BiochemiaUrody - Strona Barbary Kwiatkowskiej (TYLKO-DO-ODCZYTU)

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Glacka

Wysłany: 04 Sie 2005 12:11 pm Temat postu: Laser na blizny po trądziku ?
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Na czym polega ta metoda ? Nie moge nigdzie znalezc jakis konkretnych i szczegolowych informacji na ten temat. Natomiast w ofertach roznych klinik oferujacych zabiegi dermatologiczne czesto spotyka sie np " laserowe usuwanie blizn potradzikowych " czy moze pod tym kryc sie np. dermabrazja laserowa ? Czy tez istnieja inne metody usuwania tych blizn wlasnie laserem ? Jesli tak czy sa one w ogole skuteczne i godne uwagi, bo ceny czasami wysokie 1000-2000zl ...
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ayem

Wysłany: 04 Sie 2005 04:40 pm Temat postu:
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w holenderskim programie Make Me Beautiful (Chce byc piekna na TV4), ktory jest wersja amerykanskiego The Swan pokazywali taki zabieg laserem CO2 wlasnie na blizny po tradziku. efekt na oko byl calkiem niezly ale nie wiem na czym dokladnie ten zabieg polega. w kazdym razie skora kobiety ktora miala to robione byla po nim jakby poparzona a po jakims czasie mocno odlazila
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Basia
Site Admin

Wysłany: 11 Sie 2005 02:43 pm Temat postu:
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Rodzajow laserow jest duza ilosc i przybywa ciagle nowych, kazdy ma nieco inne dzialanie, polecany jest na inne problemy. Jesli znasz ang. to poslugujac sie wyszukiwarka np. [link widoczny dla zalogowanych] znajdziesz wiele informacji.
Laser to jedna metoda.
Dermabrazja to inna metoda, ktora bardziej przypomina scieranie naskorka papierem sciernym.
Laser CO2 to bardzo inwazyjny zabieg, przypomina dermabrazje, gdyz nastepuje w tym wypadku odparowanie warstwy naskorka. Oba zabiegi moga byc krwawe, proces gojenia moze zabrac kilka miesiecy do roku. Wszelkie silnie inwazyjne zabiegi, ktore siegaja gleboko w skore, do warstwy skory wlasciwiej groza powiklaniami, bliznami, wymagaja bardzo sprawnej reki.

Wybor metody sluzacej do likwidacji blizn zalezy od typu blizn, bardzo inwazyjne zabiegi stosuje sie przy glebokich bliznach, majacych postac zaglebien jak np. blizny-dziurki po przebytej ospie. Jesli sa to blizny powierzchniowe wowczas tak inwazyjne zabiegi nie sa potrzebne, a wystarczy seria bardziej powierzchownych zabiegow czy to laserowych czy na bazie kwasu TCA lub hydroksykwasow w polaczeniu z retinoidami stosowanymi w domu i koniecznie wysoka ochrona UV stosowana juz do konca zycia.
Skutecznosc metod zalezy od wielu czynnikow, laserowe zabiegi moga byc skuteczne i sa warte uwagi.
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Glacka

Wysłany: 24 Sie 2005 10:09 am Temat postu:
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Byłam dzisiaj na konsultacji u lekarza, mam wrazenie facet zna sie na rzeczy, ale zawsze mam potem jakies obawy czy czasem mnie nie naciaga, dlatego tez pisze tutaj i licze na cenne rady .

