Section 4 Plastic and Reconstructive Problems

Richter et al

skin types IV through VI may eliminate unwanted hair, improve the appearance of fine wrinkles, and even skin tone, texture, and pigmentation.

REFERENCES

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superinfections typically present with pain, increased erythema, exudates, erosions, and crusting. Infections should be cultured and treated with broad-spectrum oral antibiotics to reduce long-term risk of scarring. When treating patients of dark skin types, the development of acne erup- tions, HSV infection, or bacterial superinfections can intensify the likelihood of pigment issues and discoloring of the soft-tissue envelope. Every effort should be made to prevent these complica- tions or treat them aggressively should they occur. Ethnic skin presents a unique challenge for laser skin rejuvenation because of higher density of larger melanosomes, thicker collagen bundles, and increased fibroblast responses. Special con- siderations need to be made when considering laser therapy for ethnic patients for the treatment of skin laxity, dyschromia, hypertrichosis, keloids, and hypertrophic scarring. Lasers may be safely used in patients with dark skin tones by choosing fractional technologies with appropriate wave- lengths, lower fluences, longer pulse durations, and maintaining careful attention to preprocedural and postprocedural management strategies. When considering the use of lasers, the treatment goals should reflect individual patient complaints and the realistic expectations of laser skin rejuve- nation. Patients should be counseled on the risks of laser therapy, including scarring, postinflamma- tory hyperpigmentation, and hypopigmentation. With this in mind and in the hands of an experi- enced laser surgeon, laser resurfacing in darker Fig. 6. Posttreatment acneiform eruptions. A common complication after laser therapy is acneiform erup- tions and HSV infections. This risk can be minimized with premedication in select patients with skin types predisposed to such infections. SUMMARY