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17. Ablative Laser Resurfacing
Juan L. Rendon, Simon Moradian
See Essentials of Aesthetic Surger y, pp. 212–222
EQUIPMENT
1. Which of the following lasers provide ablative resurfacing?
A. Carbon dioxide laser only.
B. Carbon dioxide laser and erbium:yttrium aluminum garnet (ER:YAG) laser.
C. Carbon dioxide laser and neodymium-doped:yttrium aluminum garnet (ND:YAG) laser.
D. Erbium:yttrium aluminum garnet (ER:YAG) laser and neodymium-doped:yttrium aluminum garnet (ND:
YAG) laser.
E. Carbon dioxide laser and Q-switched neodymium-doped:yttrium aluminum garnet (ND:YAG) laser.
EQUIPMENT
2. Compared to the carbon dioxide laser, the erbium:yttrium aluminum garnet (ER:YAG) laser produces which of
the following?
A. More residual thermal damage and less precise tissue vaporization.
B. Less residual thermal damage and more precise tissue vaporization.
C. Equivalent residual thermal damage but more precise tissue vaporization.
D. No residual thermal damage and an increasing depth of tissue penetration with each additional pass.
E. More thermal damage and an increasing depth of tissue penetration with each additional pass.
EQUIPMENT
3. A 52-year-old woman comes to the office for evaluation of persistent erythema 2 weeks after she underwent
ablative carbon dioxide laser treatment. Which of the following topical treatments is most appropriate to
decrease this patient's postoperative erythema?
A. Amoxicillin.
B. Hydroquinone.
C. Ascorbic acid.
D. Valacyclovir.
E. Prednisone.
EQUIPMENT
4. Which of the following lasers has the greatest affinity for water and therefore greatest dermal ablative
potential?
A. Carbon dioxide.
B. Neodymium-doped:yttrium aluminum garnet (ND:YAG).
C. Q-switched neodymium-doped:yttrium aluminum garnet (ND:YAG).
D. Erbium:yttrium aluminum garnet (ER:YAG).
E. Intense pulse light (IPL).
TECHNIQUE
5. The use of tumescent local anesthesia for ablative laser is associated with which of the following?
A. Increased depth of penetration.
B. Decreased depth of penetration.
C. Faster healing times.
D. More predictable treatment area.
E. Increased residual thermal damage.
Chapter 17&Ablative Laser Resurfacing 99
TECHNIQUE
6. The addition of hyaluronidase to local anesthetics achieves which of the following?
A. pH neutralization.
B. Increased tissue diffusion.
C. Increased hemostasis.
D. Increased depth of tissue ablation.
E. Vasoconstriction.
TECHNIQUE
7. A 45-year-old woman comes to the office because of rhytides caused by photoaging. Treatment using CO2laser
resurfacing is planned. Laser resurfacing with a carbon dioxide laser should employ which of the following
techniques and clinical endpoints?
A. Multiple overlapping passes until there is a brown coloration of the treated area without skin contracture.
B. Multiple overlapping passes until there is a brown coloration of the treated area with skin contracture.
C. Multiple overlapping passes until there is a yellow coloration of the treated area with skin contracture.
D. Nonoverlapping passes until there is a brown coloration of treated area without skin contracture.
E. Nonoverlapping passes until there is a yellow coloration of treated area with skin contracture.
TECHNIQUE
8. A 67-year-old woman with Fitzpatrick type I skin comes to the office with concerns over deep rhytides and
signs of photoaging. She would like to avoid surgery and has had limited results with prior chemical peels.
She is interested in laser therapy and wants recovery to have as little downtime as possible, but with maximal
results. She elects for erbium:yttrium aluminum garnet (ER:YAG) laser resurfacing. Resurfacing with an ER:YAG
laser should employ which of the following techniques and clinical endpoints?
A. Overlapping passes until there is eradication of the rhytid and penetration into the papillary dermis as dem-
onstrated by fine fibrillar bleeding.