Stwierdzil, ze najlepsza metoda usuniecia moich blizn bedzie laser erbowo-yangowy( badz erbowo-yagowy napisal mi nazwe ale ledwo ja mozna odczytac ) . Mowil, ze polega to na zamrozeniu i odparowaniu warstwy naskorka, potem trzeba sie schowac na troche w domu, zeby ludzi nie wystraszyc. Cena rozniez mnie nie zabila, bo u mnie w gre wchodza tylko policzki 400-500zl. Zabieg ten mozna robic tylko 3-4 razy do roku. Powiedzial, ze w moim przypadku w zupelnosci wystarcza 2 zabiegi. I teraz juz totalnie zglupialam, bo nie powiem ze sie na to nie napalilam . Walcze juz z tymi bliznami od kilku lat i naprawde aktualnie jestem juz bardzo zdesperowana! Moja twarz przezyla juz zarowno kwasy ( peelingi u dermatologa ) , ziolowe peelingi u kosmetyczki(Neoderma ) i bez wiekszego efektu. Slyszlam, ze lasery sa bardzo skuteczne, ale czy faktycznie tak jest.
Pani Basiu czy posiada Pani jakies informacje o skutecznosci laseru erbowo-yangowego ? Chcialam poszukac czegos na zagranicznych stronach, ale nawet nie wiem jak nazwe tego laseu wpisac.

Serdecznie prosze o jakies info.

Pozdrawiam
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Basia
Site Admin
Wysłany: 24 Sie 2005 01:42 pm Temat postu:
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Erbowo-Yagowy

Precise Erbium: YAG treatment levels acne scars, M.D. says
'Island resurfacing' offers dramatic results for some patients
Mar 1, 2005

[link widoczny dla zalogowanych]

[link widoczny dla zalogowanych]

Wystarczy wpisac w google "Er:YAG acne scars" a pojawi sie mnostwo informacji po ang.

Tutaj nieco o mozliwych komplikacjach:

Plastic and Reconstructive Surgery
Volume 109(1) January 2002 pp 308-316
Prevention and Treatment of Side Effects and Complications of Cutaneous Laser Resurfacing
Alster, Tina S. M.D.; Lupton, Jason R. M.D.
[link widoczny dla zalogowanych]

Over the past 15 years, cutaneous laser resurfacing has become a popular method of treatment for a variety of ultraviolet light-induced skin disorders. Continued refinement in laser technology and technique over the years has made safe treatment of photoinduced facial rhytides, dyschromias, lentigines, and atrophic scars possible, with low incidences of adverse sequelae. 1–8 Derived from the principles of selective photothermolysis elucidated by Anderson and Parrish in 1983, 9 an entire generation of lasers has been developed to improve tissue specificity. High-energy, pulsed, and scanned carbon dioxide (CO2) and erbium:yttrium-aluminum-garnet (Er:YAG) lasers represent these newer systems. Early laser technology consisted of continuous wave mode CO2 lasers that produced nonspecific cutaneous injury because of prolonged exposure of tissue to laser light energy. The risk of scarring was high because of excessive and uncontrollable conduction of heat to uninvolved structures. 10–12 Current systems emit higher fluences in short pulses, thus largely restricting energy deposition to targeted sites without significant collateral thermal damage. Pulse durations shorter than the thermal relaxation time of the targeted chromophore (intracellular water for resurfacing lasers) are used to also ensure selective tissue destruction. 13–15

Although complication rates reported in association with cutaneous laser resurfacing are consistently low, many potential adverse reactions may occur. Even in the hands of an experienced laser surgeon, unexpected side effects may result. Complicating factors include poor intraoperative technique, failure to adhere to a strict postoperative recovery regimen, and the individual characteristics of each patient undergoing treatment (e.g., Fitzpatrick skin phototype, degree of ultraviolet light exposure, pretreatment, and medical condition). Clinical results from cutaneous laser resurfacing range widely from the expected posttreatment morbidity with eventual clinical improvement to permanent disfigurement. It is, thus, essential that the normal recovery process after cutaneous laser ablation be well understood and that side effects and complications are recognized and treated at the first sign of their development.

Regardless of which laser system is used (CO2 or Er:YAG), some degree of posttreatment morbidity is experienced by all patients undergoing laser resurfacing. Fortunately, true adverse reactions are rare and can usually be differentiated from the typical responses of the skin to laser wounding. Resurfacing with either the high-energy, pulsed, or scanned CO2 or Er:YAG laser results in complete epidermal ablation and upper papillary dermal destruction with collagen remodeling. As a result, newly resurfaced skin lacks an intact epithelium, producing an exposed weeping wound with copious serous discharge. Complete reepithelialization occurs within an average of 8.5 days for CO2 laser-resurfaced skin, compared with 5.5 days for Er:YAG laser-treated skin. 1,16

