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108 Part V&Noninvasive and Minimally Invasive Therapy
APPLICATIONS
13. What is the mechanism of action of using a laser for hair removal?
A. Target chromophore is water.
B. Target chromophore is melanin.
C. Target chromophore is oxyhemoglobin.
D. Collagen denaturation via heat.
E. Laser must reach the stratum corneum.
APPLICATIONS
14. Laser hair reduction is most effective in which individuals?
A. Light hair and fair skin.
B. Dark hair and fair skin.
C. Light hair and dark skin.
D. Dark hair and dark skin.
E. No significant difference among any skin type.
COMPLICATIONS
15. Which of the following is the most likely complication after nonablative laser therapy?
A. Hyperpigmentation.
B. Hypopigmentation.
C. Blistering.
D. Scarring.
E. Unsatisfactory result.
COMPLICATIONS
16. Which of the following is the most likely complication after monopolar radiofrequency therapy?
A. Hyperpigmentation.
B. Hypopigmentation.
C. Subdermal fat atrophy.
D. Blistering.
E. Scarring.
SIDE EFFECTS
17. Which of the following is the most likely side effect after nonablative laser therapy?
A. Erythema.
B. Swelling.
C. Hyperpigmentation.
D. Purpura.
E. Herpes simplex virus outbreak.
SIDE EFFECTS
18. A patient with Fitzpatrick skin type V is how many times more likely to have hyperpigmentation compared
to a patient with Fitzpatrick skin type I after nonablative laser therapy?
A. 5×.
B. 10×.
C. 20×.
D. 50×.
E. 100×.
Chapter 18&Nonablative Laser Resurfacing 109
Answers
EQUIPMENT
1. Which of the following nonablative lasers is most useful for resurfacing atrophic acne scars?
A. ND:YAG 1320 nm.
Of the choices listed, the ND:YAG 1320 nm laser is the most effective in resurfacing atrophic acne scars.
The Q-switched ND:YAG 1064 nm laser is very effective in treating tattoos. The pulsed dye 585–595 nm
laser is most effective at treating port-wine stains. Intense pulsed light is not a laser but is very effective
in treating hypervascularity and dyspigmentation. Radiofrequency is not a laser and is used to improve
skin laxity.
REFERENCES
1. Bellew SG, Lee C, Weiss MA, et al. Improvement of atrophic acne scars with a 1,320 nm Nd:YAG laser: retrospective study. Dermatol Surg 2005;31:1218
2. Rogachefsky AS, Hussain M, Goldberg DJ. Atrophic and a mixed pattern of acne scars improved with a 1320-nm
Nd:YAG laser. Dermatol Surg 2003;29:904
3. Sadick NS, Schecter AK. A preliminary study of utilization of the 1320-nm Nd:YAG laser for the treatment of acne
scarring. Dermatol Surg 2004;30:995
4. Goldberg DJ, Cutler KB. Nonablative treatment of rhytids with intense pulsed light. Lasers Surg Med 2000;26:196
EQUIPMENT
2. Which of the following nonablative lasers is most useful for treating tattoos?
C. Q-switched ND:YAG 1064 nm.
Compared with a continuous or shuttered mode of energy delivery by a laser, the energy is not blocked
but stored and then released in a super pulse, which greatly exc eeds the energy in the on phase of the
continuous or shuttered modes. In turn, this allows for a short burst but with a very high energy, known
as Q-switching. Of the choices listed, the Q-switched ND:YAG 1064 nm laser is very effectiv e in treating
tattoos. The erbium-doped 1550 nm has multiple applications such as dyschromia, fine rhytids, acne scars,
and burn scars. The pulsed dye 585–595 nm laser is most effective at treating port-wine stains. The ND:
YAG 1320 nm and diode 1450 nm laser are both effective in resurfacing atrophic acne scars.