B. Overlapping passes until there is eradication of the rhytid and penetration into the mid-reticular dermis as
demonstrated by large dermal bleeding spots.
C. Nonoverlapping passes until there is eradication of the rhytid and penetration into the papillary dermis as
demonstrated by fine fibrillar bleeding.
D. Nonoverlapping passes until there is eradication of the rhytid and penetration into the reticular dermis as
demonstrated by large dermal bleeding spots.
E. Nonoverlapping passes until there is eradication of the rhytid and penetration past the reticular dermis with
small exposed areas of subcutaneous fat.
POSTOPERATIVE CARE
9. A 45-year-old female with a history of well-controlled diabetes and a Fitzpatrick type III skin type who under-
went ER:YAG laser resurfacing 4 days ago presents to your clinic with worsening blanching erythema over the
past 24 hours that is warm to touch and has a grape-like odor over the treated area. She was advised to perform bio-occlusive dressing changes daily and ice water soaks. You suspect a pseudomonas infection and cultures are taken and empiric treatment is started. What do you suspect the primary cause of such an infection
to be?
A. Fitzpatrick type III skin or above.
B. Prolonged use of bio-occlusive dressings for >72 hours.
C. ER:YAG laser use which is associated with a higher risk of infection when compared to other laser types.
D. History of diabetes.
E. Minimal ice water soaks.
POSTOPERATIVE CARE
10. In open wound care protocols, which of the following topical agents should be used during the reepitheliali-
zation healing phase?
A. Mupirocin.
B. Bacitracin.
C. Polymyxin B.
D. Non-antibiotic petroleum-based ointment.
E. Hydroquinone.
100 Part V&Noninvasive and Minimally Invasive Therapy
COMPLICATIONS
11. Which of the following prophylactic measures should be universally continued pre and post ablative
resurfacing?
A. Antifungals, antibiotics, and antivirals.
B. Antifungals and antibiotics.
C. Antibiotics and antivirals.
D. Antibiotics alone.
E. Antivirals alone.
COMPLICATIONS
12. Hyperpigmentation is most associated with which of the following?
A. Preoperative use of hydroquinone.
B. Preoperative use of retinoid.
C. Heavy sun exposure.
D. Increased Fitzpatrick score.
E. Decreased Fitzpatrick score.
COMPLICATIONS
13. A 54-year-old female patient with a Fitzpatrick skin type III is noted to have immediate hypopigmentation
after ablative laser resurfacing in the preauricular area directly adjacent to an area of untreated skin. How
will you counsel this patient?
A. This phenomenon occurs more often with erbium:yttrium aluminum garnet (ER:YAG) than with carbon
dioxide resurfacing.
B. It is a normal finding related to the transition between treated and untreated areas.
C. It can be addressed with steroid injection.
D. This is likely permanent.
E. This is related to her Fitzpatrick skin type.
Chapter 17&Ablative Laser Resurfacing 101
Answers
EQUIPMENT
1. Which of the following lasers provide ablative resurfacing?
B. Carbon dioxide laser and erbium:yttrium aluminum garnet (ER:YAG) laser.
The CO
1960s. However, newer laser technologies developed to include erbium:yttrium aluminum garnet (ER:
YAG) lasers and fractional lasers. The most commonly used ablative lasers to date continue to be CO
laser (10,600 nm) and the erbium:YAG laser (2,940 nm) with their target chromophore being water. The
goals of all these devices are to eliminate or reduce sun-damaged collagen and encourage new collagen
deposition and remodeling through a combination of tissue vaporization and collagen denaturation.
CO
CO
tional lasers. The neodymium-doped:yttrium aluminum garnet (ND:YAG) and the Q-switched neodymium-doped:yttrium aluminum garnet (ND:YAG) lasers are both nonablative lasers.
