31 - 209 - LASER SKIN RESURFACING: COSMETIC AND MEDICAL APPLICATIONS

Question 1

Most severe complications associated with ablative cutaneous laser resurfacing

a. Reactivation of HSV

b. Hypertrophic scarring

c. Ectropion

d. B and C

Answer 1

D

Question 2

Gold standard in ablative LSR

a. CO2 laser

b. Er:YSGG

c. Excimer

Answer 2

A

Question 3

Absolute contraindication for LSR

a. Mild erythema

b. Edema

c. Active skin infection

d. Skin phototype VI

Answer 3

C

Question 4

Ideal patient for LSR

a. Enlarged pores

b. Dark complexion Skin phototype V-VI

c. Fair complexion Skin phototype I or II

d. Photodamaged or scarred facial skin

Answer 4

C, D

• The ideal patient for cutaneous laser resurfacing has a fair complexion (Fitzpatrick skin phototype I or II) with photodamaged or scarred facial skin.

Question 5

Average time for reepithelialization for single pass CO2

a. 2.5 days

b. 10.5 days

c. 5 days

d. 5.5 days

Answer 5

D

Question 6

Wavelength of CO2

Answer 6

10,600 nm

Question 7

Wavelength of Er:YAG

Answer 7

2940 nm

Question 8

Examples of Ablative pulsed/scanned lasers

Answer 8

Question 9

Question 10

Nonablative lasers

Answer 10

Question 11

Erbium fiber wavelength

Answer 11

1550 nm

Question 12

Thulium wavelength

Answer 12

1927 nm

Question 13

Question 14

ideal patient for cutaneous laser resurfacing

Answer 14

fair complexion (Fitzpatrick skin phototype I or II) with photodamaged or scarred facial skin

Question 15

Question 16

Question 17

Expected reactions of laser

Answer 17

■ Erythema

■ Edema

■ Pruritus

Question 18

MILD Side Effects and Complications of Ablative and Nonablative Laser Skin Resurfacing

Answer 18

■ Prolonged erythema

■ Milia

■ Acne

■ Allergic or irritant contact dermatitis

Question 19

MODERATE Side Effects and Complications of Ablative and Nonablative Laser Skin Resurfacing

Answer 19

■ Infection (bacterial. viral, fungal)

■ Transient hyperpigmentation

Question 20

SEVERE Side Effects and Complications of Ablative and Nonablative Laser Skin Resurfacing

Answer 20

■ Permanent hypopigmentation

■ Hypertrophic scarring

■ Ectropion

Question 21

what areas have decreased pilosebaceous units?

Answer 21

eyelid, neck and chest

Excessive thermal injury in these areas can result in subsequent hypertrophic scarring.

Question 22

gold standard in ablative LSR

Answer 22

CO2 lasers

Question 23

absolute contraindications to laser resurfacing procedures

Answer 23

Active skin infections—whether bacterial, viral, or fungal

• Furthermore, as ablated skin heals from progenitor cells contained within the pilosebaceous units, patients with adnexal abnormalities may have significant issues with postoperative wound healing, and should not undergo ablative LSR.
• This subset of patients includes those who have previously undergone therapeutic skin irradiation which often compromises local adnexa.
• newer published research demonstrates normal reepithelialization and lack of scar formation in patients undergoing ablative LSR while on concomitant isotretinoin therapy

Question 24

predominant response seen after CO2 irradiation

Answer 24

Immediate thermal-induced collagen tightening

Question 25

most severe complications associated with ablative cutaneous laser resurfacing

Answer 25

hypertrophic scarring and the formation of ectropion

Question 26

findings that may signal impending scar formation

Answer 26

focal areas of bright erythema with associated pruritus, particularly along the mandible

• Potent topical corticosteroid preparations should be applied to these areas to decrease the inflammatory response.
• Pulseddye laser treatment can be used to improve the appearance and symptoms of such scars.

Question 27

test that can be done to assess eyelid laxity

Answer 27

Snap test

If the infraorbital skin does not return briskly to its normal resting position after a manual downward pull (“snap test”), then ablative laser resurfacing near the lower eyelid margin should be avoided.