Aftercare Instructions for SmartXide CO2 Laser Skin Resurfacing.

Laser resurfacing is still considered to be the gold standard for skin rejuvenation including skin tightening, wrinkle improvement, improving age spots and acne scars. Although this produces a dramatic result, it can be a demanding recovery. The recovery process is simple, but patients can be confused about exactly what to do. It is important to keep in mind that the care of your lasered face has an effect on your final result so the better you do, the better you look.

The laser essentially produces a second degree burn and removes a fraction of the outer layer of your skin. In order to heal properly, you must follow some basic daily skin care steps. It is important that you follow these directions exactly and not substitute your own products, devices or care regimen.

Be Prepared.

Patients that do the best are those that are prepared for their procedure. You will need wash-cloths for compresses, white vinegar, ice or cold water and an old pillow case so as not to stain your good linen. You will also need a post-laser ointment, cleanser, moisturizer, sunscreen and gauze.

You should read the directions in advance so you are clear what to use and when.

Laser Aftercare: Quick Start Guide. 1. Aquaphor Ointment- Begin immediately and use 24/7 to keep the skin moist for first 9-10 days. 2. Cetaphil Cleanser- Begin gently washing your face with this twice a day on day 2. 3. Alternative Moisturizing Skin Cream- Begin using instead of Aquaphor on day 8-10. 4. Mineral Sunscreen (minimum SPF 30)- Begin using twice a day on day 12-14. This is what you do in a nutshell, but please read more detailed instructions below.

Laser Medicines.

Undergoing  extensive laser skin resurfacing  requires numerous medicines to prevent infection, ease discomfort, and reduce swelling. Lasering small areas of skin such as the lower eyelids or a simple scar does not require many of the standard medications. You may be issued the following medications

1. Antiviral Medicine. Lasering the skin can put you at risk of developing viral infections of that skin, especially but not only in patients with a history of herpes or cold sores. This medicine is called acyclovir. Follow the directions. Note that this medicine is started 2 days before your treatment and is for a total of 7 days.
2. Antibiotic Medicine. Lasering the skin can put you at risk of developing viral infections of that skin. Antibiotics are prescribed to reduce the risk of bacterial infection bacterial infection and are usually called Cephalexin. You should begin taking this the morning of your procedure before you attend the clinic. The dose is one 500mg pill twice a day for a week.
3. Pain medicine. If paracetamol 1g 4 times a day with or without ibuprofen 200-400mg 3 times a day is insufficient, over the counter co-codamol 8/500 should be an adequate top-up pain killer.

Skin Care Routine.

• Week Number One

Cold Compresses

Laser recovery is usually a 4-14 day recovery and the first week is the most demanding period. Your face will be swollen and covered with ointment. Your skin may produce a yellowish exudate that is part of “Nature’s Band-Aid”. Do not be alarmed at this build up of yellowish residue (especially under the eyes) and DO NOT try to scrub it off. It will resolve naturally over the next week.

When you get home from the clinic, placing cold compresses (gauze or wash-cloths soaked in cold water) on your face will cool the heat and help reduce swelling. Although this is not a necessity, most patients feel better with the cold compresses. Using a large clean glass bowl filled with ice water and several wash clothes is a good way to manage this. As one compress loses its chill, another can be removed from the bowl and placed on the skin. This can be done for the first several days.

DO NOT PUT ANYTHING ELSE ON YOUR FACE. As much as we warn patients, someone always wants to try some potion or lotion which can cause problems and delay healing. This includes aloe, vitamin E, herbal potions and lotions, etc. You need to cover your lasered areas with the “grease” (Aquaphor) on a 24 hour basis. You do not need excessive ointment (don’t want to drip and irritate eyes), only enough to provide a light greasy covering of the skin. The cold compresses will wash off the Aquaphor, so it needs to be reapplied continuously. Dry skin will delay your healing and it is important to continually reapply the ointment every several hours. Always wash your hands before touching your face as the open skin is more susceptible to infection.

Wash

You will need to wash your face with luke-warm water twice a day, beginning the day after surgery, with Cetaphil Cleanser.

Your skin will be sore, so only use your fingertips and NOT a washcloth or mechanical device. Men should not shave for 10 days. Most patients find it convenient to wash their face in the shower where they can let the shower water soak and soften the residue on their face and then gently wash with the cleanser. Again, the goal is not to wash all the residue off of your face but rather to lightly cleanse it. Carefully blot dry with a clean towel and reapply the healing ointment. Do not apply excessive ointment to your forehead and upper lids as it will drip and irritate the eyes. This will not hurt your eyes, but it can sting or irritate them.

Soak

Many patients find white vinegar soaks very cleansing and soothing. They are optional.

This is made by mixing 1 teaspoon of white vinegar mixed with 1 cup of tap water. Do not use more as the level of acidity is important. The dilute white vinegar is actually anesthetic, but if it burns you can use less than a teaspoon. The white vinegar mixture is applied to the face by soaking for 10-15 minutes with gauze soaked in the solution. These soaks help with the pain, dissolve some of the residue and are also antimicrobial which decreases infections and can be done every several hours, for example typically up to 4 times a day. The soaks can be done at any time but may be more effective after your shower or face wash and before reapplying the healing ointment.

Cover Again

After you wash, reapply “grease” (Aquaphor).

The above regimen is the basically all the care that needs to be done until the new skin grows back. This generally happens between days 9-12. When the new outer layer of the skin (epidermis) grows back, the face is no longer raw, but rather the healing skin is smooth and pink. This healing process does not happen all at once. Some areas of your face will heal faster while other areas (eyelids especially) take longer. By the beginning of the second  week any raw areas should still be covered with ointment but any smooth and pink areas can be treated with the moisturizer only.