The high-energy, pulsed CO2 lasers produce greater wound depths, penetrating an average of 20 to 60 µm with each pass and producing another 20 to 150 µm of collateral thermal necrosis. 1,10,12,13,17,18 The short-pulsed Er:YAG laser systems effect more shallow tissue ablation (2 to 5 µm per pass) and less residual thermal damage (20 to 50 µm ). 19–22 Because the degree of postoperative erythema correlates directly with the degree of thermal necrosis, patients resurfaced with CO2 lasers experience more intense and prolonged postoperative erythema compared with those treated with an Er:YAG laser. Erythema is most intense during the first month after CO2 laser resurfacing, but may persist for 6 months or more. Erythema following short-pulsed Er:YAG laser resurfacing is usually less pronounced and subsides within weeks after the procedure.

In addition to intense erythema, other expected side effects occurring in virtually all patients during the first postoperative week include marked edema, pain, and pruritus. Edema is most pronounced on the second and third postoperative days and can be alleviated by frequent ice pack applications. Postoperative pain can also be problematic during the initial healing process, requiring the use of nonsteroidal antiinflammatory agents and/or narcotics. Mild to moderate pruritus should be treated with corticosteroids and antihistamines to prevent unintentional scratching of the area, which could potentially scar the newly resurfaced skin.

A carefully executed postoperative wound care regimen is probably the most important measure to ensure proper wound healing after cutaneous laser resurfacing. Regardless of whether an open or closed wound care technique is used, patients must adhere to strict recovery protocols to avoid untoward effects or delayed wound healing. The open technique involves liberal application of topical healing ointments (e.g., Aquaphor, BiO2 balm, Catrix-10, Recovery balm, or plain petrolatum) and frequent application of cold compresses to enhance epithelial recovery and reduce swelling. Although the open approach may be associated with slightly increased patient discomfort and inconvenience, it is associated with fewer wound infections, decreased wound maceration, and improved ability to survey the healing wound. Semiocclusive biosynthetic dressings (e.g., Biobrane, Flexzan, Second Skin, Silon TSR, Vigilon) are used in the closed wound care technique for 3 to 5 postoperatively. Once intact, these dressings require less effort on the part of the patient and may expedite wound healing. Their use has several disadvantages, however, including higher incidences of postoperative infections (particularly when dressings are left in place for prolonged periods), impaired ability to observe the wound bed for signs of infection or early scar formation, 23 and increased material cost because of frequent dressing changes. Some physicians now prescribe a closed technique for the first 1 or 2 postoperative days to maximize patient comfort, followed by an open technique for the remainder of the healing process so as to decrease risk of wound infection and improve wound visualization until reepithelialization is complete.

Complications of cutaneous laser resurfacing range from transient side effects to permanent disfigurement. Mild complications include prolonged erythema, acne, milia formation, contact dermatitis, and pruritus. 1,5–7,24–28 Complications of moderate severity include reactivation of herpes simplex virus, superficial bacterial and fungal infections, postinflammatory hyperpigmentation, and delayed-onset hypopigmenta-tion. 1,5–7,23–30 The most severe complications associated with resurfacing include hypertrophic scar formation, ectropion, and disseminated infection. 1,23,24,27,28,30 Although management of these complications is relatively straightforward, their detection may at times be difficult because of the altered appearance of deepithelialized skin. Patients must also be discouraged from self-diagnosis and treatment when a complication does arise, to prevent its exacerbation. Close monitoring by the laser surgeon and/or his or her medical staff during the immediate postoperative recovery period is therefore vital to ensure proper wound healing and encourage patient compliance.

