Quick Hits

  • Listen on Apple Podcasts
  • Listen on Google Podcasts

Laser Resurfacing:

  • Several types of lasers
    • Ablative, nonablative, and fractional 
  • Ablative laser resurfacing involves selective thermal destruction and wounding to the level of the dermis
    • Wound healing originates from cells in the dermis and inflammatory cells recruited to the site of injury leading to remodeling and production of firmer, smoother skin
    • Patients with Fitzpatrick skin type I to IV are good candidates
      • Can be used to treat fine and deep rhytids, uncontrollable acne, acne scars, telangectasias, and actinic keratoses
  • Fractional Lasers
    • Deliver columns of spatially confined thermal injury to the skin, with surrounding unaffected follicular units aiding in skin remodeling
    • Effective for treatment of acne scarring and photoaging
  • Nonablative Lasers
    • Heat tissue but do NOT ablate
    • Main benefit – Minimizes side effects when compared to albative lasers

Specific Lasers
CO2 lasers

  • Used for laser skin resurfacing
      • Wavelength is 10,600, Chromophore is water
      • Important to stop isotreinoin or acutane for 12-18mo prior
      • Hyperpigmentation is most common adverse effect of laser resurfacing for Fitzpatrick Type III or IV
        • Treat with hydroquinone and tretinoin, usually resolves within a few months. 
        • Rates of hyperpigmentation reduced by pretreatment with retinoic acid and bleaching agents
      • Erythema is normal and can last 1-4 months depending on type of laser used
        • Ascorbic acid can be used decreases duration and severity of erythema
      • Hypopigmentation is the main long term complication

Er: YAG: 

  • Treatment of choice for ablative resurfacing of skin
    • Wavelength is 2940, chromophore is water
    • Compared to CO2 laser – decreased thermal heating, minimal contraction of dermis, creates transudative wound (photomechanical), less coagulative necrosis, decreased permanent hypopigmentation

Specific lesions
Vascular lesions

  • Lasers used to damage vessel intima and cause contraction collagen surrounding vessel
  • PDL
    • Wavelength 585, Chromophore is oxyhemoglobin
    • Used for capillary lesions (Port wine Stains)
  • KTP 
    • Wavelength of 532, oxyhemoglobin is chromophore
    • Used for superficial vascular telangectasias, red facial capillaries 
  • Nd: Yag
    • Wavelength 1064
    • Can be used for venou and venolymphatic malformations or hemangiomas

Acne Scars 

  • Can be treated with infared lasers like Ed:YAG, diode, and erbium (infrared lasers at wavelengths 1064 to 1540)-

Tattoo removal

    • Q-switched lasers are used (includes ruby, ND:yag, alexandrite). 
    • Colors
      • Dark ink (black/blue) – Nd: YAG 1064
      • Green ink – Alexandrite
      • Red inks (purple, red, brown) – KTP 532
      • Yellow/orange – highly resistant to treatment

Laser hair removal

    • Targets melanin in hair follicle 
    • Lasers used – Diode, Alexandrite, Nd: Yag 1064, intense pulsed light 4000-1300nm (best for facial hair)
    • Not useful in fair haired patients due to lack of melanin 
      • Electrolysis used for hair removal in fair skin patients
    • Safety 
      • Reactivation of HSV is most common infectious complication after resurfacing
        • Antiviral prophylaxis should be used in all patients undergoing laser resurfacing
        • Herpes outbreak despite oral management: IV antiviral and antibiotic
      • High-efficiency smoke evacuator placed within 1 to 2 cm of the smoke plume, high-filtration or laser masks should be used instead of standard surgical masks
      • To prevent fire for laser: use conscious sedation, nerve blocks, and no supplemental oxygen

Get Notified

Subscribe to our newsletter to receive the latest updates about our hosts and podcast.