Laser procedures occupy a significant place among aesthetic interventions aimed at improving the condition of the skin. They are very effective when indicated and fairly safe, but should still be performed by a qualified physician and after a careful history taking. Since laser skin resurfacing has contraindications, patient selection is very important to prevent possible complications.

Possible contraindications for laser procedures

Careful patient selection and detailed pre-treatment consultation is paramount to the success of laser procedures.

It is important to remember that carbon dioxide lasers cause burns, although they are potentially accurate, and that improper use can result in significant scarring. In cases where there is a history of abnormal scarring, including keloids, special care should be taken.

Patients who have taken systemic isotretinoin (roaccutane) should be advised to wait at least 1 year before resurfacing as they are at risk of developing abnormal scarring. Patients who have previously had dermabrasion should wait at least 3-4 months.

People with systemic vascular connective tissue disease (eg, systemic lupus erythematosus, scleroderma), autoimmune disease (eg, vitiligo), or immunodeficiencies should not undergo laser resurfacing due to slower or inadequate postoperative healing, or reactivation or worsening of underlying disease due to the procedure itself.

Patients with Fitzpatrick skin types IV-VI should be treated cautiously due to the risk of hypo- or hyperpigmentation.

Measures to prevent complications in laser procedures

The full informed consent of the patient must be obtained before proceeding with laser procedures.

Patients with fair skin types Fitzpatrick I and II who have not been overexposed to UV radiation are the best candidates for laser resurfacing of non-expressive wrinkles, actinic cheilitis or epidermal lesions (seborrheic/actinic keratosis). But in situations where the result is cannot be predicted with certainty, it is possible to treat a small trial area and observe it for several months before making a final decision.

Patients with Fitzpatrick skin types IV and above can be treated for depigmentation 6 weeks prior to laser resurfacing.

The need for antiviral prophylaxis should be considered. Some doctors routinely prescribe antibacterials such as amoxillin, as well as antiherpetic drugs.

Peculiarities of skin control during laser treatment

The initial light spot is used to evaluate the effect of the first pass. Clinical parameters are used for depth calibration. Nothing can replace experience in evaluating the changes seen in the skin as layers of tissue are vaporized by the laser.

Milky blistering and crackling sounds indicate ablation of the epidermis. Removal of residual epidermis with a damp cloth reveals a pink surface – papillary dermis. Vaporization of the pink layer causes contraction of the tissue, and the yellow color observed in this case indicates the reticular layer of the dermis. This is an important indication as the skin treated up to this layer should heal without scarring.

If a brown color is observed, this is a sign of entry into the reticular layer of the dermis, in which case a scar may form. If charring occurs, thermal diffusion will go beyond the depth of vaporization, and scarring is almost inevitable.

Thus, carbon dioxide laser vaporization is a safe and effective way of skin resurfacing, but only in the hands of a skilled doctor. Patient selection and careful history taking are of paramount importance for the success of therapy.

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