Prolonged Erythema
Posttreatment erythema is an expected consequence of cutaneous laser resurfacing and occurs in every patient after treatment. 1,2,24,25,27,28,30,31 Erythema is most intense after CO2 laser resurfacing and may persist for 6 months or longer. 24 Er:YAG laser-induced erythema is usually less severe and of shorter duration, lasting several weeks on average. 4,32 The risk of prolonged erythema is increased when multiple laser passes or inadvertent stacking or overlapping of laser pulses are performed, producing greater depths of tissue injury. It has also been proposed that aggressive debridement of the skin to remove partially desiccated tissue during surgery may also contribute to excessive erythema. 33 Postoperative wound infection and dermatitis irritate the skin and may also result in persistent erythema. Patients who have acne rosacea or who regularly use topical tretinoin before resurfacing may be predisposed to intensified erythema 34,35 (Fig. 1).

Topical ascorbic acid has been shown to decrease the severity and duration of postoperative erythema. 36 It is best applied when reepithelialization has been completed to avoid irritation of the denuded skin surface, which could further aggravate the erythema. Application of topical corticosteroids will not reduce normal postoperative erythema and could potentially retard wound healing and therefore should not be prescribed with the intention of speeding resolution of erythema. On the other hand, focal areas of erythema with induration and tenderness may signal incipient scar formation and should be promptly and aggressively treated with potent class I topical corticosteroid preparations or pulsed dye laser irradiation (see below).

Acne and Milia
Acne flares and milia formation are relatively common side effects of cutaneous laser resurfacing caused by the use of occlusive healing ointments and biosynthetic dressings during the acute recovery process 1,24,25,27,28,30,31 (Fig. 2). Aberrant follicular epithelialization during healing may also contribute to acne exacerbation within 1 to 2 weeks postoperatively. Patients with a prior history of acne are at particular risk of its development after resurfacing.

Acne has been reported to occur in as many as 80 percent of patients, and milia in up to 14 percent who undergo laser resurfacing. 25 Treatment is usually not necessary for mild flares, since spontaneous resolution is commonly observed once use of the occlusive ointments and dressings are discontinued. Short courses of oral antibiotics such as tetracycline or minocycline may be necessary for moderate to severe acne flares, especially in patients with a strong predisposition. 1,2,24 Once the skin has reepithelialized, topical antibiotics (e.g., erythromycin, clindamycin) can be used without fear of allergic or irritant contact dermatitis. Milia typically resolve spontaneously during continuation of the reepithelialization process, but can also be remedied with topical application of retinoic acid or manual extraction. Intralesional corticosteroids may be necessary for the rare inflamed cyst.

Contact Dermatitis
Contact dermatitis following cutaneous laser resurfacing occurs in up to 65 percent of patients and is usually irritant in nature. 1,2,24,25,27,28,30,31 Because of the deepithelialized state of newly resurfaced skin, the normal protective epidermal barrier is impaired, rendering the skin more susceptible to irritation. An allergic or irritant reaction to fragrances or allergens contained within a wide variety of topical ointments, soaps, moisturizers, or cosmetics may develop. 27 Topical antibiotics (e.g., Neosporin, Polysporin, or bacitracin) are the most common offending agents, so their use should be avoided during the reepithelialization process (Fig. 3). It is also imperative that patients refrain from application of self-prescribed remedies during recovery, since many herbal or other “natural” compounds may actually enhance irritation and contribute to postoperative morbidity.

Signs and symptoms suggestive of an irritant or allergic contact dermatitis include diffuse and intense facial erythema and/or pruritus. The eczematous eruptions observed are not usually the result of a true type IV allergic reaction, as patch tests fail to reveal allergy in the majority of cases. Since most reactions are of the irritant variety, only the sole use of bland, non–fragrance-containing emollients is necessary during recovery. When an allergic or irritant contact dermatitis is suspected, all potential inciting agents must be immediately discontinued. Although most reactions will clear once the offending agents are removed, the use of strong class I corticosteroids and oral antihistamines may speed the resolution of the dermatitis and reduce the risk of scarring. In severe cases, oral corticosteroids can be prescribed to decrease the inflammatory response. Frequent application of cool compresses can also alleviate pruritus. The incidence of contact dermatitis may be lower after Er:YAG laser resurfacing because of the faster rate of epithelial recovery compared with CO2 laser systems. 1

