Transcript abblative laser resufacing

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
Histological
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Clinical manifestations
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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
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How we can choose the
most appropriate
technique
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Severity of photo damage and rhytides
The expertise the laser surgeon
Expectations and life style of the patient
What is ablative laser
resurfacing?
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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
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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
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Skin photo type I and II,
Cutaneous lesion amenable to treatment
with resurfacing laser .
Realistic expectations of resurfacing
procedure.
Preoperative preparation
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Bleaching agent
Retinoic acid compounds
Antibiotics
Anti viral agents
Ablative skin resurfacing
Carbon dioxide
10,600
 Erbium YAG laser
2,940
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Characteristics of co2 laser
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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
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Coagulation and cutting
Resurfacing is gold standard
Longer healing time, redness
Hypo-pigmentation
Erbium:YAG
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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
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Pitfalls and their management
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Proper patients selection
Has patient ever had the areas treated before
What is the patients skin prototype?
Dose the patients had history of H.L.
Pitfalls and their management
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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
pruritus
Contact dermatitis
hyperpigmentation Hyper trophic scar
Ectropin
Thank you