1,2,3,4
1,2,3,4,5,6,7,8
REFERENCES
1. Bellew SG, Lee C, Weiss MA, et al. Improvement of atrophic acne scars with a 1,320 nm Nd:YAG laser: retrospective study. Dermatol Surg 2005;31:1218
2. Rogachefsky AS, Hussain M, Goldberg DJ. Atrophic and a mixed pattern of acne scars improved with a 1320-nm
Nd:YAG laser. Dermatol Surg 2003;29:904
3. Zelickson BD, Kilmer SL, Bernstein E, et al. Pulsed dye laser therapy for sun damaged skin. Lasers Surg Med
1999;25:229
4. Sadick NS, Schecter AK. A preliminary study of utilization of the 1320-nm Nd:YAG laser for the treatment of acne
scarring. Dermatol Surg 2004;30:995
5. Cohen JL, Ross EV. Combined fractional ablative and nonablative laser resurfacing treatment: a split-face comparative study. J Drugs Dermatol 2013;12:175
6. Collawn SS. Fraxel skin resurfacing. Ann Plast Surg 2007;58:237
7. Ong MW, Bashir SJ. Fractional laser resurfacing for acne scars: a review. Br J Dermatol 2012;166:1160
8. Glaich AS, Rahman Z, Goldberg LH, et al. Fractional resurfacing for the treatment of hypopigmented scars: a pilot
study. Dermatol Surg 2007;33:289
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.
Of the choices listed, the erbium-doped 1550 nm is most effective in treating fine rhytids. The pulsed dye
585–595 nm laser is most effective at treating port-wine stains. The Q-switched ND:YAG 1064 nm laser
110 Part V&Noninvasive and Minimally Invasive Therapy
is very effective in treating tattoos. The ND:YAG 1320 nm and diode 1450 nm laser are both effective in
resurfacing atrophic acne scars.
1,2,3,4,5,6,7,8
REFERENCES
1. Bellew SG, Lee C, Weiss MA, et al. Improvement of atrophic acne scars with a 1,320 nm Nd:YAG laser: retrospective study. Dermatol Surg 2005;31:1218
2. Rogachefsky AS, Hussain M, Goldberg DJ. Atrophic and a mixed pattern of acne scars improved with a 1320-nm
Nd:YAG laser. Dermatol Surg 2003;29:904
3. Zelickson BD, Kilmer SL, Bernstein E, et al. Pulsed dye laser therapy for sun damaged skin. Lasers Surg Med
1999;25:229
4. Sadick NS, Schecter AK. A preliminary study of utilization of the 1320-nm Nd:YAG laser for the treatment of acne
scarring. Dermatol Surg 2004;30:995
5. Cohen JL, Ross EV. Combined fractional ablative and nonablative laser resurfacing treatment: a split-face com-
parative study. J Drugs Dermatol 2013;12:175
6. Collawn SS. Fraxel skin resurfacing. Ann Plast Surg 2007;58:237
7. Ong MW, Bashir SJ. Fractional laser resurfacing for acne scars: a review. Br J Dermatol 2012;166:1160
8. Glaich AS, Rahman Z, Goldberg LH, et al. Fractional resurfacing for the treatment of hypopigmented scars: a pilot
study. Dermatol Surg 2007;33:289
EQUIPMENT
4. What is the main mechanism of action of radiofrequency?
E. Collagen denaturation via heat.
Radiofrequency waves cause collagen denaturation when heated to 55 to 62C, and the amount of
collagen in the skin increases over time. The amount of tissue heating and the placement of that heating
zone can be controlled by modifying the fluence of the radiofrequency waves and the intensity of the
cryogenic cooling spray. Although multiple reports have described fat atrophy from heat damage to
adipose tissue early in the treatment's evolution, current treatment protocols greatly minimize or
eliminate this risk. Radiofrequency is not a laser and does not target any specific chromophores.
1
REFERENCE
1. Low DW. Lasers in plastic surgery. In: Thorne CH, Bartlett SP, Beasley RW, et al, eds. Grabb and Smith's Plastic
Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007
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?
