2 Ablative Rejuvenation

Mitalee P. Christman and Roy G. Geronemus

Summary

Ablative rejuvenation is still considered the gold standard for nonsurgical treatment of photoaging. Treatment options include both traditional full-field ablative and fractional ablative carbon dioxide and erbium:yttrium aluminum garnet lasers. The ideal candidate has fine static rhytides and appropriate expectations regarding recovery and results. A thorough preoperative consult is performed and antiviral and antibacterial prophylaxis is provided to the patient. A multipronged anesthetic strategy is often necessary for optimal pain management. During the treatment, careful attention is paid to the clinical endpoint of visible wrinkle effacement and total energy delivered to the treatment area. Laser-assisted drug delivery of poly-L-lactic acid, postprocedure peptide serums, and photomodulation might enhance results and patient satisfaction. Close clinical follow-up is warranted to monitor for infectious complications. Recognition of symptoms and signs of other possible complications including erythema, dyspigmentation, and scarring is critical to allow for early intervention. With careful preoperative, intraoperative, and postoperative care, ablative rejuvenation can be a very satisfying and successful procedure.

Key words

ablative resurfacing - ablative rejuvenation - ablative lasers - resurfacing - carbon dioxide - erbium:YAG

• 1 Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation.. Science 1983; 220 (4596) 524-527 PubMed

• 2 Walsh Jr JT, Deutsch TF. Pulsed CO₂ laser tissue ablation: measurement of the ablation rate.. Lasers Surg Med 1988; 8 (3) 264-275 PubMed

• 3 Brightman LA, Brauer JA, Anolik R et al. Ablative and fractional ablative lasers.. Dermatol Clin 2009; 27 (4) 479-489, vi–vii PubMed

• 4 Ross EV, Swann M, Soon S, Izadpanah A, Barnette D, Davenport S. Full-face treatments with the 2790-nm erbium:YSGG laser system.. J Drugs Dermatol 2009; 8 (3) 248-252 PubMed

• 5 Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing.. J Am Acad Dermatol 2008; 58 (5) 719-737, quiz 738–740 PubMed

• 6 Hantash BM, Mahmood MB. Fractional photothermolysis: a novel aesthetic laser surgery modality.. Dermatol Surg 2007; 33 (5) 525-534 PubMed

• 7 Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury.. Lasers Surg Med 2004; 34 (5) 426-438 PubMed

• 8 Campbell TM, Goldman MP. Adverse events of fractionated carbon dioxide laser: review of 373 treatments.. Dermatol Surg 2010; 36 (11) 1645-1650 PubMed

• 9 Tierney EP, Eisen RF, Hanke CW. Fractionated CO₂ laser skin rejuvenation.. Dermatol Ther (Heidelb) 2011; 24 (1) 41-53 PubMed

• 10 Spring LK, Krakowski AC, Alam M et al. Isotretinoin and timing of procedural interventions: a systematic review with consensus recommendations.. JAMA Dermatol 2017; 153 (8) 802-809 PubMed

• 11 Orringer JS, Kang S, Johnson TM et al. Tretinoin treatment before carbon-dioxide laser resurfacing: a clinical and biochemical analysis.. J Am Acad Dermatol 2004; 51 (6) 940-946 PubMed

• 12 West TB, Alster TS. Effect of pretreatment on the incidence of hyperpigmentation following cutaneous CO₂ laser resurfacing.. Dermatol Surg 1999; 25 (1) 15-17 PubMed

• 13 Nestor MS. Prophylaxis for and treatment of uncomplicated skin and skin structure infections in laser and cosmetic surgery.. J Drugs Dermatol 2005; 4 (6) (Suppl. Suppl) s20-s25 PubMed

• 14 Metelitsa AI, Alster TS. Fractionated laser skin resurfacing treatment complications: a review.. Dermatol Surg 2010; 36 (3) 299-306 PubMed

• 15 Walia S, Alster TS. Cutaneous CO₂ laser resurfacing infection rate with and without prophylactic antibiotics.. Dermatol Surg 1999; 25 (11) 857-861 PubMed

• 16 Robertsiii T, Lettieri J, Ellis L. CO₂ laser resurfacing: recognizing and minimizing complications.. Aesthet Surg J 1996; 16 (2) 142-148

• 17 Palamaras I, Semkova K. Perioperative management of and recommendations for antithrombotic medications in dermatological surgery.. Br J Dermatol 2015; 172 (3) 597-605 PubMed

• 18 Eaton JS, Grekin RC. Regional anesthesia of the face.. Dermatol Surg 2001; 27 (12) 1006-1009 PubMed

• 19 Brotzman EA, Sandoval LF, Crane J. Use of nitrous oxide in dermatology: a systematic review.. Dermatol Surg 2018; 44 (5) 661-669 PubMed

• 20 Ibrahim O, Ionta S, Depina J, Petrell K, Arndt KA, Dover JS. Safety of laser-assisted delivery of topical poly-l-lactic acid in the treatment of upper lip rhytides: a prospective, rater-blinded study.. Dermatol Surg 2019; 45 (7) 968-974 PubMed

• 21 Vanaman Wilson MJ, Bolton J, Fabi SG. A randomized, single-blinded trial of a tripeptide/hexapeptide healing regimen following laser resurfacing of the face.. J Cosmet Dermatol 2017; 16 (2) 217-222 PubMed

• 22 Batra RS, Ort RJ, Jacob C, Hobbs L, Arndt KA, Dover JS. Evaluation of a silicone occlusive dressing after laser skin resurfacing.. Arch Dermatol 2001; 137 (10) 1317-1321 PubMed

• 23 Alster TS, Lupton JR. Erbium:YAG cutaneous laser resurfacing.. Dermatol Clin 2001; 19 (3) 453-466 PubMed

• 24 Avci P, Gupta A, Sadasivam M et al. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring.. Semin Cutan Med Surg 2013; 32 (1) 41-52 PubMed

• 25 Alster TS, Wanitphakdeedecha R. Improvement of postfractional laser erythema with light-emitting diode photomodulation.. Dermatol Surg 2009; 35 (5) 813-815 PubMed

• 26 Ho C, Nguyen Q, Lowe NJ, Griffin ME, Lask G. Laser resurfacing in pigmented skin.. Dermatol Surg 1995; 21 (12) 1035-1037 PubMed