REFERENCES
1. Alexiades Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: non-ablative, fractional,
and ablative laser resurfacing. J Am Acad Dermatol 2008;58:719
2. Brightman LA, Brauer JA, Anolik R, et al. Ablative and fractional ablative lasers. Dermatol Clin 2009;27:479
3. Walsh JT Jr, Flotte TJ, Anderson RR, et al. Pulsed CO
duration on thermal damage. Lasers Surg Med 1988;8:108
laser was the f irst ablative laser of its kind and originally used as a continuous wave in the
2
It should be noted that the absorption coefficient of a (ER:YAG) laser is 10 times greater than that of
laser (12,000 cm−1). It produces more precise tissue vaporization and less thermal coagulation than
2
lasers. Alternatively, other ablative lasers include the yttrium scandium gallium garnet (YSGG) frac-
2
1,2,3
laser tissue ablation: effect of tissue type and pulse
2
2
EQUIPMENT
2. Compared to the carbon dioxide laser, the erbium:yttrium aluminum garnet (ER:YAG) laser produces which of
the following?
B. Less residual thermal damage and more precise tissue vaporization.
Ablative lasers vaporize the epidermis and possibly part of the dermis. Additionally, they cause mild to significant edema and an open wound, all dependent on the depth of injury.
Compared to the carbon dioxide laser, the erbium:yttrium aluminum garnet (ER:YAG) laser produces
more precise tissue vaporization and less thermal coagulation, and therefore results in less residual thermal
damage and faster healing times.
1,2,3
REFERENCES
1. Alexiades Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: non-ablative, fractional,
and ablative laser resurfacing. J Am Acad Dermatol 2008;58:719
2. Walsh JT Jr, Flotte TJ, Anderson RR, et al. Pulsed CO2laser tissue ablation: effect of tissue type and pulse
duration on thermal damage. Lasers Surg Med 1988;8:108
3. Fitzpatrick RE, Williams B, Goldman MP. Preoperative anesthesia and postoperative considerations in laser
resurfacing. Semin Cutan Med Surg 1996;15:170
EQUIPMENT
3. A 52-year-old woman comes to the office for evaluation of persistent erythema 2 weeks after she underwent
ablative carbon dioxide laser treatment. Which of the following topical treatments is most appropriate to
decrease this patient's postoperative erythema?
C. Ascorbic acid.
Erythema following laser treatment is an expected consequence of therapy. Postoperative topical
application of ascorbic acid has been shown to decrease the duration as well as the severity of erythema
by restoring the normal skin pH. Topical therapy with ascorbic acid should be applied following
reepithelialization. Antibiotics or antivirals have not been shown to decrease erythema. Hydroquinone is
a skin bleaching agent that does not treat erythema. Topical corticosteroids postoperatively may delay
reepithelialization and have not been associated with a decrease in erythema.
1,2
102 Part V&Noninvasive and Minimally Invasive Therapy
REFERENCES
1. Alster TS, Lupton JR. Prevention and treatment of side effects and complications of cutaneous laser resurfacing.
Plast Reconstr Surg 2002;109(1):308–316
2. Neaman KC, Baca ME, Piazza RC III, et al. Outcomes of fractional CO
retrospective review. Aesthet Surg J 2010;30(6):845–852
laser application in aesthetic surgery: a
2
EQUIPMENT
4. Which of the following lasers has the greatest affinity for water and therefore greatest dermal ablative potential?
D. Erbium:yttrium aluminum garnet (ER:YAG).
Although both the carbon dioxide and the erbium:yttrium aluminum garnet (ER:YAG) lasers target the chromophore water, the absorption coefficient of the ER:YAG laser is 10 times greater than that of carbon dioxide
laser. This produces more precise tissue vaporization and less thermal coagulation than CO
ER:YAG laser is quite comprehensive and versatile. It has quicker healing times, or it can be much more
aggressive and ablative than CO2with less residual thermal damage and an optimal efficacy safety profile
(i.e., can be as aggressive or as superficial as needed).