E. 60 minutes.
Topical anesthesia, typically with EML A (2.5% prilocaine/2.5% lidocaine) or LMX (4% or 5% lidocaine) must
be applied at least 1 hour before treatment, covered with an occlusive dressing, and wiped off just before
treatment.
1
REFERENCE
1. Low DW. Lasers in plastic surgery. In: Thorne CH, Bartlett SP, Beasley RW, et al, eds. Grabb and Smith's Plastic
Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007
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.
Medical lasers are all class IV devices. They are hazardous to view directly, under reflection or under
scatter. Therefore, all persons in the room must wear wavelength-specific safety goggles. A warning sign
must be placed on each entrance, with extra goggles hanging outside the door. Corneal eye shields are
placed, with ophthalmic ointment lubrication. The laser must be test fired prior to use. If the patient is
under general anesthesia, a laser-safe ET tube must be used if treating around the mouth, and the lowest
Chapter 18&Nonablative Laser Resurfacing 111
possible FiO2should be given. Wet towels should be applied around the treatment area to absorb heat
energy; the color of the towel is irrelevant. If treating viral warts, live viral particles can be transmitted
into personnel's airway. Therefore, appropriate masks and ventilation systems must be in place.
Additionally, a smoke evacuator is often times used to remove the laser plume.
REFERENCE
1. Low DW. Lasers in plastic surgery. In: Thorne CH, Bartlett SP, Beasley RW, et al, eds. Grabb and Smith's Plastic
Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007
TECHNIQUE
7. What is the clinical end point when using a nonablative laser for tattoo removal?
A. Skin whitening.
Skin whitening is the clinical end point in tattoo removal. When treating hypervascularity, mild pupura
is the clinical end point. Pinpoint bleeding is often the clinical end point in skin resurfacing techniques
for rhytids when using ablative lasers.
1
REFERENCE
1. Low DW. Lasers in plastic surgery. In: Thorne CH, Bartlett SP, Beasley RW, et al, eds. Grabb and Smith's Plastic
Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007
TECHNIQUE
8. What is the recommended overlap between treatment zones when using a pulsed dye laser?
B. 10–20%.
Most authors recommend a 10 to 20% overlap between treatment zones because of the Gaussian distribution
of intensity within each treatment zone if using a pulse dyed laser.
1
1
REFERENCE
1. Low DW. Lasers in plastic surgery. In: Thorne CH, Bartlett SP, Beasley RW, et al, eds. Grabb and Smith's Plastic
Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007
APPLICATIONS
9. Which of the following nonablative lasers is most useful for treating scar pliability and texture?
A. Fractional laser.
Of the choices listed, the fractional laser is the most effective for scar pliability and texture. The pulsed
dye laser is very effective in treating erythema and irritation of immature scar. Intense pulsed light is not
a laser but is very effective in treating scar dyschromia. Radiofrequency is not a laser and is used to
improve skin laxity. The Q-switched ND:YAG 1064 nm laser is very effective in treating tattoos.
1,2,3,4,5,6
REFERENCES
1. Haedersdal M, Moreau KE, Beyer DM, et al. Fractional nonablative 1540 nm laser resurfacing for thermal burn
scars: a randomized controlled trial. Lasers Surg Med 2009;41:189
2. Parrett BM, Donelan MB. Pulsed dye laser in burn scars: current concepts and future directions. Burns
2010;36:443
3. Allison KP, Kiernan MN, Water RA, et al. Pulsed dye laser treatment of burn scars. Alleviation or irritation? Burns
2003;29:207
4. Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and z-plasty for facial burn scars: the alternative
to excision. Ann Plast Surg 2008;60:480
5. Hultman CS, Edkins RE, Wu C, et al. Prospective, before-after cohort study to assess the efficacy of laser therapy
on hypertrophic burn scars. Ann Plast Surg 2013;70:521
6. Erol OO, Gurlek A, Agaoglu G, et al. Treatment of hypertrophic scars and keloids using intense pulsed light (IPL).
Aesth Plast Surg 2008;32:902
112 Part V&Noninvasive and Minimally Invasive Therapy
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?
