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| FACIALAESTHETICS | ARTICLE


Discussion Facial skin resurfacing has undergone many changes over the past 15 years. In summary, treatments went from aggressive high-fluence, high-density, multipass resurfacing to more gentle fractional treatments, both of which have their pros and cons. The newer fractional treatments are superb for minor rejuvenation with minimal downtime. Traditional high-power, high-density, ablative CO2


treatments


produce a burn of the entire skin surface. Fractional laser treatment, on the other hand, is a subtotal treatment and leaves untreated regions of normal skin next to micro-columns of burned skin. As the entire skin surface is not treated, the recovery process is easier and re-epithelialisation faster. Newer lasers have the capacity to perform a number of


levels of treatment by using traditional and newer fractional platforms. This gives both health professional and patient an increasing number of treatment options to suit and balance the damage with customised recoveries. Fractional laser-based skin resurfacing has shown promise for a more user-friendly procedure, but to this point it cannot rival the results of traditional, aggressive CO2


Ultimately, the CO2


laser skin resurfacing quality and results. laser can also serve as a surgical


adjunct for bloodless tissue incision in blepharoplasty and other eyelid surgeries, lesion removal, and even in resection of tumours.


Key points


periocular surgeries such as blepharoplasty, ptosis, entropion and ectropion, and xanthelasma excision are discussed in this article


n The benefits of using the CO2


laser in n CO2 laser systems


have the advantage of both cutting the skin and for rejuvenation of the skin


the gold standard


n Skin resurfacing has evolved rapidly over the past two decades, but the CO2


laser remains Laser technology alone or in combination with


botulinum toxin and hyaluronic acid fillers may give very promising results. Although the degree of improvement is less than with traditional CO2


laser


treatment, the recovery is much shorter and tolerable, and the complication rate is lower. However, traditional CO2


lasers are the workhorse of


cosmetic facial surgery practice; a single minimally-invasive fractional laser treatment (regardless of company, wavelength, etc.) cannot compare to the level of rhytide effacement and improvement in dyschromia seen with a traditional CO2


laser device.


There is no doubt that the recovery is much easier, but in order to get really significant results, the patient may have to undergo up to five treatments. In the author’s clinic, superficial ablative treatments are not used. Superficial fractional laser treatments, on the other hand, can frequently be performed without sedation, which is a huge advantage for practitioners. The majority of these patients are treated with a topical anaesthetic only, while the remainder will request full sedation. The procedure is performed by degreasing the face


and applying a generous coat of BLT (benzocaine, lidocaine and tetracaine) topical anaesthesia. A single pass is made over the patient’s entire face. Generally, 100 mJ with a density of 2 is used for facial treatments. The entire procedure can be completed in 10–20 minutes on an awake, topically-treated patient.


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