1
lasers. The
2
REFERENCE
1. Alexiades, Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: non-ablative, fractional,
and ablative laser resurfacing. J Am Acad Dermatol 2008;58:719
TECHNIQUE
5. The use of tumescent local anesthesia for ablative laser is associated with which of the following?
B. Decreased depth of penetration.
Because tumescent anesthesia introduces water into the tissue, it ultimately decreases the depth of
penetration, which may not be desired as this would alter your predicted treatment depth and ultimately
affect the final outcome. For example, a fractionated laser only treats a fraction of the skin (as the name
implies) leaving the intervening skin untouched. These treated areas are known as ablative microthermal
treatment zones (MTZs). This is accomplished by the laser emitting numerous narrow microscopic columns.
The higher energy within those small spot sizes will increases the depth of the laser per given volume of
tissue; however, if this depth is infiltrated with tumescence at varying areas/depths, this may affect your
penetration and effect. Kessels etal reported using 0.11% solution of 500 mL lactated Ringer solution, 20 mL
1% ropivacaine, 20 mL 2% xylocaine, and 0.5 mL epinephrine, with a minimum of 6 mL/kg.
1,2,3
REFERENCES
1. Kessels JP, Ostertag JU. The use of tumescent local anesthesia in ablative laser treatments. J Eur Acad Dermatol
Venereol 2012;26:1456
2. Cartee TV, Wasserman DI. Commentary: Ablative fractionated CO2laser treatment of photoaging: a clinical and
histologic study. Dermatol Surg 2012;38:1790
3. Hantash BM, Bedi VP, Kapadia B, et al. In vivo histological evaluation of a novel ablative fractional resurfacing
device. Lasers Surg Med 2007;39:96
TECHNIQUE
6. The addition of hyaluronidase to local anesthetics achieves which of the following?
B. Increased tissue diffusion.
The addition of hyaluronidase increases tissue diffusion. The addition of sodium bicarbonate to the local
anesthesia to the lateral face neutralizes the pH. Epinephrine combined with a local anesthetic would
provide a hemostatic effect. Hyaluronidase would not affect the depth of tissue ablation.
1,2,3,4
REFERENCES
1. Alexiades Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: non-ablative, fractional,
and ablative laser resurfacing. J Am Acad Dermatol 2008;58:719
2. Fitzpatrick RE, Williams B, Goldman MP. Preoperative anesthesia and postoperative considerations in laser
resurfacing. Semin Cutan Med Surg 1996;15:170
3. Saedi N, Hamilton HK, Arndt KA, et al. How to prepare patients for ablative laser procedures. J Am Acad Dermatol
2013;69:e49
Chapter 17&Ablative Laser Resurfacing 103
4. Tierney EP, Hanke CW, Petersen J. Ablative fractionated CO2laser treatment of photoaging: a clinical and histologic study. Dermatol Surg 2012;38:1777
TECHNIQUE
7. A 45-year-old woman comes to the office because of rhytides caused by photoaging. Treatment using CO2laser
resurfacing is planned. Laser resurfacing with a carbon dioxide laser should employ which of the following
techniques and clinical endpoints?
E. Nonoverlapping passes until there is a yellow coloration of treated area with skin contracture.
With the carbon dioxide laser, ablation in the treatment area is performed in a nonoverlapping manner.
After the first pass, debris is removed, and the treatment area will have a pink color as the papillary dermis
is exposed. A second pass is then performed, also in a nonoverlapping manner. With the second pass, the
treated area will transition to a yellow color, and the dermis will contract. In CO
safety endpoint is the appearance of a “chamois” yellow skin color, which is seen at the reticular dermis.
Most treatment areas will only need two or three passes to achieve optimal results. Clinical endpoints for
the carbon dioxide laser include a yellow-brown discoloration, no further skin contraction, and disappearance of the photodamaged area or rhytid. Of note, additional laser treatment may be applied to deep rhytides to soften transition zones. Excessive laser exposure should be avoided as browncolorationindicates
thermal necrosis and charring of the skin.