C. Pulsed dye laser.
Of the choices listed, the pulsed dye laser is very effective in treating erythema and irritation of
immature scar. The fractional laser is the most effective for scar pliability and texture. Intense pulsed
light is not a laser but is very effective in treating scar dyschromia. Radiofrequency is not a laser and is
used to improve skin laxity. The Q-switched ND:YAG 1064 nm laser is very effective in treating
1,2,3,4,5,6
tattoos.
REFERENCES
1. Haedersdal M, Moreau KE, Beyer DM, et al. Fractional nonablative 1540 nm laser resurfacing for thermal burn
scars: a randomized controlled trial. Lasers Surg Med 2009;41:189
2. Parrett BM, Donelan MB. Pulsed dye laser in burn scars: current concepts and future directions. Burns
2010;36:443
3. Allison KP, Kiernan MN, Water RA, et al. Pulsed dye laser treatment of burn scars. Alleviation or irritation? Burns
2003;29:207
4. Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and z-plasty for facial burn scars: the alternative
to excision. Ann Plast Surg 2008;60:480
5. Hultman CS, Edkins RE, Wu C, et al. Prospective, before-after cohort study to assess the efficacy of laser therapy
on hypertrophic burn scars. Ann Plast Surg 2013;70:521
6. Erol OO, Gurlek A, Agaoglu G, et al. Treatment of hypertrophic scars and keloids using intense pulsed light (IPL).
Aesth Plast Surg 2008;32:902
APPLICATIONS
11. Of the modalities listed, which of the following is most useful for treating scar rosacea?
D. Intense pulsed light.
Of the choices listed, intense pulsed light is very effective in treating hypervascularity such as rosacea
or telangiectasias. The pulsed dye laser is very effective in treating erythema and ir ritation of immature
scar, or scar dyschromia. The fractional laser is the most effective for scar pliability and texture.
Radiofrequency is not a laser and is used to improve skin laxity. The Q-switched ND:YAG 1064 nm laser
is very effective in treating tattoos.
1,2,3,4,5,6
REFERENCES
1. Haedersdal M, Moreau KE, Beyer DM, et al. Fractional nonablative 1540 nm laser resurfacing for thermal burn
scars: a randomized controlled trial. Lasers Surg Med 2009;41:189
2. Parrett BM, Donelan MB. Pulsed dye laser in burn scars: current concepts and future directions. Burns
2010;36:443
3. Allison KP, Kiernan MN, Water RA, et al. Pulsed dye laser treatment of burn scars. Alleviation or irritation? Burns
2003;29:207
4. Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and z-plasty for facial burn scars: the alternative
to excision. Ann Plast Surg 2008;60:480
5. Hultman CS, Edkins RE, Wu C, et al. Prospective, before-after cohort study to assess the efficacy of laser therapy
on hypertrophic burn scars. Ann Plast Surg 2013;70:521
6. Erol OO, Gurlek A, Agaoglu G, et al. Treatment of hypertrophic scars and keloids using intense pulsed light (IPL).
Aesth Plast Surg 2008;32:902
APPLICATIONS
12. Which of the following nonablative lasers is most useful for removing green pigment in tattoos?
C. Q-switched alexandrite.
Q-switching is necessary in order to produce the high energy pulse to break up large particles into
smaller particles that can then be phagocytized by macrophages by a photoacoustic effect from the
laser. Of the choices listed, Q-switched alexandrite is very effective in removing green pigment in
Chapter 18&Nonablative Laser Resurfacing 113
tattoos. The Q-switched ND:YAG 1064 nm and the Q-switched ruby 694 nm are very effective in
removing black-blue pigment in tattoos. Radiofrequency is not a laser and is used to improve skin laxity.
Intense pulsed light is not a laser but is very effective in t reating scar dyschromia.
