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Priyanka K
Priyanka K

Laser therapy began in the 1960s and was initially used in ophthalmology. Aesthetic laser development expanded in the 1980s-2000s to include resurfacing, vascular treatments, and non-ablative options. Lasers are classified by wavelength and pulse duration. Precise targeting relies on chromophore absorption and thermal relaxation time. Risks include eye injury, fire hazards, and airborne particles. Non-ablative options cause minimal downtime while ablative resurfacing has more risks but deeper effects. Fractional resurfacing combines benefits of each. Tattoo removal requires multiple treatments over weeks to slowly break up ink.

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Laser therapy Light therapy
Laser history Theoretical concept 1912, Albert Einstein. First working laser, 1960. Initially used ophthalmology transparency of tissues clear view of directed beam. Surgical excision and hemostasis.
Aesthetic laser development. 80s resurfacing CO2. Early 90s vascular PDL, argon. Mid 90s resurgent of surfacing laser. CO2, Erbium. Late90s early 2000s non ablative laser IPL. Mid 2000s present, fractionated laser, Fraxel; fractionated erbium. Fractionated CO2, fractionated NdYAG, fractionated RF.
Laser Acronyms. Laser, light ampli鍖cation, by stimulated emissions of radiation. PDL pulsed dye laser. IR infrared KTP, Kalium titanyl phosphate. LED light emitting diode. PDT photodynamic therapy IPL intense pulsed light.
Lasers classi鍖cation. Wavelength output 1064/NdYAG. 10,600/ CO2. 532/KTP Pulse duration, continuous, pulsed: picosecond, Q- switched nanosecond, long pulse millisecond.
De鍖nition 1millisecond, 1 thousandth of a second. .001 Sec, 1/1000sec. 1 nanosecond, 1 billionth of a sec, 10^-9 sec. 1 picosecond, 1 trillionth of a sec, 10^-12 sec
Laser physics Laser emissions, coherent photons in de鍖nite phase relation. Monochromatic single, de鍖ned wavelength. Collimating, narrow/ low divergent.
Laser gain mediums Gases CO2, argon, krypton, helium and neon. Liquid dye, coumarin, Rhodamine and 鍖uorescein. Solid crystal and glasses, neodymium, Nd, yttrium aluminum garnet YAG, erbium, sapphire ruby, KTP, potassium titanyl phosphate.
Laser light wavelength output Argon, 488,514nm KTP, 532nm Pulsed due 585,595nm Ruby 694nm Alexandrite 755nm Diode 810nm. NdYAG, 1064, 1054, 1320 nm Erbium: YAG, 2,940nm Erbium:glass 1540, 1550nm CO2, 10,600nm IPL, 500-1200nm
Energy Measured in joules. Fluence energy delivered per area J/cm2, mJ/cm2. Power the rate at which energy is delivered measured in watt J/sec.
Photoselectivity Laser or light therapies, photoselectivity. Selective photothermolysis, destruction of target without destruction of surrounding tissues.
Thermal effects Non selective thermal e鍖ects> 100 Celsius, tissues destruction. Selective thermal e鍖ect, 45-100 Celsius, protein denaturation. < 45celsius, collagenesis, reversible tissue injury.
Non selective thermal effects Too high power or too many passes. Non selective thermal damage to tissue outside targe5 area.
Non selective thermal effects Scarring. Hyperpigmentation/PIH. Hypopigmentation.
Chromophores Chromophores, speci鍖c target of a laser, absorbs a speci鍖c laser wavelength. Common chromophores in Aesthetic. Water resurfacing, collagen tightening, melanin hyperpigmentation, hemoglobin vascular lesions, tattoo ink.
Thermal relaxation time. TRT, time required for heat energy to dissipate from chromophores into surrounding tissue. Selective photothermolysis requires, all the energy in a laser pulse must be deievered to a chromophores before it can release its heat and cool.
Photo acoustic Mechanical shock wave e鍖ect. Q switched and picosecond lasers phenomenal only, high energy released in short duration. Tattoo removal breaking up of ink.
Wavelength and spot light Shorter wavelength, increase melanin absorption. Longer wavelength, deeper penetration. Increase Spot size, increase pain and discomfort. Consider lower 鍖uence with larger spot size.
Cooling Decrease unintentional injuries. Allows higher 鍖uence. Forced cold air, before during after. Contact cooling, chilled laser tip. Pre and post cooling with copper plate, cooled gel.
