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The right post-treatment care helps maintain positive results of laser treatments and prevent scars.
By: Jwala Karnik, MD
Dr. Jwala Karnik is Chief Medical Officer at Suneva Medical, Inc. She was previously the Vice President of Clinical and Medical Affairs at Myoscience, Inc., a private medical device company, and was an Entrepreneur-in- Residence with Versant Ventures. Over the past seven years, Dr. Karnik has focused on dermatology and aesthetics, and has consulted with many pharmaceutical and device companies on clinical and strategic issues.
Laser resurfacing was introduced in the 1980s by Dr. Rox Anderson. The first laser procedures were effective in addressing photodamage but were associated with significant side effects and could result in substantial patient discomfort and a prolonged recovery. Newer lasers and techniques allow physicians to more accurately focus on a patient’s exact needs and help reduce recovery time and side effects. But any laser resurfacing treatment will alter the nature of the skin immediately following the procedure. The skin deserves special care to ensure the best results after treatment.
The importance of a good post-treatment skin care regimen is underscored by the rising popularity of laser treatments. According to a 2013 consumer study conducted by the American Society of Dermatologic Surgeons, laser/light/ energy-based procedures increased by 34 percent from 2012 to 2013. While it’s accurate to differentiate lasers by their effect on the epidermis/dermis—ablative, non-ablative, fractional— that classification system does not entirely capture the broad range of effect that can be achieved by varying wavelength, fluence (energy density), thermal relaxation time, and number of passes. Rather, it may be useful to discuss laser treatments the way patients view them: from an aggressive treatment requiring significant downtime, to a mild treatment with almost no visible side effects upon leaving the office.
An aggressive treatment—typically an ablative procedure that can remove the superficial layers and leave skin raw and oozing—has the greatest potential to scar and/or hyperpigment or hypopigment. A mask bandage may be appropriate for the first few days. Crusting may develop, and an occlusive ointment product like petrolatum can help with itching and dryness. It prevents transepidermal water loss and helps the skin’s barrier return to normal as quickly as possible. Patients should be instructed not to pick at scabs to avoid scarring.
Gentle cleansing with a non-irritating solution, like CeraVe Hydrating Cleanser, or even plain water is best. If possible, it’s best for patients to stay out of the sun completely for the first few days, and as much as possible thereafter. Sun exposure could lead to poor healing, exacerbated inflammation, post-inflammatory hyperpigmentation, and acceleration of photoaging after undergoing a resurfacing treatment. Any time a patient will be outdoors, he/she should use a full-spectrum sunscreen. After several weeks, patients can re-incorporate any retinoids or alpha/beta hydroxy acid products.
If there is a concern about the possibility of a bacterial infection or herpes labialias reactivation, prophylactic and subsequent therapy with antibiotics or antivirals, respectively, may be warranted.
If post-inflammatory hyperpigmentation does develop, a skin lightener may be necessary. While there are many types of ingredients out there that may help prevent melanin production, or inhibit transfer of melanosomes to keratinocytes, or promote cell turnover, or reduce melanocyte metabolic activity, the most widely-studied active ingredient remains hydroquinone. It is available in strengths of 2% (over-the-counter) or 4% (prescription). Higher doses can be made at compounding pharmacies and prescribed for patients. However, it can prove irritating so patients’ needs should be evaluated individually.
MEDIUM INTENSITY TREATMENTS
In general, the recommendations associated with an aggressive treatment also apply for a medium intensity treatment. Using sunscreen and avoiding direct sunlight are vitally important. Ideally, patients should use an at least an SPF 35 with UVA and UVB protection. UVA rays can penetrate through glass, so patients should be instructed to be vigilant about applying sunscreen at all times. Different ideologies exist for whether a physical blocker is better than a chemical sunscreen. The rationale for using a physical blocker is to avoid absorption of chemicals that could gain access to the systemic circulation, especially while skin is compromised. There is likely to be some redness and swelling for the first few days to weeks depending on the level of intensity of the treatment. Keeping the skin cleansed and moisturized with a non-irritating lotion or cream can increase patient’s comfort, especially if they experience dryness and peeling. This can be a great time to apply a growth factor product that can help hasten re-epithelialization, restore the skin barrier, and minimize downtime, such as Regenica Rejuvenation Complex, which was specifically developed for the post-laser treatment setting. It contains the latest growth factor technology developed by Dr. Gail Naughton, who helped develop TNS.
Patients may be able to apply makeup after a few days to camaflouge the erythema that can persist. A green tinted makeup helps to offset redness.
Newer technology is allowing physicians to treat patients with multiple lower-energy treatments instead of one aggressive treatment. The benefit is minimal to no downtime while continuing to stimulate collagen production. Patients may still feel warmth and mild stinging after the treatment. A cooling biocellulose restorative mask applied immediately after treatment can feel refreshing and increase patient comfort. The minimal disruption to the epithelium can also safely facilitate the penetration of beneficial topicals like antioxidants. As always, sunscreen and sun avoidance are the cornerstones of post-laser skin care.
Every patient has unique skin that can respond differently to the multiple variants of lasers and laser settings available. Careful patient selection and follow-up is something only you as an expert provider can offer. The benefits of laser treatment can be lasting but so too can the consequences of inadequate post-treatment care. Thoughtful counseling and product selection are keys to maintaining healthy and beautiful results after a laser resurfacing treatment.