April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Plastic and Reconstructive Surgery • January 2019

Fig. 5. Preoperative laser resurfacing patient with maximum score improvement of her perioral rhytides.

Fig. 6. Postoperative laser resurfacing patient with maximum score improvement of her perioral rhytides.

equally important in delivering optimal results. The removal of debris, initially on postoperative day 1 and then at 2-day intervals, allows for com- plete cleansing of the skin without any scarring or irregular wound healing (Figs. 7 and 8). It is para- mount that patients are seen frequently to ensure that no debris has reaccumulated and to ensure the skin is optimally moisturized. A moist wound environment is critical during those initial 7 to 10 days to prevent any scarring or wound complica- tions. One of the changes made from our previous study 9 was a more meticulous removal of debris and maintenance of a moist wound environment during the first weeks after resurfacing. This has been critical in improving our complication rate. Comparing long-term results with the differ- ent resurfacing modalities (e.g., carbon dioxide, chemical peel) to determine the “best” treatment is beyond the scope of this study. It is our belief that in experienced hands, all resurfacing modali- ties can produce acceptable aesthetic results and reduction of rhytides. 17 Likewise, all resurfacing

proper endpoint is the critical component of this technique. Obliteration of the wrinkle or reach- ing the midreticular dermis are the only accept- able endpoints. The incidence of complications in this current study was much lower than our own published complication rates with carbon dioxide laser. 9 Although erythema is sometimes considered a complication, when performing an aggressive depth laser resurfacing, erythema for several weeks is a given, and such expectations are explained to every patient. Erythema is considered a compli- cation only if it lasts longer than 6 months. Such prolonged erythema was not uncommon in the carbon dioxide study, but no patient in the pres- ent study had erythema past 3 months. Full-field ablative procedures that treat into the midreticular dermis require both meticu- lous laser technique and meticulous postopera- tive care. The current regimen, although more extensive and time consuming than other docu- mented post–laser resurfacing treatments, is

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