| Category Name | Content |
| Name | Ablative Laser Treatment (CO2, Erbium:YAG) |
| Uses | Fractional or full-field skin resurfacing for wrinkles, fine lines, acne scars, surgical scars, hyperpigmentation, and overall skin rejuvenation. |
| Route Of Administration | Laser application to the skin’s surface. |
| Frequency Of Use | Typically once every 3-6 months for deep resurfacing. Superficial treatments may be done every 4-6 weeks as needed. |
| Concentration(s) | CO2: 10,600 nm wavelength; Erbium:YAG: 2940 nm wavelength. |
| Maximum Dosage (Day, Wk) | Energy settings and pulse durations should be titrated based on skin type, severity of concern, and patient tolerance. Maximum cumulative session energy should follow manufacturer guidelines. |
| Contraindications | Pregnancy or breastfeeding, active skin infections (herpes simplex, bacterial, or fungal), history of keloid scarring, Fitzpatrick V-VI (relative contraindication due to post-inflammatory hyperpigmentation risk), use of isotretinoin within the last 6 months, uncontrolled diabetes, autoimmune diseases affecting skin healing, recent sunburn or tanning. |
| Possible Side Effects | Redness, swelling, crusting, peeling, hyperpigmentation (especially in darker skin tones), hypopigmentation, prolonged erythema, scarring, infection, pain, delayed healing. |
| Compatibility With Other Treatments/Drugs | Avoid concurrent use with other aggressive resurfacing treatments (chemical peels, microneedling, deep exfoliation) within 4 weeks. Caution when combining with isotretinoin, photosensitizing medications, or immunosuppressants. |
| Allergies | Topical anesthetics (if used), post-procedure skincare ingredients, latex (if using gloves during treatment). |
| Administration Time | 30-90 minutes depending on the treatment area and depth of resurfacing. |
| Dosing/Settings | Settings should be customized based on skin type and concern. Example ranges: - CO2 Laser: 5-30 mJ per pulse, 200-500 µm spot size, 5-10% density, 5-20 W power. - Erbium:YAG: 1-5 J/cm², 250-350 µs pulse duration, 5-20% density. |
| Test Spot Requirement | A test spot should be performed 24-48 hours before treatment for patients with Fitzpatrick III-VI or a history of post-inflammatory hyperpigmentation. |
| Pre-Treatment Guidelines | - Stop all retinoids, AHAs, BHAs, and exfoliants 7-10 days prior. - Antiviral prophylaxis (e.g., valacyclovir 500 mg BID x 5 days) for patients with a history of cold sores. - No active tanning or self-tanner use within 4 weeks. - Pre-procedure hydration and skin barrier repair (moisturizer use encouraged). |
| Provider Clearance Guidelines | - Ensure patient meets all clearance criteria before treatment. - If any contraindications are present, consult a supervising physician for approval or denial. - Document any physician consultation or clearance decision in the patient’s medical record. |
| Pre-Treatment Screening Workflow | - Has the patient used isotretinoin in the last 6 months? (If YES, contraindicated) - Does the patient have a history of keloids? (If YES, proceed with caution & document risk counseling) - Any history of post-inflammatory hyperpigmentation? (If YES, consider alternative treatments) - Does the patient have a history of herpes simplex (cold sores)? (If YES, antiviral prophylaxis required) - Has the patient recently received fillers or neurotoxins? (If YES, document location and timing) |
| What To Do If Adverse Reaction Occurs | - Burns/blistering: Stop treatment immediately, cool area with saline-soaked gauze, apply a topical antibiotic, and monitor healing. - Hyperpigmentation: Initiate hydroquinone 4% BID and strict sun avoidance. Consider low-dose corticosteroids if inflammation is present. - Hypopigmentation: Educate patient on prolonged healing timeline; refer to a dermatologist if persistent. - Infection: If suspected, swab for culture and start empirical antibiotic therapy (mupirocin topical or oral cephalexin if indicated). - Prolonged redness (>4 weeks): Consider short-term topical steroid use (hydrocortisone 1% cream BID x 5 days). |
| Clinic Implementation Guidelines | - Front desk must confirm all consents are signed prior to the provider seeing the patient. - Ensure protective eyewear and cooling gel are prepared before treatment begins. - Conduct post-treatment follow-up within 24-48 hours to check on healing progress. |
| Photographic Documentation Protocol | - Pre-treatment photos taken from 3 standardized angles (front, left, right). - Post-treatment photos immediately after procedure and again at 2-week follow-up. - Store images securely in the patient's medical record. |
| Post-Treatment Care | - Cold compresses as needed for discomfort. - Apply a thick emollient (petrolatum-based) until peeling is complete (5-10 days). - No makeup for 5-7 days. - Avoid direct sun exposure for at least 4 weeks; SPF 50+ mandatory. - Hydration and gentle skin barrier repair (ceramide-based moisturizers). |
| Additional Documentation Requirements | - Pre-treatment photography (standardized lighting/angles). - Fitzpatrick skin type assessment. - Signed informed consent, including risks of pigmentation changes and scarring. - Treatment log including settings, test spot location/results (if applicable), and post-care instructions provided. |