mea-
sures should be implemented and consideration given to
topical peeling (e.g., retinoids) or skin-lightening preparations
(e.g., hydroquinone). Minimizing postoperative infl ammation
Acne
Milia, papules, and pustules occur not uncommonly after abla-
tive fractional treatment. Occlusive moisturizers play a signifi -
cant role in the appearance of acne lesions, so ointments should
be discontinued once reepithelialization occurs and crusting
resolves. Transition to a nonocclusive bland moisturizer will
lessen the occurrence of acne lesions. Signifi cant acne eruptions
can generally be well controlled with oral antibiotics, typically of
the tetracycline class or alternatives as deemed appropriate (49).
(
A
)
(
B
)
(
C
)
(
D
)
Figure 7.14
Asian female (
A
) before, (
B
) immediately postfractional carbon dioxide laser, (
C
) 6 weeks after treatment, and (
D
) 3 months after treatment.
Note postinfl ammatory hyperpigmentation and slow resolution. Acne scarring continues to improve.