Infection
Viral, bacterial, and fungal infections may complicate any ablative laser resurfacing procedure with development of signs and symptoms during the first postoperative week before reepithelialization is complete. These infections must be promptly identified and treated so as to avoid scarring, delayed wound healing, infection with other opportunistic pathogens, or dissemination. Reactivation of herpes simplex virus is the most frequently occurring infectious sequela of cutaneous laser resurfacing 24,25,27,29,30 (Fig. 4). Because of the high rate of subclinical herpes simplex virus infection, all patients must be assumed to be carriers of the virus. Therefore, any patient, regardless of prior herpes simplex virus history, planning to undergo full-face or perioral resurfacing should receive prophylactic oral antiviral therapy. Despite adequate antiviral prophylaxis, 2 to 7 percent of laser-treated patients have been shown to develop herpes simplex virus reactivation. 24,29,37

Detection of a postoperative herpetic infection may be difficult because of the lack of intact epithelium. Whereas a herpetic infection on normal skin typically presents as intact vesicopustules on an erythematous base, an outbreak on laser-treated skin may only appear as superficial erosions. There may also be associated symptoms of pruritus or dysesthesia with delayed reepithelialization. Since dissemination of the herpes virus may result in atrophic scarring, suspected herpes simplex virus infection should be treated aggressively with an appropriate antiviral agent.

Oral antiviral agents (e.g., acyclovir, famciclovir, valacyclovir) should be initiated 1 to 2 days before the resurfacing procedure and continued for another 7 to 10 days until reepithelialization is complete. Acyclovir (400 mg) is prescribed three times daily, whereas famciclovir (250 to 500 mg) and valacyclovir (250 to 500 mg) are used twice a day. 29 If a herpetic outbreak occurs despite adequate prophylaxis, drug dosages should be increased to maximum zoster levels (double dose five times daily for acyclovir and 500 mg three times daily for famciclovir and valacyclovir) or a change to a different antiviral should be made, as viral resistance to the initially prescribed drug may have occurred. For the rare case of herpetic dissemination, intravenous administration of acyclovir with hospital admission becomes necessary. 29

Superficial cutaneous bacterial and fungal infections may also complicate recovery from cutaneous laser resurfacing. Bacterial infections are often caused by excessive wound occlusion during the initial postoperative recovery period and therefore are more commonly seen when a closed wound technique is used. The moist environment of newly resurfaced skin is an ideal medium for overgrowth of opportunistic pathogens. Staphylococcus aureus and Pseudomonas aeruginosa are the most commonly isolated bacteria, whereas Candida is the most commonly isolated fungus, although many wounds have multiple contaminating organisms on culture (Fig. 5). Patients with nasal colonization of staphylococci may be more susceptible to infection; however, it has not been proved that prophylactic topical antibiotic ointment decreases this risk.

Signs and symptoms of an acute bacterial process include focal areas of increased erythema, purulent discharge, pain, delayed healing, and erosions with crusting. A meticulous postoperative wound care regimen is essential to decrease the risk of bacterial infection. Patients should be advised to wash their hands with antibacterial soap before dressing or ointment application. Washcloths and other linens should not be reused during the recovery process. Frequent dressing changes and dilute acetic acid compresses are additional measures that keep the wound clean and free of infection. If an infection is suspected, patients should be given broad-spectrum antibiotics (e.g., semisynthetic penicillins or first-generation cephalosporins) until results of bacterial cultures with antibiotic sensitivities are obtained.

Although some laser surgeons prescribe antimicrobial agents for patients undergoing cutaneous laser resurfacing, this practice may be unjustified given the low risk of infection—0.4 to 4.5 percent. 23–25 One recent study by Walia and Alster 38 failed to show a decrease in cutaneous infection rates when prophylactic antibiotics were administered to 133 consecutive patients undergoing full-face CO2 resurfacing. In addition, the routine use of broad-spectrum antibiotics may lead to development of drug resistance or favor the growth of more highly pathogenic bacteria. 39 Although antibiotic prophylaxis remains standard practice for those patients at increased risk of infection (e.g., immunosuppression, mitral valve prolapse with regurgitation, valvular heart disease), its routine use is controversial, with large-scale prospective and controlled studies indicated to determine whether antimicrobial coverage is warranted in all patients.

