Laser

1. Thermal effect by longer pulses
• Fractional Erbium-YAG causes minimal thermal damage (10 um), fx CO2 (100 um) if pulse durations
are used shorter than tissue TRT.
• By lengthening pulse duration created wounds created by erbium-YAG can induce a thermal coagulation
zone. Aside from collagen shrinkage/ skin tightening Haemostasis is a beneficial effect.
• Increasing energy increases the ablation depth.

2. Thermal zone
• 5microns @ 500 psec pulse duration
• 15 microns @ 4 msec pulse duration
• 20 microns @ 7 msec pulse duration
• 30 microns @ 10 msec pulse duration

5. Comparitive Zones of Thermal Effect
Er:YAG, 0.5 ms
CO2
Long Pulse
Er:YAG
um

6. Fractional
Pre 4 weeks after 2nd treatment

7. Fractional

8. Fractional
17.10.2007 19.10.2007 23.10.2007

9. Fractional
17.10.2007 19.10.2007 23.10.2007

10. Fractional
16.03.2008 immediately after

11. Fractional

12. Fractional

13. Considerations in darker skin
Nonablative are considered first line therapies because of
lower risk of post 0.p. complications
However, ablative therapies can beused in conservative
fashion to treat advanced damage & scaring
Pre-and postprocedural sun protection and bleaching
creams can minimize the risk of postinflammatory
hyperpigmentation
Post op short steroid cr usage may reduce risk of
hyperpigmentation
In case of hyperpigmentation AHA Peels and bleaching
creams can hasten resolution.

14. Fractional

15. Effective
v Haemostatic
xProlonged Erythema
x High Incidence of PIH
CO2
Much Safer xLess Effective
x Not Haemostatic
Er:YAG
Effective
v Haemostatic
v Safe (in good hands)
[ong Pulse Er: YAG (Up 0 10msec PD)

16. Thickness
of the
skin

17. Pretreatment care
•* RetinA
•* Alpha-
•* Hydroquinone Acid
•* Antioxidants
•* Antiviral
(Acyclovir)
•* Antibiotics
•* Sunprotection
(SPF> 15)
Day of surgery
* Make up should be removed
¢ Clean face with soap and water
* Males -close shave * Loose fitting
clothing * No hair spray

18. Anesthesiea
Topical anesthesia
(EMLA cream, 40%
lidocain in acid
mantle
cream)
Nerve block Local
infiltration
i.v. sedation
General anesthesia
Intraoperative
Physician and staff wear eye
protection
Protect patients eyes
Prep with non-flammable
solution
Surgical area draped with
moist towels

19. Post-operative care
‘Immediately
-Antibiotic ointment -Sterilized surgical dressing
“At home
-Pain medication -Acyclovir
-AVOID SUN EXPOSURE!!!

20. Ablative Erbium-Yag Laser Asclepion MCL 30

21. Other Fractional Lasers
Fraxel from Solta Medical ,1550nm diode pumped erbium
fibre laser beam which is then split into thousands of microscopic
beams, producing tiny dot, or pixel-like treatment zones on
the skin MicroThermal Zones (MTZs)
AffirmTM from Cynosure 1440nm Nd:Yag non-ablative
laser
Active FX from Lumenis, fractional photothermolysis with
aCO2 laser. Active FX is the most aggressive of the
fractional laser devices
Profractional from Sciton -2940nm fractional ablative laser, 25 to
1500 microns in depth
Lux 1540TM Fractional device from Palomar (distributed
in the UK by Eden Aesthetics) is a 1540nm erbium glass
fibre non-ablative laser,
PIXEL 2940 nm Alma Lasers, impulses delivered through
a micro optics lens which creates 49 or 81 pixel sized ablation
dots.

22. Management of Post-Op Expectations
« Will look horrible for several days
« Can’t wear make-up until re-epithelialized
« Sunburn feeling for 12 -24 hours « Crusting and
scabbing -don’t pick

23. Erbium-YAG ablative

24. blative Erbium-Yag Laser Asclepion MCL 30

25. Xanthelasma
12 wks post OP

28. Erbium‘YAG
ablative,
3 mm spotsize,
2940 nm 10 J, 2 passes

29. Erbium-YAG e 2. peel ablative. 3 m spotsiee.
10 ), 2 passes

30. Result after 2 treatments

31. Skin rejuvenation- Skintightening

32. Nd:YAG
Laser facial 50msec, 50J/cm2, 10mm Spot