1
REFERENCE
1. Alster TS. Q-switched alexandrite laser treatment (755nm) of professional and amateur tattoos. J Am Acad
Dermatol 1995;33:69
APPLICATIONS
13. What is the mechanism of action of using a laser for hair removal?
B. Target chromophore is melanin.
Lasers that target melanin are effective in hair reduction. The laser needs to reach the dermal papilla to
destroy the follicle which is below the stratum basale. Radiofrequency is not a laser and does not target
any specific chromophores. It causes collagen denaturation when heated to 55 to 62C, and the amount
of collagen in the skin increases over time.
1
REFERENCE
1. Lanigan SW. Incidence of side effects after laser hair removal. J Am Acad Der matol 2003;49:882
APPLICATIONS
14. Laser hair reduction is most effective in which individuals?
B. Dark hair and fair skin.
Lasers used for hair removal target the chromophore melanin. Therefore, the lower the concentration of
melanin in the skin and the more melanin in the hair will allow the laser to be more effective at
targeting the hair follicles.
1
REFERENCE
1. Lanigan SW. Incidence of side effects after laser hair removal. J Am Acad Der matol 2003;49:882
COMPLICATIONS
15. Which of the following is the most likely complication after nonablative laser therapy?
E. Unsatisfactory result.
Several treatments are often needed to achieve the desired clinical result. Hypopigmentation occurs in
10 to 20% of cases and is usually transient and self-limiting. Rarely, delayed hypopigmentation can
develop 6 to 12 months after treatment. Blistering is usually mild and self-limiting. Scarring is very
1
rare.
REFERENCE
1. Guimarães P, Hadad A, Sabino Neto M, et al. Striae distensae after breast augmentation: treatment using the
nonablative fractionated 1550-nm erbium glass laser. Plast Reconst Surg 2013;131:636
COMPLICATIONS
16. Which of the following is the most likely complication after monopolar radiofrequency therapy?
C. Subdermal fat atrophy.
The frequency of subdermal fat atrophy is unclear but is associated with the use of monopolar
radiofrequency devices. Although multiple reports have described fat atrophy from heat damage to
adipose tissue early in the treatment's evolution, current treatment protocols greatly minimize or
eliminate this risk. The remaining complications are more commonly associated with nonablative
1
lasers.
114 Part V&Noninvasive and Minimally Invasive Therapy
REFERENCE
1. Guimarães P, Hadad A, Sabino Neto M, et al. Striae distensae after breast augmentation: treatment using the
nonablative fractionated 1550-nm erbium glass laser. Plast Reconst Surg 2013;131:636
SIDE EFFECTS
17. Which of the following is the most likely side effect after nonablative laser therapy?
A. Erythema.
Erythema occurs very commonly (60%). Swelling occurs commonly (15–20%). Hyperpigmentation is
much less common (0.7%). Purpura is more common when using a pulsed dye laser. Herpes simplex
virus outbreak occurs most commonly in patients with a history of herpes simplex virus (2–7%).
1,2
REFERENCES
1. Fodor L, Peled IJ, Ullmann Y, et al. Using intense pulsed light for cosmetic purposes: our experience. Plast
Reconstr Surg 2004;113:1789
2. Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photo-thermolysis: experience
with 961 treatments. Dermatol Surg 2008;34:301
SIDE EFFECTS
18. A patient with Fitzpatrick skin type V is how many times more likely to have hyperpigmentation compared
to a patient with Fitzpatrick skin type I after nonablative laser therapy?
E. 100×.
Hyperpigmentation is thought to be caused by melanocyte stimulation by heat energy. Patients with
dark skin types are at much higher risk. General incidence is 0.3 to 0.7% in Fitzpatrick skin type I and
33% in Fitzpatrick skin type V.