Pigmentary Alteration
Transient postinflammatory hyperpigmentation is one of the most common complications of cutaneous laser resurfacing occurring in one-third of all patients treated regardless of skin tone. 1,2,24,25,27,28,30,31 Individuals with darker skin phototypes (Fitzpatrick IV to VI) almost universally hyperpigment after treatment and must be warned of this reaction before the procedure (Fig. 6). Hyperpigmentation usually develops 3 to 4 weeks postoperatively and can last for several months without intervention. Because this reaction pattern is so conspicuous, however, most patients seek treatment to hasten its resolution. Treatment options for hyperpigmentation include topical bleaching agents (hydroquinone, kojic acid); retinoic, azelaic, ascorbic, and glycolic acid compounds; and broad-spectrum sunscreens to prevent further ultraviolet light-induced melanin synthesis. Light glycolic acid peels (30 to 40%) may also hasten pigment resolution; these peels can be repeated at 2- to 4-week intervals for maximum results. 27,40 Since any of these topical remedies has the potential to irritate the skin and thus further contribute to the abnormal pigmentation, their use should be avoided during the first postoperative month.

Careful preoperative screening is necessary to determine which patients are at greatest risk of developing hyperpigmentation after laser resurfacing. Patients should regularly use sunscreens with a sun protection factor of 15 or higher for a minimum of 4 weeks preoperatively in preparation for the procedure. Patients with a suntan should not be resurfaced, since they have a much higher risk of postoperative hyperpigmentation because of stimulation of their melanocytes. It is also important for patients to get into the practice of regular sunscreen use before laser resurfacing, since it will be necessary to limit their ultraviolet exposure postoperatively. Long-term regular sunscreen use also becomes important so that the benefits obtained with the laser procedure can be maintained.

Although many laser surgeons continue to pretreat patients with topical bleaching agents and retinoic or glycolic acid compounds before cutaneous laser resurfacing, no studies to date have demonstrated any reduction in the rate of postinflammatory hyperpigmentation with this practice. In fact, a recent prospective study examined the effects of treating 100 patients with either glycolic acid cream, hydroquinone with tretinoin cream, or no treatment at all before CO2 laser resurfacing; these treatment groups were equivocal in their incidence of postinflammatory hyperpigmentation, further supporting the notion that pretreatment is unnecessary. 41 Topical agents primarily exert their effects on the superficial epithelium and do not reach the deeply situated melanocytes located within hair follicles or adnexal structures that potentiate the hyperpigmentation. Although treatment with a short-pulsed Er:YAG laser produces less collateral thermal damage than that of a CO2 laser, the incidence of postoperative hyperpigmentation is the same because the mechanism of cutaneous insult with both lasers is similar.

Hypopigmentation is an uncommon complication of cutaneous laser resurfacing and does not usually manifest until 6 to 12 months after the procedure (Fig. 7). Once residual erythema and hyperpigmentation have faded, conspicuous skin lightening becomes more apparent. 1,2,24,25,27,28,30,31 The risk of hypopigmentation after resurfacing appears to be directly related to the depth of penetration and degree of thermal injury imparted on the tissue. True hypopigmentation is rare; most cases of skin lightening represent “relative hypopigmentation” caused by the removal of photodamaged skin (appearing as pale skin adjacent to nontreated dyspigmented skin). To reduce the appearance of postoperative hypopigmentation, it is important to treat within appropriate cosmetic units. When more than one facial area requires treatment, it may be best to resurface the entire face to minimize obvious lines of demarcation. True hypopigmentation is more common in patients who have had previous dermabrasion or phenol peeling, as fibrosis from the prior procedures may become unmasked. Treatment for relative or true hypopigmentation involves the use of chemical peels (glycolic acid or trichloroacetic acid) to help blend lines of demarcation. The application of topical Oxsoralen and limited exposure of the skin to ultraviolet light has also been used to induce melanogenesis in these areas.

