Microsoft word - co2 total fx laser resurfacing instructions.doc

Hooman Khorasani, M.D.
Chief, Division of Mohs, Reconstructive and Cosmetic Surgery
Department of Dermatology
5 East 98th Street – 5th Floor
Box 1048
New York, NY 10029-6574
Tel 212.241.9728 Fax 212.426.3160
We are here for you 24/7
If you have any concerns, at anytime please page Dr. Khorasani’s
on-call Fellow at (917) 205-3208

Laser General Instruction
The following are general instructions for your care prior to, during, and after laser treatment.
After performing many lasers treatments, we have found these guidelines, when followed, give
optimal results. Please read it carefully several times and refer to it as needed, as most of your
questions should be answered here. Instructions for your care will be reviewed with you prior to
consenting to the procedure and prior to taking any pain and/or anxiety medications. By
carefully following these instructions, and asking all the questions you should have, you can
expect to obtain very good results from your laser procedure.
Prior to Laser Treatment
Prior to laser therapy please follow these recommendations:
• Avoid any sunlight on the planned treatment area(s) for a minimum of 2 weeks prior to • Wear a sunscreen with sun protection factor (SPF) of ≥ 30 at all times up until the day of surgery. Any sunscreen will do, but ones with both UVA and UVB protection are best,
such as Neutrogena Ultra-Sheer Dry Touch Sunblock
• After surgery, you will be instructed not to apply sunscreen for 3 days and to stay indoors. After 3 days, proper sun protection is essential and includes the following: o A broad-brimmed hat that covers the entire face, including under the chin and the o Canopy designed sun protective umbrella/clothing such as those made by Coolibar Sun Protective Products (http://www.coolibar.com/our-
mission.html).
o A non-chemical, fragrance-free sunscreen that contains zinc or titanium dioxide such as Blue Lizard Australian Sunscreen – Sensitive
(http://www.crownlaboratories.com/bluelizard/products.html) or Vanicream
Sunscreen SPF 30 or 60
(http://www.psico.com/products/vanicream_sunscreen30.cfm).
• Fill any topical prescription medications the doctor has prescribed and plan to use them immediately after laser treatment. Medications typically prescribed (may vary depending on individual allergies) include: o Biafine, EpiCeram, Eletone - creams used for moisturizing and wound
Hooman Khorasani, M.D.
Chief, Division of Mohs, Reconstructive and Cosmetic Surgery
o Mupirocin, a prescription topical antibiotic ointment used for the prevention of
• Fill any oral prescription medications the doctor has prescribed and begin them as instructed 1-2 days prior to treatment. It is important to bring them with you on the procedure day. Medications typically prescribed (may vary depending on individual allergies) include: o Valtrex, an antiviral medication use to prevent cold sores (herpes infection).
o Keflex, an antibacterial medication used to prevent bacterial skin infections.
o Percocet or Vicodin, pain medications.
o Valium or Ativan, anti-anxiety and sedation medications.
• Obtain any wound care supplies, such as 4x4 gauze, white vinegar (acetic acid), and a gentle cleanser such as CeraVe, Cetaphil, or Vanicream Free and Clear Liquid
Cleanser (http://www.psico.com/products/free_and_clear_liquid_cleanser.cfm).
• It is always important to have an oral, over-the-counter antihistamine such as Benadryl
at home. These can be used as needed if itching becomes prominent, but may cause drowsiness. Itching is a common symptom of new skin healing after laser treatment. o Anti-itch creams that can be used 3 days after the laser treatment include Sarna
Sensitive Anti-Itch Lotion, Gold Bond Intensive Healing Anti-Itch
Cream, Gold Bond Maximum Relief Anti-Itch Cream, or Aveeno
Anti-Itch Concentrated Lotion.
• Expect to be at the clinic for up to 4 hours for a complete treatment. The entire process includes photography, consenting process, pain management, laser procedure with instructions on wound care management, and the scheduling of follow-up appointments.
During the Procedure
During the procedure, it is our number one priority that you are comfortable. As pain is
subjective and each person is different, we will do everything we can to minimize your pain
during the procedure and to maximize your experience at our office. Prescription pain and/or
anxiety medications will be given after signing the procedure consent (unless there is a
contraindication such as an allergy or personal preference). In addition, a topical anesthetic
medication (such as lidocaine) will be applied to the treatment area 45-60 minutes prior to the
procedure. Once time has elapsed and the topical and oral anesthetics are working, you will be
escorted to procedure room. The treatment area(s) will be cleansed and you will be ready to
begin the procedure.

