| Category Name | Content |
| Name | Fully Ablative Laser Resurfacing (CO2, Erbium:YAG) |
| Uses | Deep skin resurfacing for severe wrinkles, deep acne scars, surgical scars, hyperpigmentation, and overall skin rejuvenation. Provides significant collagen remodeling and long-term skin texture improvements. |
| Route Of Administration | Laser application directly to the skin's surface, leading to controlled removal of the epidermis and partial dermis. |
| Frequency Of Use | Typically one session per treatment area every 6-12 months; additional treatments based on healing and provider discretion. |
| 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 to prevent excessive thermal injury. |
| 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 | Prolonged redness, swelling, crusting, peeling, hyperpigmentation, hypopigmentation, scarring, infection, pain, delayed healing, prolonged erythema. |
| Compatibility With Other Treatments/Drugs | Avoid concurrent use with deep chemical peels, microneedling, aggressive exfoliation, or recent dermal fillers within 4 weeks. Caution when combining with isotretinoin, photosensitizing medications, or immunosuppressants. |
| Allergies | Assess for allergies to topical anesthetics (if used), post-procedure skincare ingredients, latex (if using gloves during treatment). |
| Administration Time | 60-120 minutes depending on treatment depth, anesthesia used, and area treated. |
| 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 or pre-treat with hydroquinone) - Does the patient have a history of herpes simplex (cold sores)? (If YES, antiviral prophylaxis required) - Has the patient recently received fillers, neurotoxins, or other cosmetic treatments? (If YES, delay treatment per provider discretion). |
| 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 antibiotics if needed. - **Severe pain or 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, 4-week, and 3-month follow-ups. - 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 (7-14 days). - No makeup for 10-14 days. - Avoid direct sun exposure for at least 6 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. |