134

Skin Rejuvenation Techniques:

General Considerations

Erin L. Holloman and Sterling S. Baker

Most patients want cosmetic and rejuvenative procedures with minimal to no downtime and visible results. The services most cosmetic surgeons offer run the spectrum from topical treatments (light chemical peels, microdermabrasion), to nonablative lasers and light sources, to radiofrequency skin tightening, to injectable fillers and Botox, to more traditional ablative skin resurfacing with chemical peels, lasers, or dermabrasion. Every of ce may not be able to offer every device or service. The most important keys are to listen to the patient, identify goals, and decide if those goals can be achieved with the techniques available. Obtain informed consent even on the most mundane procedures, but most importantly, ensure that the patient has realistic expectations.

Patient Evaluation

This is probably the most important step in discussing skin rejuvenation techniques with prospective patients. Realistic expectations have to be discussed before the procedure or you will have unhappy patients who are willing to share their dissatisfaction. A patient wanting a surgical result needs to have surgery, or at least agree to realistic results from a nonsurgical procedure.

An excellent idea, especially for ablative skin rejuvenation, is to show patients a photo book of the daily postoperative recovery period at the initial consultation. This is the best way to properly consent the patients and prepares them for exactly what to expect.

One of the most important patient history questions to ask is about use of Accutane in acne patients wanting to undergo laser skin resurfacing. Reepitheliazation can be delayed after its use. Wait at least 6 months and preferably a year before pursuing ablative resurfacing.

Surgical Planning

The gold standard of surgical skin rejuvenation techniques is laser skin resurfacing. This is usually performed as a one-time procedure, although it can be repeated. In contrast, most nonablative services need to be

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135

CO2 Laser Skin Resurfacing

Prophylaxis

Jemshed A. Khan

Large raw exposed facial areas following resurfacing may invite devastating bacterial cellulitis (Staphylococcus aureus Streptococcus pyogenes and Pseudomonas aeruginosa), primary herpes simplex, or reactivation of latent herpes simplex with disseminated facial scarring. To achieve therapeutic levels at the time of treatment, physicians may prescribe prophylactic antibiotic and antiviral medications prior to surgery (Table 135.1). Medications are continued for 12 days or until reepithelialization is well established. All resurfacing patients, except those undergoing very small treatment areas, receive a preoperative oral antibiotic, usually cipro oxacin hydrochloride (Cipro® ) 500 mg orally B.I.D. for 14 days, beginning 48 hours prior to surgery. Acyclovir (Zovirax® ), a thymidine kinase inhibitor that is active against human herpesviruses, may be prescribed as 400 mg orally every 8 hours for 14 days, begun at least 2 days prior to surgery.

Table 135.1. Resurfacing Prophylactic Preoperative Care

Originally published in: Chen WPD, Khan JA, McCord, Jr. CD. Color Atlas of Cosmetic Oculofacial Sugery. Philadelphia: Butterworth Heinemann/Elsevier. 2004.

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136

CO2 Laser Resurfacing Immediate Postoperative Care Prior to Complete Epithelialization

Jemshed A. Khan

Wound care is designed to hasten the resolution of erythema and minimize postinflammatory hyperpigmentation subsequent to reepithelialization (Table 136.1). Topical application of hydrocortisone cream 1% at bedtime for up to 6 weeks after surgery will minimize both conditions. Postinflammatory hyperpigmentation is also reduced by the prophylactic use of sunscreen SPF 30 or greater for 12 weeks after surgery. Topical hydroquinone cream 4% may be applied at bedtime to speed the resolution of hyperpigmentation.

Table 136.1. Resurfacing Postoperative Care Prior to Epithehalization

Originally published in: Chen WPD, Khan JA, McCord, Jr. CD. Color Atlas of Cosmetic Oculofacial Sugery. Philadelphia: Butterworth Heinemann/Elsevier.

2004.

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137

Products Used in CO2 Laser

Resurfacing Wound Care: Late

Postoperative Care After Complete

Epithelialization

Jemshed A. Khan

After re-epithelialization has occurred, treatment is directed toward reducing erythema and postinfl ammatory hyperpigmentetion (Table

137.1).

Table 137.1. Resurfacing Postoperative Care After Epithelialization

Originally published in: Chen WPD, Khan JA, McCord, Jr. CD. Color Atlas of Cosmetic Oculofacial Sugery. Philadelphia: Butterworth Heinemann/Elsevier. 2004.

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