Quick Hits

  • Listen on Apple Podcasts
  • Listen on Google Podcasts

CO2 lasers

    • Used for laser skin resurfacing
    • Chromophore is water
    • 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. Must stop isotreinoin or acutane for 12-18 months prior. Tretinoin is used as pretreatment
      • 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 decreases duration and severity of erythema following laser resurfacing
    • Hypopigmentation is the main long term complication
    • Er: YAG: treatment of choice for ablative resurfacing of skin: 2940nm- greatest affinity for water, (compared to CO2) decreased thermal heating, minimal contraction of dermis, creates transudative wound (photomechanical), less coagulative necrosis, decreased permanent hypopigmentation

Vascular lesions

    • Pulsed dye  good for capillary lesions, port wine stains 585nm
      • Chromophore is oxyhemoglobin
    • KTP 532 good for superficial vascular telangectasias; especially in face, red facial capillaries
    • Ed:YAG, diode, and erbium (infrared lasers at wavelengths 1064 to 1540)- best for acne scars

Tattoo removal

    • Q-switched good for tattoos (includes ruby -violet, ND:yag, alexandrite). Uses principles of photothermolysis
    • ND yag 532 good for red/orange/yellow
      • ND yag targets blood vessels, red blood cells, collagen, melanin
    • Q-switched alexandrite (755 nm) for green tattoo ink
    • ND YAG 1064 (pulse duration short, high affinity for water, minimal tissue necrosis, low coag necrosis, photomechanical, collagen contraction less than CO2)- black
      • Good for foreign body removal 
      • Good for vessel reduction in the leg
      • Long pulsed 1320 used for non-ablative skin remodeling (varicose veins)

Laser hair removal

    • Targets melanin in hair follicle so it is not useful in fair haired patients
    • Electrolysis used for hair removal in fair skin patients
    • Otherwise, often use long-pulse Nd:YAG
    • Safety 
      • Can have acne post-laser treatment of herpes simplex outbreak in those with and without a history
      • Reactivation of HSV is most common infectious complication after resurfacing
        • Antiviral prophylaxis now used in all patients undergoing laser resurfacing
        • Herpes outbreak despite oral management: IV antiviral and antibiotic; give prophylactic HSV prior to laser treatment
      • 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.