Hypertrophic Scarring
Hypertrophic scarring and textural changes are rare but serious complications of cutaneous laser resurfacing and, although there are individual differences with respect to scar propensity, most scars seen after laser resurfacing appear to be a result of poor intraoperative technique. The use of excessively high energy densities, stacking or overlapping of pulses or scans, or failing to completely remove desiccated tissue between laser passes are known causes of excessive residual thermal necrosis production in treated tissue that may eventuate in scar production. 1,2,5–7,24,25,27,28,30,31 Patients who experience postoperative wound infection or contact dermatitis or those with a history of radiation therapy, isotretinoin use within the previous 6 months, or keloid tendency are also at increased risk of scarring. 42 Additionally, certain anatomic locations are more prone to scar formation, including the mandible, neck, and periorbital areas and should, thus, be treated conservatively with fewer laser passes 24,30,31 (Fig. .

Focal areas of increased erythema or induration are the first signs of impending scar formation. The skin may be tender in these locations, and the prompt initiation of treatment is warranted. Application of strong (class I) topical corticosteroids (e.g., Temovate, Diprolene, Cyclocort) as well as intralesional corticosteroid injections or use of silicone gel sheeting can halt or slow scar progression. The 585-nm pulsed dye laser can also be used to treat erythematous and hypertrophic scars. Numerous reports in the literature have demonstrated the superior efficacy of this laser system in the treatment of hypertrophic scars; the pulsed dye laser targets cutaneous blood vessels and improves scar color, pliability, texture, and bulk. 43–46 Pulsed dye laser treatment also alleviates associated symptoms of pruritus or dysesthesia and sessions are repeated at 6- to 8-week intervals using parameters similar to those used for benign vascular lesions (4.5 to 5.0 J/cm2 with a 10-mm spot size, 6.5 to 7.0 J/cm2 with a 7-mm spot size). Two or three pulsed dye laser treatments are necessary to effect significant (50 percent or more) clinical improvement.

Ectropion Formation
Ectropion of the eyelids is another potentially serious complication following cutaneous laser resurfacing, often requiring surgical correction. 1,2,24,25,27,28,30,31 Patients who have undergone previous lower blepharoplasty or other surgical manipulation of the eyelids are at increased risk. A preoperative evaluation of each patient with a manual “snap” test of the lower eyelid should be performed to determine their risk of lid eversion. Although application of lower energy densities and fewer laser passes are advocated for infraorbital treatment to reduce the risk of scar formation and/or potential compromise of the eyelid margin, it is important to also observe laser-tissue interaction intraoperatively, as immediate collagen contraction can lead to lid eversion (Fig. 9).

Conclusions
Cutaneous laser resurfacing has become a safe and effective method of facial rejuvenation because of the development of high-energy, pulsed, and scanned CO2 and Er:YAG lasers. Although complications following laser resurfacing have been documented in the literature, most patients heal rapidly after treatment with low incidences of adverse sequelae. A successful resurfacing procedure is dependent on several factors, including expertise of the laser surgeon, proper patient selection, intraoperative technique, and strict adherence to the postoperative wound regimen prescribed. Prevention is key because complications are much easier to avoid than to treat. Fortunately, serious complications are rare; mild side effects, however, may significantly impede the normal recovery process and cause significant anxiety for the patient. For these reasons, laser surgeons must be prepared to manage the epithelial recovery process with its inherent morbidity and be able to recognize and efficiently treat any complications that may occur.

Erythema, edema, and pruritus are normal consequences of any ablative laser procedure; these effects are transient and largely resolve once reepithelialization is completed. Mild side effects of laser resurfacing include prolonged erythema (which is more common after CO2 laser treatment), acne exacerbation, milia formation, and contact dermatitis. Moderate complications of laser resurfacing include reactivation of herpes simplex virus, superficial cutaneous bacterial and fungal infections, and postinflammatory pigmentary alteration. The most serious complications include hypertrophic scarring, ectropion formation, and dissemination of infection. With appropriate pretreatment patient education, a properly executed operative technique, and implementation of a meticulous postoperative recovery program, most patients undergoing cutaneous laser resurfacing can be expected to heal quickly with low risk of permanent adverse sequelae.