Calecim/AQ Products.

If you have opted to use Calecim or AQ products after laser skin resurfacing treatment you can use them alongside the advice that has been presented in this document.

The AQ Recovery Serum or Calecim Serum can be applied before other products, twice a day and allowed to dry in for a minute or two before applying anything else.

The Recovery Masks can be used 1-2x a day after cleaning the face and before application of any other products afterwards.

• Week Number Two

Moisturize

When the entire face is smooth and pink, no greasy ointment is needed and continual use will only clog your pores. The average time that most patients switch from the “grease” to the moisturizer is about 9-10 days.

Throughout this entire healing process, you should only use our recommended products and never anything with preservatives, fragrances, stabilizers, alcohol or other ingredients. Dry skin will delay your healing and it is important to continually reapply the moisturizer at least every 2 hours as it really soaks up into the skin.

Approved Moisturizers include:

• Calecim Multi Action Cream or Calecim Professional Restorative Hydration Cream.
• Cetaphil Moisturizer

Protect

When you begin leaving your house, you will need sunscreen to protect your skin. Not any old sunscreen will suffice as many products have irritants that will delay your healing. We can supply a Medik8 sunscreen which does not irritate skin and also contains zinc oxide which promotes healing.

AfterCare Overview. Day 1 Cold packs and “grease”( Aquaphor). Day 2-7 Wash face with luke warm water twice a day with Cetaphil Soap; perform white vinegar soaks as required; keep face covered with “grease”. Day 7-9 Begin to use moisturizer on skin that is healing well instead of Aquaphor. Only use moisturizer on non-oozing skin. Day 9-14 Continue with washing face; use moisturizer; use sunscreen.

The primary goal is to get through the first 2 weeks of laser treatment and ease back into your normal skin care regimen. We recommend all patients using prescription strength skin care including either Calecim or AQ Skin Solutions products to maintain their youthful results. Retinol serum 3%, bleaching cream and sunscreen may additionally be cautiously introduced as soon as the skin is healed and will tolerate it.

Common Post Laser Conditions.

Your laser treatment will be your new hobby for the first 4-6 weeks as you need to take gentle care of your brand new “baby skin”. During healing you skin will undergo numerous changes. Some patients will experience a secondary peel where their skin gets flakey. This is frequently a sign that the skin is under moisturized. Remember, you have to apply your ointments or creams every several hours.

After you two week healing period, your skin regimen will become less intense and washing and applying moisturizer and sun screen is all that is necessary.

Post Laser Pinkness (erythema).

Post laser Skin Pinkness is the most common complaint of post laser patients. Pinkness is sign of a normal healing process and is a sign of newly formed skin. Pinkness is extremely variable and can last several weeks in some patients and several months in other patients. A general rule is that the longer the pinkness, the better the result as more collagen is being formed. When pinkness is extreme or longer lasting than expected it can be a sign of over aggressive scrubbing or rubbing, or a sign of some irritating substance being applied. As stated numerous times, this is baby sensitive skin and patients have to be careful of what they apply. Extreme irritation can occur from the sue of aloe, baby oil, make up, and numerous topical products that patients think it is OK to apply. If you think you pinkness is getting worse, please come into the office so we can evaluate your condition. We may recommend an over the counter hydrocortisone cream for a short while to reduce inflammation or other therapies. Again, pinkness is normal and patients can cover this with makeup.

Post Laser Hyperpigmentation.

Our skin has pigment cells called melanocytes. Blondes and redheads have much less melanin and the darker your skin type the more melanin that is present. When the skin is irritated, the melanocytes are stimulated to produce increased melanin and this causes a blotchy tan across the lasered skin. On some patients it is mild and on others it can be severe. THIS IS NOT A PERMANENT CONDITION AND CAN BE CLEARED UP IN SEVERAL WEEKS. The use of bleaching cream and Retin-A and sunscreen can make a dramatic difference in clearing the hyperpigmentation.

As hyperpigmentation is caused by light and inflammation, it is important to use sunscreen, even in doors. Overhead lighting in your office can increase pigmentation as can driving. Use sunscreen twice a day! Finally any irritation to the new “baby” skin can accelerate hyperpigmentation. This can include wind, car defrost and hair dryers blowing on the face. Be gentle to your face! Post laser hyperpigmentation usually presents between 20 and 30 days after laser. Don’t be alarmed, 40% of patients can experience this and it will resolve.

Acne Breakout.

Although uncommon, some patients may experience some minor acne after laser. This will usually resolve without treatment or may require antibiotics.

Skin Infection.

Post laser infections are rare but bacterial, viral and yeast infections can occur. It is important to wash your hands frequently and not touch your face after touching other body parts. After several days, pain of the treatment should improve. Increasing pain, severe itching, new pimples, ulcers or lesions may signify infection and if you are concerned, call the clinic for evaluation.

Milia.

Milia are small white bumps that are clogged pores. They can form as single bumps or in clusters. They usually resolve by themselves and if they persist are easily removed in clinic with a sterile needle.

Shiny Skin.

Newly formed, well moisturized skin may at first be shiny or have a different texture. The thin skin under the eyes may feel bumpy. All of these changes will normalize with time.

Scarring.

Scars are rare with laser treatment but some isolated areas of skin thickening can occur. This is treated with anti-inflammatory medications and responds well. Permanent scarring is extremely rare.