After Surgery
Immediately following surgery, we require you have another adult escort you home and we
recommend they stay with you for the first night. It is important to ensure proper pain
management after the procedure, so continue taking the prescription pain medications as
instructed by the doctor. Cold therapy with cool compresses or frozen vegetables (such as peas
or corn wrapped in a damp cloth or paper towel) will help minimize swelling and decrease post-procedure pain. The doctor may recommend a holistic/homeopathic over-the-counter item Hooman Khorasani, M.D.
Chief, Division of Mohs, Reconstructive and Cosmetic Surgery

containing A rnica montana (plant) and Bromelain (pineapple) to help decrease swelling called
BruiseguardMD (http://www.scarguard.com/bruiseguard.html). If this has been
recommended, please begin at home after the procedure. We recommend that you:
• Keep your head elevated by sleeping on multiple pillows and/or in a recliner tilted at 45 degrees for the first 2 weeks following surgery. • Avoid rolling onto your face. Sleeping on your back for the first 2 weeks helps to ensure
Daily Care
• With a 4x4 gauze soaked with cool or tepid tap water diluted with white vinegar (acetic acid 0.25%, one teaspoon per cup), gently go over all resurfaced areas 4-6 times a day until the skin has stopped exfoliating. The goal with each cleaning is to lightly remove the exfoliating skin and crusting that develops after the laser procedure. This should be a gentle process with no scrubbing or abrading. If you have pain or develop bleeding you are scrubbing too hard and you should just pat the area softly. Frequent cleanings are most important for the first 3 days to help prevent any fungal or bacterial infections and promote proper wound healing. • After each cleaning, apply a thick coat of the prescribed topical moisturizer with Q-tips. This should look like icing on a cake. This will provide the moisture your skin needs during the healing process. • Do not be afraid to over-moisturize. Following these directions and keeping your skin well lubricated will help quicken the healing process. • You will continue the complex wound care outlined above for 7-10 days, at which point your skin will be completely resurfaced and you can continue to moisturize and apply sun protection. • Make-up can be applied beginning 3 days after treatment, but it is best to wait till the skin has fully exfoliated and all that remains is new, shiny, pink-to-white skin. We
recommend CoverFX, Jane Iredale, Clinique, or BareMinerals about 1-2 weeks
after the procedure.
What to Expect
Discomfort: Most people will feel some heat-related discomfort (pain) that is usually temporary
during the procedure and localized to the treatment area(s). Pain medications such as Tylenol or
those prescribed by the doctor and/or cold therapy with cool compresses and/or frozen
vegetables can be helpful.
Bleeding, Oozing, Crusting: Aggressive laser treatments may cause pinpoint bleeding, petechiae
(small red dots under the skin surface), and/or oozing. Crusting or scabbing may form if the
clear fluid or blood dries. This will resolve and is treated by appropriate wound care
management (see above).
Hooman Khorasani, M.D.
Chief, Division of Mohs, Reconstructive and Cosmetic Surgery

Blisters, Burns, Scabbing: Heating the upper layers of the skin may cause blisters or burns and
subsequent scab formation. Steam from the heating process may also produce a separation
between the upper and middle layers of the skin, resulting in blister formation. The natural
wound healing process, along with appropriate wound care management (see above), will result
in complete resolution.
Swelling: This will vary patient-to-patient depending on the aggressiveness of the treatment and
may increase in the first few days before subsiding. Most of your swelling should resolve over
the first two to three weeks. Do expect, however, to have minor fluctuations in the remaining
swelling over the course of the next 2-3 months. To minimize swelling, keep your head elevated
as much as possible over the first 2-3 weeks, avoid bending over or heavy lifting for the first few
weeks, and avoid prolonged sun exposure for the first 3 months. Cold therapy with cold
compresses and/or frozen vegetables can be beneficial the first few days after the procedure.