1,2
REFERENCES
1. Fodor L, Peled IJ, Ullmann Y, et al. Using intense pulsed light for cosmetic purposes: our experience. Plast
Reconstr Surg 2004;113:1789
2. Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photo-thermolysis: experience
with 961 treatments. Dermatol Surg 2008;34:301
19. Chemical Peels
Juan L. Rendon, Simon Moradian
See Essentials of Aesthetic Surgery, pp. 231–258
TREATMENT CONSIDERATIONS
1. Which of the following is an absolute contraindication for a chemical peel?
A. Recent facelift.
B. Fitzpatrick skin types IV, V, VI.
C. Isotretinoin therapy within the last 6 months.
D. Pigmentary dyschromias.
E. Actinic keratoses.
TREATMENT CONSIDERATIONS
2. Antiviral prophylaxis before a chemical peel is recommended in which patient population?
A. All patients.
B. Patients with a history of herpes simplex.
C. Patients with active herpes simplex infection.
D. Antiviral prophylaxis is not recommended prior to chemical peel.
E. Immunosuppressed patients.
TREATMENT CONSIDERATIONS
3. Which of the following findings would indicate an abnormal result when evaluating a patient under a Wood's
lamp?
A. Under a Wood's lamp, epidermal hyperpigmentation would not be seen or is less pronounced.
B. Under a Wood's lamp, deep dermal hyperpigmentation would be bright and accentuated.
C. The deeper the pigmentation, the worse the patient would look.
D. Under a Wood's lamp, the worse the patient looks the more superficial the pigmentation.
E. The skin will not shine or fluoresce under UV light.
TREATMENT CONSIDERATIONS
4. Superficial and medium depth chemical peels provide excellent results for which of the following patients?
A. Fitzpatrick II skin type with seborrheic keratoses.
B. Fitzpatrick II skin type with epidermal melasma.
C. Fitzpatrick VI skin type with epidermal melasma.
D. Fitzpatrick IV skin type with dermal hyperpigmentation.
E. Fitzpatrick II skin type with dermal melasma.
TREATMENT ENDPOINTS
5. A 42-year-old male with Fitzpatrick skin type II is interested in treating his sunburn freckles on his chest.
Which of the following is pertinent to this patient's desired treatment area when discussing chemical peels in
nonfacial areas such as the chest?
A. Usually take 50 to 100% longer to heal than facial areas.
B. Provide excellent results for dermal hyperpigmentation.
C. Achieve optimal results after a single treatment.
D. Dermal peels are less prone to scarring and abnormal textural changes.
E. Carry a lower risk for systemic reaction than facial chemical peels.
116 Part V&Noninvasive and Minimally Invasive Therapy
TREATMENT CONSIDERATIONS
6. You are discussing the indications and limitations of a chemical peels with a 37-year-old Fitzpatrick II female
patient. Which of the following is an unrealistic expectation of a chemical peel?
A. Correction of sun damage.
B. Flattening of mild scarring.
C. Correct ion of rhytids.
D. Improvement of hyperpigmentation.
E. Decreased pore size.
TREATMENT CONSIDERATIONS
7. A 55-year-old Fitzpatrick skin type II female patient who is being treated for hyperpigmentation is undergoing
a chemical peel with two sequential applications of Jessner's solution. Application first causes a faint erythema followed by a more pronounced erythema on second application. What is the expected depth of penetration of Jessner's solution?
A. Penetration into the epidermis.
B. Penetration into the papillary dermis.
C. Penetration into the mid-reticular dermis.
D. Penetration to the deep reticular dermis.
E. The depth of penetration is limited regardless of the number of applications.
TREATMENT CONSIDERATIONS
8. You are applying a full facial trichloroacetic acid peel. An appearance of a solid white frost indicates which
peel penetration depth?
A. Removal of the stratum corneum.
B. Intraepidermal peel.
C. Extension into the papillary dermis only.
D. Full-thickness epidermal peel.
E. Extension into the reticular dermis.
TREATMENT CONSIDERATIONS
9. A 63-year-old female who is Fitzpatrick skin type II is planning to address her deep facial rhytids using a chem-
ical peel. For which of the following chemical peels is cardiac monitoring required?
