Ablative laser skin resurfacing

Dr.Ali A. Maazil Plastic and reconstructive

surgeon in Alssadar medical city In Al Najaf

2012

Years of damaging UV light exposure

Clinical Histologica

l

Clinical manifestations

Roughened surface texture Variable degrees of

dyspigmenations Telangiectasia Wrinkles Skin laxity

histologically

These extrinsic aging effects are usually limited

to the epidermis and upper papillary dermis

Techniques for treatment of photo damaged skin

Derma abrasion Chemical peel Laser resurfacing

How we can choose the most appropriate

technique

Severity of photo damage and rhytides

The expertise the laser surgeon Expectations and life style of the

patient

What is ablative laser resurfacing?

Initial vaporization of epidermis and or partial dermis

Resultant open wound with exposed dermis Normal wound healing,exudate,edema and

inflammation phases New epidermis via re epithelialization from

adnexal structures New collagen and elastin production Neo-vascularity

Where laser resurfacing excels

Periorbital region and lower eye lids

Perioral region and lips Actinic chelitis Acne scar

Patient CM : Right Eye SmartXide treated (Power) 30W Dot Mode Spacing 200 μm Scanning well Time 500 μS 2 passes under R eye with obvious reduction in rhytides and neocollagenesis

Who is the ideal patients for ablative

resurfacing

Skin photo type I and II, Cutaneous lesion amenable to

treatment with resurfacing laser . Realistic expectations of resurfacing

procedure.

Preoperative preparation

Bleaching agent Retinoic acid

compounds Antibiotics Anti viral agents

Ablative skin resurfacing

Carbon dioxide 10,600

Erbium YAG laser 2,940

Characteristics of co2 laser

Invisible ,mid infrared emission Wave length 10,600 Water is primary chromphore Collagen is secondary chromophore Effect is independent of skin colour Delivery by mirrored joints, articulated

arms

Characteristics of co2 laser

Coagulation and cutting Resurfacing is gold standard Longer healing time, redness Hypo-pigmentation

Erbium:YAG Wave length 2940 More affinity for water than co2 laser Less effective haemostasis Less thermal diffusion Less collagen contraction Can combined with co2

Post operative care

Dressing Pain killer Anti inflammatory

Pitfalls and their management

1) Proper patients selection2) Has patient ever had the areas treated

before3) What is the patients skin prototype?4) Dose the patients had history of H.L.

Pitfalls and their management

Autoimmune or other immunological deficiency

Other Dermatological conditions Any medication History of hypertrophic scar and keloid Patients prone to acne Patients expectations

Side effect and complications of ablative laser resurfacing

Expected side

effect

mild Moderate Sever

erythema Extended erythema

infections hypopigmentation

Oedema Mila ad ace hyperpigmentation

Hyper trophic scar

pruritus Contact dermatitis

Ectropin

Thank you