1,2
laser resurfacing, the
2
REFERENCES
1. Alexiades Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: non-ablative, fractional,
and ablative laser resurfacing. J Am Acad Dermatol 2008;58:719
2. Batra RS, Ort RJ, Jacob C, et al. Evaluation of a silicone occlusive dressing after laser skin resurfacing. Arch
Dermatol 2001;137:1317
TECHNIQUE
8. A 67-year-old woman with Fitzpatrick type I skin comes to the office with concerns over deep rhytides and
signs of photoaging. She would like to avoid surgery and has had limited results with prior chemical peels.
She is interested in laser therapy and wants recovery to have as little downtime as possible, but with maximal
results. She elects for erbium:yttrium aluminum garnet (ER:YAG) laser resurfacing. Resurfacing with an ER:YAG
laser should employ which of the following techniques and clinical endpoints?
B. Overlapping passes until there is eradication of the rhytid and penetration into the mid-reticular der-
mis as demonstrated by large dermal bleeding spots.
With the erbium:yttrium aluminum garnet (ER:YAG) laser, ablation in the treatment area is performed in
an overlapping manner. The amount of overlap depends on the energy distribution profile for each laser.
As much as 50% overlap should be used on the most popular erbium laser system. Initially, fine fibrillar
bleeding is noted from the papillary dermis. Larger bleeding spots that are less dense imply bleeding
from the reticular dermis. Here, endpoints include eradication of the rhytid or penetration to the midreticular dermis. A common misconception is that erbium is a more superficial laser. This is unequivocally
false. The erbium laser can penetrate deeply if an adequately powered system is used, in addition to
providing a faster recovery period which would be ideal for the patient in the above clinical vignette.
1
REFERENCE
1. Alexiades Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: non-ablative, fractional,
and ablative laser resurfacing. J Am Acad Dermatol 2008;58:719
POSTOPERATIVE CARE
9. A 45-year-old female with a history of well-controlled diabetes and a Fitzpatrick type III skin type who under-
went ER:YAG laser resurfacing 4 days ago presents to your clinic with worsening blanching erythema over the
past 24 hours that is warm to touch and has a grape-like odor over the treated area. She was advised to perform
bio-occlusive dressing changes daily and ice water soaks. You suspect a pseudomonas infection and cultures are
taken and empiric treatment is started. What do you suspect the primary cause of such an infection to be?
B. Prolonged use of bio-occlusive dressings for >72 hours.
Bio-occlusive dressings have been found to improve patient comfort but require frequent changes. Also,
prolonged use (>72 hours) of bio-occlusive dressings is associated with an increased incidence of
pseudomonas infection. Fitzpatrick skin type or ER:YAG laser use vs. any other laser use is not associated
104 Part V&Noninvasive and Minimally Invasive Therapy
with an increased risk of infection. This patient has a history of well-controlled diabetes, which also
would not be a major contributor in this scenario. Ice water soaks are for minimizing edema and helping
with exudate removal. They have not been shown to be a major contributor of infection if not
performed.
1,2,3,4
REFERENCES
1. Batra RS, Ort RJ, Jacob, C, et al. Evaluation of a silicone occlusive dressing after laser skin resurfacing. Arch
Dermatol 2001;137:1317
2. Batra RS. Ablative laser resurfacing—postoperative care. Skin Therapy Lett 2004;9:6
3. Manuskiatti W, Fitzpatrick RE, Goldman MP, et al. Prophylactic antibiotics in patients undergoing laser
resurfacing of the skin. J Am Acad Dermatol 1999;40:77
4. Goldman MP, Roberts TL III, Skover G, et al. Optimizing wound healing in the face after laser abrasion. J Am Acad
Dermatol 2002;46:399
POSTOPERATIVE CARE
10. In open wound care protocols, which of the following topical agents should be used during the reepitheliali-
zation healing phase?
