Medesthetics

NOV-DEC 2016

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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SELECTIVE ABLATION 46 NOVEMBER/DECEMBER 2016 | Med Esthetics she says. Following treatment, patients cool with the Zimmer chiller for 15 to 20 minutes. For Dr. Munavalli, oral anxiolytics and analgesics combined with topical anesthetics are the mainstay for nonablative resurfacing. "These may work for low en- ergy/low density fractional ablative treatments, but they aren't suffi cient for fully ablative resurfacing," he says, adding that he has used everything from IV conscious sedation to intramuscular (IM) Toradol (ketorolac) and Demerol (meperidine), as well as other IM anxiolytics and IM antihistamines. "Multiple options are helpful since patients' pain thresholds vary," he says. Post-Care Instructions Following treatment, Dr. Nazarian asks patients to use m Following treatment, Dr. Nazarian asks patients to use cold compresses or ice packs to minimize discomfort, o cold compresses or ice packs to minimize discomfort, cold compresses or ice packs to minimize discomfort, erythema and edema. She treats occasional cases of erythema and edema. She treats occasional cases of excessive edema with oral steroids. Because of the increased risk of contact dermatitis, she avoids both Aquaphor ointment and topical antibiotics in the postop- erative period, and instead prescribes oral antibiotics and antifungals for up to two weeks following treatment. Dr. Munavalli, however, is a proponent of using bland, inert ointments such as Aquaphor and Vaniply. bland, inert ointments such as Aquaphor and Vaniply. He recommends them along with a mild cleanser to minimize crusting. They also help form a barrier to en- vironmental elements and promote a hydrated, supple healing environment. Dr. Narurkar's patients are counseled to perform dilute Dr. Narurkar's patients are counseled to perform dilute vinegar water soaks two to three times a day followed by aggressive emollition with Aquaphor until re-epithelializa- tion of the skin is complete. Afterward, he recommends tion of the skin is complete. Afterward, he recommends tion of the skin is complete. Afterward, he recommends topicals such as Biafi ne or ceramide cream until post-laser erythema is resolved. Patients can also use topical antioxi- erythema is resolved. Patients can also use topical antioxi- dants to promote proper healing. "Strict sun avoidance is necessary for a full year fol- lowing treatment for optimal recovery and to reduce the chance of pigmentary alteration," says Dr. Nazar- ian. "Instruct patients at length as to their substantial and ian. "Instruct patients at length as to their substantial and pivotal part in postoperative care. Treat cases of persistent pivotal part in postoperative care. Treat cases of persistent erythema with serial intense pulsed light (IPL) treatments erythema with serial intense pulsed light (IPL) treatments at two-week intervals until resolution. Acne and milia are at two-week intervals until resolution. Acne and milia are minor side effects seen two to three days post-op and minor side effects seen two to three days post-op and can be gently extracted during follow-up." can be gently extracted during follow-up." A localized area of non-healing skin several days post- op may signify an infection and must be closely moni- tored. tored. If infection is suspected, Dr. Nazarian performs a If tored. If infection is suspected, Dr. Nazarian performs a infection tored. If infection is suspected, Dr. Nazarian performs a is tored. If infection is suspected, Dr. Nazarian performs a suspected, tored. If infection is suspected, Dr. Nazarian performs a Dr. tored. If infection is suspected, Dr. Nazarian performs a Nazarian tored. If infection is suspected, Dr. Nazarian performs a performs tored. If infection is suspected, Dr. Nazarian performs a tored. If infection is suspected, Dr. Nazarian performs a a tored. If infection is suspected, Dr. Nazarian performs a microbiologic culture test to identify the organism and its sensitivity. Edema following treatment is a common complaint; it typically peaks at days two and three. An oral course of prednisone post-resurfacing for fi ve days can help decrease the swelling, which lasts about one week. "Ablative laser resurfacing is not a cookbook, cookie- cutter procedure," says Dr. Munavalli. "It requires a fel- lowship, or extended observational and hands-on training before performing it. Matching patient expectations with realistic results is critical. I tell my most severely photo- aged patients, who are good candidates, that I can take 5 to 10 years off of their appearance if they are willing to accept the additional cost, downtime and risk." Due to the pain, swelling, crusting and risk of infection, "these patients must be kept close, seen frequently, and reassured constantly that they are on the right track and that the long-term results will be worth the short-term inconvenience," says Dr. Munavalli. Karen Appold is a freelance writer based in Pennsylvania. BACKGROUND: NICHOLAS VEASEY © GETTY IMAGES; LEFT: IMAGE SOURCE © GETTY IMAGES Due to the ablative nature of these procedures, all patients will require some form of pain management during treatment.

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