4 classes of lasers 1 noknown biological hazard 2. Chronic viewing hazard. 3. Direct viewing hazard. 4. Direct and re鍖ected hazard Most medical lasers are classes 3 and 4.
Eye injury. Eyes, most common injury. Damage, cornea, lenses, retina. Baseline eye exam.
Eye injury Low divergence, coherent beam, focus on extreme small spot on retina. Wavelength dependent, cornea water, retinal vasculature.
Eye injury Signs and symptoms injuries Flash of light. Popping sound follows by disorientation. Burning pain in cornea or sclera. Retinal damage may not be detected. Lack of pain 鍖bers in retina,
Eye injury. Direct laser beam, indirect or re鍖ected laser exposure, inappropriate eye protection. Laser safety eyewear, goggles or glasses. Mandatory use with all laser procedures. Wavelength speci鍖c. Reduces energy to eye below MPE. Maximum permissible exposure level.
OD optical density Ability of a lens to reduce laser energy of a speci鍖c wavelength to a safe level below MPE. OD 0 1, OD 10.1 OD 20.01 OD 30.001 OD40.0001 OD50.00001 eg OD 5, 1/100,000 original light transmitted.
Non laser beam hazards Infectious Carcinogenic Teratogenic Papillomavirus cultured from plume CO2. Tissue particles splattering Q switched. Reports of viral transmission. LGAC laser generated air contaminant.
Non laser beam hazards Prevention Smoke evacuation 鍖lter < 0.1 micron. Masks and gloves laser marks 鍖lter smaller particles than operating room masks.
Indirect beam hazard Be aware of re鍖ective materials, mirrors and polished objects. Jewelry Glossy paint can be a hazard.
Fire lol laser can ignite. Co2 highest risk. Direct and re鍖ected beam Prevention measures, make sure alcohol prep dry, keep laser beam away fro gauze, plastic and rubber.
Warning labels Areas of laser usage must be labeled Caution labels for class 1 to 2. Danger labels for class 3 to 4.
Non ablative rejuvenation Creates controlled areas of injury to epidermis and dermis, destruction of wavelength speci鍖c chromophores. Most commonly IPL, intense pulse light, BBL broad band light, photo facial, photo rejuvenation. Less commonly laser toning, NdYAG, KTP, PDL.
Why non ablative skin rejuvenation is popular. Minimum down time. No oozing, swelling, crusting, blistering. Mild to moderate erythema 1to 3 hours.
Ablative rejuvenation Non ablative light therapy Chromophores, melanin, hemoglobins, vascular lesions, thermal e鍖ects limited to dermis/ epidermis, collagenesis leads to heating and remodeling.
Pulsed light physics. Light source 鍖ash lamp. BBL, broadband lights, 420-1400nm. IPL INTENSE PULSE LIGHT, 500-1200nm. Non coherent, non monochromatic, non collimated. Not a laser Wavelength range selected by changing head or adding 鍖lter.
Pulsed light indications Pigmentary D/O Melasma, solar lentigones, photo damage. Vascular lesions: telengiectasia, minor vascular birth marks. Hair removal. Photo rejuvenation,
Pulsed lights Minimal downtime. Mild moderate erythema 1 to 3 hrs. Dryness, transient hyperpigmentation minor scabbing. Requires 2 to 4 sessions for noticeable results. Repeat treatment every 2 weeks.
Non ablative complications PIH, hypopigmentation and scarring.
Laser resurfacing ablative. Standard resurfacing lasers, CO2 10,600 nm. Erbium: YAG 2,940nm Erbium shallower depth super鍖cial depth. Chromophores H2O.
Resurfacing Indications Skin rejuvenation, acne scarring, scarring, rhytids, large pores, pigmentary disorders and mild skin tightening.
Resurfacing Mechanism of rejuvenation Re epithelialization. Collagen deposition. Elastin formation. Neogenesis. Dermis healing phase includes, in鍖ammation, exudate and crusting.
Laser resurfacing. Complications: PIH. Hypopigmentation. Scarring. Uneven texture. Destruction of adnexal tissue. Demarcation. Prolonged redness.
Fractional resurfacing MTZ micro thermal zone, minimal damage, micro column of laser, light to surface of skin, not complete resurfacing. Hundreds of MTZ per square cm.