D. Non-antibiotic petroleum-based ointment.
In addition to soaks, open wound care protocols require application of petroleum-based healing
ointments after each soak. Antibiotic ointments—mupirocin, bacitracin, and bacitracin/polymyxin B—
should be avoided to prevent dermatitis. Care should be taken to apply the petroleum-based ointment
uniformly over the entire treated area to avoid areas from drying out.
1,2,3
REFERENCES
1. Batra RS. Ablative laser resurfacing—postoperative care. Skin Therapy Lett 2004;9:6
2. Manuskiatti W, Fitzpatrick RE, Goldman MP, et al. Prophylactic antibiotics in patients undergoing laser
resurfacing of the skin. J Am Acad Dermatol 1999;40:77
3. Goldman MP, Roberts TL III, Skover G, et al. Optimizing wound healing in the face after laser abrasion. J Am Acad
Dermatol 2002;46:399
COMPLICATIONS
11. Which of the following prophylactic measures should be universally continued pre and post ablative resurfacing?
E. Antivirals alone.
Herpes simplex, candida, and Gram positive/negative bacterial infections can occur with ablative
resurfacing. All patients should be treated with antivirals for herpes simplex preoperatively and postoperatively. Conversely, antifungals and antibiotics are reserved for active infections.
1,2
REFERENCES
1. Fitzpatrick RE, Williams B, Goldman MP. Preoperative anesthesia and postoperative considerations in laser
resurfacing. Semin Cutan Med Surg 1996;15:170
2. Nanni CA, Alster TS. Complications of cutaneous laser surgery. A review. Dermatol Surg 1998;24:209
COMPLICATIONS
12. Hyperpigmentation is most associated with which of the following?
D. Increased Fitzpatrick score.
The risk of hyperpigmentation increases with increasing Fitzpatrick score. Treatments include
hydroquinone, a retinoid, and sunlight avoidance. Additionally, often times hydroquinone 4% and
tretinoin 0.05% are recommended 4 to 6 weeks pretreatment to stimulate faster healing and prevent
post-treatment hyperpigmention.
1,2
REFERENCES
1. Fabi S, Massaki N, Goldman MP. Efficacy and tolerability of two commercial hyperpigmentation kits in the treat-
ment of facial hyperpigmentation and photo-aging. J Drugs Dermatol 2012;11:964
Chapter 17&Ablative Laser Resurfacing 105
2. Sriprachya-Anunt S, Marchell NL, Fitzpatrick RE, et al. Facial resurfacing in patients with Fitzpatrick skin type IV.
Lasers Surg Med 2002;30:86
COMPLICATIONS
13. A 54-year-old female patient with a Fitzpatrick skin type III is noted to have immediate hypopigmentation
after ablative laser resur facing in the preauricular area directly adjacent to an area of untreated skin. How
will you counsel this patient?
B. It is a normal finding related to the transition between treated and untreated areas.
Hypopigmentation after ablative resurfacing occurs in 16 to 57% of cases and can be immediate or
delayed. Immediate hypopigmentation is likely caused by the transition between treated areas and
untreated/photodamaged areas. Delayed hypopigmentation appears 6 to 12 months after resurfacing
and can be addressed with UV light, glycolic acid peels, and fractional laser treatments.
Hypopigmentation occurs far less often with ER:YAG laser resurfacing when compared with CO
treatments. Steroid injection is incorrect as this may worsen hypopigmentation. Although her
Fitzpatrick skin type III can increase her risk of hyperpigmentation and hypopigmentation, post-inflammatory hyperpigmentation is more likely to occur.