Redness: It is common to be red-to-pink after the skin is resurfaced and healing (after crusts
have been exfoliated). The aggressiveness of the treatment and the location treated will
determine how long this may remain. This is rarely permanent and can be covered up with
make-up until resolved.
A cne or Milia Formation: A flare of acne or formation of milia (tiny white bumps or small cysts
on the skin) may occur. These can be easily treated and will resolve completely.
Numbness: Your face will be numb following the procedure due to the local anesthetics that
were applied both topically and sometimes injected at the time of the procedure. Expect this to
wear off about 3-6 hours after the procedure.
Depression: It is not uncommon for patients to go through a period of mild depression after
procedures that alter your physical appearance. This may occur immediately after the procedure,
but more commonly will occur a few days to a week after treatment, especially if swelling
persists and/or the skin appears pink for longer than expected. You will be anxious for final
results. Realize that this is a temporary condition and things will improve—you are in excellent
hands. It will be important for you to focus diligently on following the wound care as well as
other activities to help divert your mind.
What is Possible
Herpes Reactivation: Herpes Simplex Virus (cold sore) eruption may rarely result in the treated
area or at the site of previous infection (such as the lip). Pre-treatment with oral antiviral
medications like Valtrex (see above) significantly decreases the chance of this happening. This
can be easily treated and will resolve completely.
Hooman Khorasani, M.D.
Chief, Division of Mohs, Reconstructive and Cosmetic Surgery

Scarring: Scarring is always possible when the skin is disrupted and there is an abnormal wound
healing response. Scars may be permanent and can be raised or depressed. They may also form
with red-to-pink color variations, skin darkening, or hypopigmentation (white). This is very
unlikely with the newer laser technologies and is more common with off the face treatment.
Discoloration: Some patients will develop a darkening (post-inflammatory hyperpigmentation)
or lightening (hypopigmentation) of the treatment areas that can occur weeks after the procedure.
This can usually be treated with sun protection, topical creams, and the tincture of time. This is
uncommon in patients with lighter skin, and seen more commonly in darker skin that has a
history of rarely burning and easily tanning with sun exposure. Fortunately, these complications
are also uncommon with the newer laser technologies.
Eye Injury: Protective goggles or eyelid covers will be worn during treatment to prevent any
direct eye injury. Irritation may develop if numbing medication such as lidocaine were to
accidently get into the eye, but this will not cause any permanent complications.
Infection: Bacterial or fungal infections can occur when the skin barrier is disrupted, as is the
case after laser procedures. Prophylactic antibiotics and wound care management (see above)
are essential to prevent these complications, which may lead to permanent scarring and
pigmentation changes.
Restrictions
Typically, restrictions are minimal following laser procedures. Our recommendations include:
• Remaining indoors for at least 3 days following the procedure. • Having no direct sun exposure for at least 3 months following the procedure. • No heavy lifting or strenuous exercise for at least 1-2 weeks after the skin has fully exfoliated and all that remains is new, shiny, pink-to-white skin. • No picking or scratching at the treatment site, as the skin is very friable and sensitive. Picking or scratching can lead to pigmentation changes and permanent scarring.
Pharmacy Recommendation
Madison Ave Pharmacy (Chris Breedwell)
1407 Madison Ave. (Madison between 98th and 97th on east side of street)
New York, NY 10029
Phone: (212) 722-3200
Email: [email protected]

Source: http://drkhorasani.com/wp-content/uploads/2012/08/Co2-Total-Fx-Laser-Resurfacing-Instructions.pdf