Fractional resurfacing Normal skin between MTZ, intact epidermis barrier functions, rapid re-epithelialization, keratinocytes migration, rapid healing and less risk.
Fractional resurfacing Minimal down time. Approximately 1 week healing time. No crusting or oozing, minimal exfoliating. New collagen and epithelium per treatment. 2007 clinical trail, 5-6 treatments striae improves as much as 75%.
Fractional resurfacing Erythema, mild swelling, 1 to 2 days. Bronzing/darkening after 2 to 3 days. Moderate to severe swelling Prednisone 40/30/20/10, step down. Repeats every 4 weeks.
Tattoo removal End point Gray whitening immediate. Breaking of ink. Follows by erythema and redness, edema, for 3 to 5 days. Reaction color dependent, darker color produce more whitening than lighter color.
Tattoo removal No ink is removed until 4 weeks. Pruritis, peeling, fading @4 weeks. No scratching or picking. Repeated 6 to 8 weeks, if repeat too short interval targeting old ink not yet removed.
Tattoo removal R2, protocol. 4 sessions same day, 30 minutes. Up to 80- 90% clearance of ink. Study done with 2 sessions, 30 minutes apart. Slightly less ink removal than 4 sessions. 70 - 80 % clearance.
Laser tattoo removal Amateur tattoos easier to remove, shallow ink deposition. Less dense, older tattoos easier.
Laser tattoo removal Wavelength selection, ink color, black, dark brown, red ink, easiest to remove. White, yellow, green, blue, least responsive to laser.
Laser tattoo removal Q switched, picolaser, photo acoustic, gold standard short pulse con鍖ned energy to small chromophores tattoo ink and melanin. Frequency double, FD, KTP and NdYAG, most versatile, 5321064. New generation triple wavelength picosecond. 532/1064/755expensive. Can remove green and blue ink.
Laser tattoo removal. FD NdYAG, or picosecond lasers best choice. FD NdYAG good for skin type 1 to 5. Less melanin absorption at 1064nm than alexandrite 755 nm.
General guidelines Black, dark blue, 1064 Nd YAG Red, orange 532 KTP. Blue, green and brown 755 Alexandrite 694 Ruby.
Complications Permanent darkening metallic pigment in ink. Red, white, 鍖esh color, test spot 鍖rst. Ghost image, PIH, hypopigmentation, texture abnormality and scarring.
Laser hair removal Anlagen growth phase. Cartagen, transition phase. Telegen, resting phase.
Laser hair removal Anagen, growth phase. Cartagen transition phase. Telegen, resting phase.
Laser hair removal Anagen phase Active growth phase. Approximately 20% of hair. Hair follicle most active and most susceptible to destruction.
Laser hair removal Non permanent. FDA duration 6 months. Touch up, or maintenance session 1 to 2 years.
Laser hair removal Long pulse, NdYAG, 1074nm. Penetrates deeper follicle level. Good for all skin types. Low absorption, by all 3 major skin chromophores. H2O, HgB, melanin. Alexandrite, 755 nm, one of the 鍖rst lasers used for hair removal. Safest for skin types 1 to 3.
Laser hair removal Diode laser, 810 nm, Similar to alexandrite, slightly safer for darker skin types than alexandrite. Newer generation classi鍖cation for all skin types. IPL, broadband light, not as speci鍖c as laser, more collateral tissue damage at high settings.
Laser hair removal Pt selection. Light skin and dark hair, optimal results. Active tanning, UV exposure, wait for 2 weeks, blonde hair, no5 good candidate, hypertrichosis, vs hirsuitism polycystic ovarian syndrome.
Laser hair removal Average 6 treatments, 4 to 6 weeks apart. End point, peri follicular erythema. Touch up, or maintainenence session, 1 to 2 years or when regrowth. Result varies among patients and area treated. Chin most resistant. Can be 8-9 treatments.
General laser contractions Isotretinoin/accutane, usage within 1 year, scarring, Pregnancy Chemical peel, 2 to 4 weeks. Waxing within 2 weeks. Active herpes simplex. Active infection. Bacterial, viral and fungal. Systemic corticosteroids. Lesions suspicious for malignancy.
General resurfacing complications. PIH Hypopigmentation Scarring. Uneven skin tone. Demarcation lines. Prolonged redness. Infection.