1,2,3
2
laser
REFERENCES
1. Alexiades Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: non-ablative, fractional,
and ablative laser resurfacing. J Am Acad Dermatol 2008;58:719
2. Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia: Elsevier; 2012
3. Dijkema SJ, van der Lei B. Long-term results of upper lips treated for rhytides with carbon dioxide laser. Plast
Reconstr Surg 2005;115:1731
18. Nonablative Laser Resurfacing
Ira L. Savetsky
See Essentials of Aesthetic Surgery, pp. 223–230
EQUIPMENT
1. Which of the following nonablative lasers is most useful for resurfacing atrophic acne scars?
A. ND:YAG 1320 nm.
B. Q-switched ND:YAG 1064 nm.
C. Pulsed dye 585–595 nm.
D. Intense pulsed light.
E. Radiofrequency.
EQUIPMENT
2. Which of the following nonablative lasers is most useful for treating tattoos?
A. Erbium-doped 1550 nm.
B. Pulsed dye 585–595 nm.
C. Q-switched ND:YAG 1064 nm.
D. ND:YAG 1320 nm.
E. Diode 1450 nm.
EQUIPMENT
3. A 47-year-old female with Fitzpatrick type II skin is interested in laser resurfacing for her facial rhytids. Which
of the following nonablative lasers is most useful for treating her rhytids?
A. Erbium-doped 1550 nm.
B. Pulsed dye 585–595 nm.
C. Q-switched ND:YAG 1064 nm.
D. Diode 1450 nm.
E. ND:YAG 1320 nm.
EQUIPMENT
4. What is the main mechanism of action of radiofrequency?
A. Target chromophore is water.
B. Target chromophore is melanin.
C. Target chromophore is oxyhemoglobin.
D. Lipolysis.
E. Collagen denaturation via heat.
ANESTHESIA
5. To achieve the maximal effect of topical anesthetic agents such as EMLA (2.5% prilocaine/2.5% lidocaine) or
LMX (4% or 5% lidocaine), how long prior to treatment should these agents be applied?
A. No minimal time required.
B. 5 minutes.
C. 15 minutes.
D. 30 minutes.
E. 60 minutes.
SAFETY
6. Which of the following steps are taken to ensure the upmost safety when operating a laser?
A. All persons in the room must wear wavelength-specific safety goggles.
B. The laser does not need to be test fired prior to use.
C. A standard ET tube can be used if treating around the mouth, and the lowest possible FiO2should be given.
Chapter 18&Nonablative Laser Resurfacing 107
D. A dry blue or black towel should be placed around the treatment area to absorb heat energy.
E. Masks and special ventilation systems are not required.
TECHNIQUE
7. What is the clinical end point when using a nonablative laser for tattoo removal?
A. Skin whitening.
B. Skin darkening.
C. Mild purpura.
D. Severe purpura.
E. Pinpoint bleeding.
TECHNIQUE
8. What is the recommended overlap between treatment zones when using a pulsed dye laser?
A. 5–10%.
B. 10–20%.
C. 30–40%.
D. 40–50%.
E. 50–60%.
APPLICATIONS
9. Which of the following nonablative lasers is most useful for treating scar pliability and texture?
A. Fractional laser.
B. Q-switched ND:YAG 1064 nm.
C. Pulsed dye laser.
D. Intense pulsed light.
E. Radiofrequency.
APPLICATIONS
10. A 33-year-old male actor post mole removal from his left cheek 4 weeks ago has some erythema and irrita-
tion in his immature scar and is interested in laser treatment. Which of the following nonablative lasers is
most useful for treating erythema and irritation of his immature scar?
A. Fractional laser.
B. Q-switched ND:YAG 1064 nm.
C. Pulsed dye laser.
D. Intense pulsed light.
E. Radiofrequency.
APPLICATIONS
11. Of the modalities listed, which of the following is most useful for treating scar rosacea?
A. Fractional laser.
B. Q-switched ND:YAG 1064 nm.
C. Pulsed dye laser.
D. Intense pulsed light.
E. Radiofrequency.
APPLICATIONS
12. Which of the following nonablative lasers is most useful for removing green pigment in tattoos?
A. Q-switched ND:YAG 1064 nm.
B. Q-switched ruby 694 nm.
C. Q-switched alexandrite.
D. Intense pulsed light.
E. Radiofrequency.