A. Glycolic acid.
B. Croton oil.
C. Trichloroacetic acid.
D. Salicylic acid.
E. Beta-lipohydroxy acid.
TREATMENT CONSIDERATIONS
10. With both phenol-croton and trichloroacetic acid peels, what is the most critical determinant of the depth of
the peel?
A. Degree and nature of the resultant frost.
B. The concentration of the agent used.
C. The number of applications.
D. The wetness of the applicator.
E. The type of applicator used.
TREATMENT CONSIDERATIONS
11. A 45-year-old Fitzpatrick skin type IV Hispanic female with melasma would like to discuss her options for chem-
ical peels. Which of the following chemical peel formulations is considered not safe to use for ethnic skin?
A. Trichloroacetic acid: 10 to 20%.
B. Glycolic acid: 20 to 70%.
C. Phenol-Croton.
D. Salicylic acid: 20 to 30%.
E. Jessner's solution.
Chapter 19&Chemical Peels 117
TREATMENT CONSIDERATIONS
12. For medium and deep peels, the use of tretinoin prior to performing chemical peel is associated with which
of the following?
A. Increased risk of dyschromias post chemical peel.
B. Attenuated effect of the peel.
C. Slower epidermal healing post chemical peel.
D. Increased dermal layer cell division and remodeling.
E. Faster epidermal healing and enhanced effect of the chemical peel.
TREATMENT CONSIDERATIONS
13. A patient with dyschromias would like to undergo a chemical peel. She is already taking a tretinoin. Which
of the following bleaching agents should she take in combination with her t retinoin prior to the peel?
A. 2% hydroquinone.
B. 4% hydroquinone.
C. 2% hydroquinone with 20% glycolic acid gel.
D. 4% hydroquinone with 10% glycolic acid gel.
E. 4% hydroquinone with 2% kojic acid and 6% alpha-hydroxy acid gel base.
TREATMENT CONSIDERATIONS
14. Prior to a trichloroacetic acid facial chemical peel, a patient is treated with topical EMLA cream. Which of
the following adjustments should be made?
A. A higher strength of trichloroacetic acid than originally planned should be used because vasoconstriction
will lead to a more superficial peel.
B. A lower strength of trichloroacetic acid than originally planned should be used because vasoconstriction
will lead to a deeper peel.
C. A higher strength of trichloroacetic acid than originally planned should be used because vasodilation will
lead to a more superficial peel.
D. A lower strength of trichloroacetic acid than originally planned should be used because vasodilation will
lead to a deeper peel.
E. No change to the strength of trichloroacetic acid is necessary with the use of topical anesthetics.
TREATMENT CONSIDERATIONS
15. Strategies for performing an optimal trichloroacetic acid periorbital peel should include which of the
following?
A. Maintaining the head of the bed at 30 to 45 degrees.
B. Applying product below the superior tarsal plate.
C. Protective ophthalmic antibiotic ointment.
D. Avoiding skin tension along the crow's feet during application.
E. Increasing the strength of the TCA in the second coat.
TREATMENT CONSIDERATIONS
16. After a trichloroacetic acid chemical peel, a patient presents with a sharply demarcated area of bright ery-
thema. The patient denies picking any scabs. On examination, there is premature peeling of the skin. Which
of the following is most likely to have contributed to her presentation?
A. Reactivation of dormant her pes virus.
B. Copious use of petrolatum-containing ointment to keep treated areas moist.
C. Avoiding gentle exfoliation of the treated area.
D. Minimizing facial expressions.
E. Use ice packs or cold compresses to decrease the swelling.
TREATMENT CONSIDERATIONS
17. A 57-year-old female with Fitzpatrick skin type II is about to undergo a facelift with simultaneous chemical
peel. Which of the following peels should not be used on undermined facelift flaps?
A. Phenol-croton oil.
B. Glycolic acid.
C. Jessner's solution.