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Presentation

  • 2. Laser history Theoretical concept 1912, Albert Einstein. First working laser, 1960. Initially used ophthalmology transparency of tissues clear view of directed beam. Surgical excision and hemostasis.
  • 3. Aesthetic laser development. 80s resurfacing CO2. Early 90s vascular PDL, argon. Mid 90s resurgent of surfacing laser. CO2, Erbium. Late90s early 2000s non ablative laser IPL. Mid 2000s present, fractionated laser, Fraxel; fractionated erbium. Fractionated CO2, fractionated NdYAG, fractionated RF.
  • 4. Laser Acronyms. Laser, light ampli鍖cation, by stimulated emissions of radiation. PDL pulsed dye laser. IR infrared KTP, Kalium titanyl phosphate. LED light emitting diode. PDT photodynamic therapy IPL intense pulsed light.
  • 5. Lasers classi鍖cation. Wavelength output 1064/NdYAG. 10,600/ CO2. 532/KTP Pulse duration, continuous, pulsed: picosecond, Q- switched nanosecond, long pulse millisecond.
  • 6. De鍖nition 1millisecond, 1 thousandth of a second. .001 Sec, 1/1000sec. 1 nanosecond, 1 billionth of a sec, 10^-9 sec. 1 picosecond, 1 trillionth of a sec, 10^-12 sec
  • 7. Laser physics Laser emissions, coherent photons in de鍖nite phase relation. Monochromatic single, de鍖ned wavelength. Collimating, narrow/ low divergent.
  • 8. Laser gain mediums Gases CO2, argon, krypton, helium and neon. Liquid dye, coumarin, Rhodamine and 鍖uorescein. Solid crystal and glasses, neodymium, Nd, yttrium aluminum garnet YAG, erbium, sapphire ruby, KTP, potassium titanyl phosphate.
  • 9. Laser light wavelength output Argon, 488,514nm KTP, 532nm Pulsed due 585,595nm Ruby 694nm Alexandrite 755nm Diode 810nm. NdYAG, 1064, 1054, 1320 nm Erbium: YAG, 2,940nm Erbium:glass 1540, 1550nm CO2, 10,600nm IPL, 500-1200nm
  • 10. Energy Measured in joules. Fluence energy delivered per area J/cm2, mJ/cm2. Power the rate at which energy is delivered measured in watt J/sec.
  • 11. Photoselectivity Laser or light therapies, photoselectivity. Selective photothermolysis, destruction of target without destruction of surrounding tissues.
  • 12. Thermal effects Non selective thermal e鍖ects> 100 Celsius, tissues destruction. Selective thermal e鍖ect, 45-100 Celsius, protein denaturation. < 45celsius, collagenesis, reversible tissue injury.
  • 13. Non selective thermal effects Too high power or too many passes. Non selective thermal damage to tissue outside targe5 area.
  • 14. Non selective thermal effects Scarring. Hyperpigmentation/PIH. Hypopigmentation.
  • 15. Chromophores Chromophores, speci鍖c target of a laser, absorbs a speci鍖c laser wavelength. Common chromophores in Aesthetic. Water resurfacing, collagen tightening, melanin hyperpigmentation, hemoglobin vascular lesions, tattoo ink.
  • 16. Thermal relaxation time. TRT, time required for heat energy to dissipate from chromophores into surrounding tissue. Selective photothermolysis requires, all the energy in a laser pulse must be deievered to a chromophores before it can release its heat and cool.
  • 17. Photo acoustic Mechanical shock wave e鍖ect. Q switched and picosecond lasers phenomenal only, high energy released in short duration. Tattoo removal breaking up of ink.
  • 18. Wavelength and spot light Shorter wavelength, increase melanin absorption. Longer wavelength, deeper penetration. Increase Spot size, increase pain and discomfort. Consider lower 鍖uence with larger spot size.
  • 19. Cooling Decrease unintentional injuries. Allows higher 鍖uence. Forced cold air, before during after. Contact cooling, chilled laser tip. Pre and post cooling with copper plate, cooled gel.
  • 20. 4 classes of lasers 1 noknown biological hazard 2. Chronic viewing hazard. 3. Direct viewing hazard. 4. Direct and re鍖ected hazard Most medical lasers are classes 3 and 4.
  • 21. Eye injury. Eyes, most common injury. Damage, cornea, lenses, retina. Baseline eye exam.
  • 22. Eye injury Low divergence, coherent beam, focus on extreme small spot on retina. Wavelength dependent, cornea water, retinal vasculature.
  • 23. Eye injury Signs and symptoms injuries Flash of light. Popping sound follows by disorientation. Burning pain in cornea or sclera. Retinal damage may not be detected. Lack of pain 鍖bers in retina,
  • 24. Eye injury. Direct laser beam, indirect or re鍖ected laser exposure, inappropriate eye protection. Laser safety eyewear, goggles or glasses. Mandatory use with all laser procedures. Wavelength speci鍖c. Reduces energy to eye below MPE. Maximum permissible exposure level.
  • 25. OD optical density Ability of a lens to reduce laser energy of a speci鍖c wavelength to a safe level below MPE. OD 0 1, OD 10.1 OD 20.01 OD 30.001 OD40.0001 OD50.00001 eg OD 5, 1/100,000 original light transmitted.
  • 26. Non laser beam hazards Infectious Carcinogenic Teratogenic Papillomavirus cultured from plume CO2. Tissue particles splattering Q switched. Reports of viral transmission. LGAC laser generated air contaminant.
  • 27. Non laser beam hazards Prevention Smoke evacuation 鍖lter < 0.1 micron. Masks and gloves laser marks 鍖lter smaller particles than operating room masks.
  • 28. Indirect beam hazard Be aware of re鍖ective materials, mirrors and polished objects. Jewelry Glossy paint can be a hazard.
  • 29. Fire lol laser can ignite. Co2 highest risk. Direct and re鍖ected beam Prevention measures, make sure alcohol prep dry, keep laser beam away fro gauze, plastic and rubber.
  • 30. Warning labels Areas of laser usage must be labeled Caution labels for class 1 to 2. Danger labels for class 3 to 4.
  • 31. Non ablative rejuvenation Creates controlled areas of injury to epidermis and dermis, destruction of wavelength speci鍖c chromophores. Most commonly IPL, intense pulse light, BBL broad band light, photo facial, photo rejuvenation. Less commonly laser toning, NdYAG, KTP, PDL.
  • 32. Why non ablative skin rejuvenation is popular. Minimum down time. No oozing, swelling, crusting, blistering. Mild to moderate erythema 1to 3 hours.
  • 33. Ablative rejuvenation Non ablative light therapy Chromophores, melanin, hemoglobins, vascular lesions, thermal e鍖ects limited to dermis/ epidermis, collagenesis leads to heating and remodeling.
  • 34. Pulsed light physics. Light source 鍖ash lamp. BBL, broadband lights, 420-1400nm. IPL INTENSE PULSE LIGHT, 500-1200nm. Non coherent, non monochromatic, non collimated. Not a laser Wavelength range selected by changing head or adding 鍖lter.
  • 35. Pulsed light indications Pigmentary D/O Melasma, solar lentigones, photo damage. Vascular lesions: telengiectasia, minor vascular birth marks. Hair removal. Photo rejuvenation,
  • 36. Pulsed lights Minimal downtime. Mild moderate erythema 1 to 3 hrs. Dryness, transient hyperpigmentation minor scabbing. Requires 2 to 4 sessions for noticeable results. Repeat treatment every 2 weeks.
  • 37. Non ablative complications PIH, hypopigmentation and scarring.
  • 38. Laser resurfacing ablative. Standard resurfacing lasers, CO2 10,600 nm. Erbium: YAG 2,940nm Erbium shallower depth super鍖cial depth. Chromophores H2O.
  • 39. Resurfacing Indications Skin rejuvenation, acne scarring, scarring, rhytids, large pores, pigmentary disorders and mild skin tightening.
  • 40. Resurfacing Mechanism of rejuvenation Re epithelialization. Collagen deposition. Elastin formation. Neogenesis. Dermis healing phase includes, in鍖ammation, exudate and crusting.
  • 41. Laser resurfacing. Complications: PIH. Hypopigmentation. Scarring. Uneven texture. Destruction of adnexal tissue. Demarcation. Prolonged redness.
  • 42. Fractional resurfacing MTZ micro thermal zone, minimal damage, micro column of laser, light to surface of skin, not complete resurfacing. Hundreds of MTZ per square cm.
  • 43. Fractional resurfacing Normal skin between MTZ, intact epidermis barrier functions, rapid re-epithelialization, keratinocytes migration, rapid healing and less risk.
  • 44. Fractional resurfacing Minimal down time. Approximately 1 week healing time. No crusting or oozing, minimal exfoliating. New collagen and epithelium per treatment. 2007 clinical trail, 5-6 treatments striae improves as much as 75%.
  • 45. Fractional resurfacing Erythema, mild swelling, 1 to 2 days. Bronzing/darkening after 2 to 3 days. Moderate to severe swelling Prednisone 40/30/20/10, step down. Repeats every 4 weeks.
  • 46. Tattoo removal End point Gray whitening immediate. Breaking of ink. Follows by erythema and redness, edema, for 3 to 5 days. Reaction color dependent, darker color produce more whitening than lighter color.
  • 47. Tattoo removal No ink is removed until 4 weeks. Pruritis, peeling, fading @4 weeks. No scratching or picking. Repeated 6 to 8 weeks, if repeat too short interval targeting old ink not yet removed.
  • 48. Tattoo removal R2, protocol. 4 sessions same day, 30 minutes. Up to 80- 90% clearance of ink. Study done with 2 sessions, 30 minutes apart. Slightly less ink removal than 4 sessions. 70 - 80 % clearance.
  • 49. Laser tattoo removal Amateur tattoos easier to remove, shallow ink deposition. Less dense, older tattoos easier.
  • 50. Laser tattoo removal Wavelength selection, ink color, black, dark brown, red ink, easiest to remove. White, yellow, green, blue, least responsive to laser.
  • 51. Laser tattoo removal Q switched, picolaser, photo acoustic, gold standard short pulse con鍖ned energy to small chromophores tattoo ink and melanin. Frequency double, FD, KTP and NdYAG, most versatile, 5321064. New generation triple wavelength picosecond. 532/1064/755expensive. Can remove green and blue ink.
  • 52. Laser tattoo removal. FD NdYAG, or picosecond lasers best choice. FD NdYAG good for skin type 1 to 5. Less melanin absorption at 1064nm than alexandrite 755 nm.
  • 53. General guidelines Black, dark blue, 1064 Nd YAG Red, orange 532 KTP. Blue, green and brown 755 Alexandrite 694 Ruby.
  • 54. Complications Permanent darkening metallic pigment in ink. Red, white, 鍖esh color, test spot 鍖rst. Ghost image, PIH, hypopigmentation, texture abnormality and scarring.
  • 55. Laser hair removal Anlagen growth phase. Cartagen, transition phase. Telegen, resting phase.
  • 56. Laser hair removal Anagen, growth phase. Cartagen transition phase. Telegen, resting phase.
  • 57. Laser hair removal Anagen phase Active growth phase. Approximately 20% of hair. Hair follicle most active and most susceptible to destruction.
  • 58. Laser hair removal Non permanent. FDA duration 6 months. Touch up, or maintenance session 1 to 2 years.
  • 59. Laser hair removal Long pulse, NdYAG, 1074nm. Penetrates deeper follicle level. Good for all skin types. Low absorption, by all 3 major skin chromophores. H2O, HgB, melanin. Alexandrite, 755 nm, one of the 鍖rst lasers used for hair removal. Safest for skin types 1 to 3.
  • 60. Laser hair removal Diode laser, 810 nm, Similar to alexandrite, slightly safer for darker skin types than alexandrite. Newer generation classi鍖cation for all skin types. IPL, broadband light, not as speci鍖c as laser, more collateral tissue damage at high settings.
  • 61. Laser hair removal Pt selection. Light skin and dark hair, optimal results. Active tanning, UV exposure, wait for 2 weeks, blonde hair, no5 good candidate, hypertrichosis, vs hirsuitism polycystic ovarian syndrome.
  • 62. Laser hair removal Average 6 treatments, 4 to 6 weeks apart. End point, peri follicular erythema. Touch up, or maintainenence session, 1 to 2 years or when regrowth. Result varies among patients and area treated. Chin most resistant. Can be 8-9 treatments.
  • 63. General laser contractions Isotretinoin/accutane, usage within 1 year, scarring, Pregnancy Chemical peel, 2 to 4 weeks. Waxing within 2 weeks. Active herpes simplex. Active infection. Bacterial, viral and fungal. Systemic corticosteroids. Lesions suspicious for malignancy.
  • 64. General resurfacing complications. PIH Hypopigmentation Scarring. Uneven skin tone. Demarcation lines. Prolonged redness. Infection.