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Fractional ablative laser treatment, Halo laser, spot resurfacing and TCA Cross

This information applies if you are having any of the following treatments:

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Preparing for treatment

The most important consideration is to avoid a tan. You should attend treatment sessions tan free. Laser treatment cannot be carried out if you have a tan. For 4 weeks before a laser treatment avoid the sun, wear a hat and apply factor 50 sunscreen regularly.

You should also not have any fake tan on your skin before a laser treatment. Stop using fake tan products for 4 weeks before a laser treatment session.

Stop topical retinoids, exfoliants, salicylic acid, glycolic acid and any other strong skin care 3 days before laser treatment. You can continue other skin care products.

Start antiviral treatment for the prevention of cold sore virus if this has been prescribed to you on the night before your treatment and continue for 5 days. The usual treatment is acyclovir 400mg three times a day.

Attend your appointment make up free. Use a gentle foaming cleanser at home before attending and thoroughly remove make up and skin care products. This includes not wearing any eye makeup.

Bring a hat with you if it is sunny.

If you have acne, you may be advised to amend your oral acne medication to help reduce flares of acne from laser.

You will need to purchase the following before your treatment:

  • Skin barrier petroleum jelly-based ointment – either Vaseline or Aquaphor (make sure it’s a new product with each treatment cycle)
  • A lightweight moisturiser to use as a regular moisturiser from day 4/5 onwards, such as Cerave Moisturising Lotion or Avene Hydrance
  • Dermol 500 lotion for washing (you can also use your lightweight moisturiser to wash with if you wish)
  • Ultra-absorbent kitchen towel
  • Any prescribed medications such as antiviral medication.

If you are having a large area of the face treated then you should not drive after treatment. If you are having a small area treated, or only have TCA cross or spot resurfacing, you will be able to drive after treatment.

What to expect during treatment

Your skin will be cleansed and a hair net will be used to cover your hair. Please bring a hair tie or bobble with you if you have long hair.

The areas being treated may be numbed with anaesthetic injections or with an anaesthetic cream.

Your eyes will be covered with protective eyewear.

If you have planned treatment involving the eyelids, then anaesthetic eyedrops and an eye shield will be inserted and you should not drive following your treatment.

A barrier cream may be applied on your skin before you leave.

What to expect after fractional ablative laser treatment

It is normal to experience swelling, redness and heat in the treated areas. The swelling starts almost immediately after treatment and the heat starts in a couple of hours as the numbing medicine wears off.

Take paracetamol every 6 hours for any discomfort. You can also take ibuprofen regularly if it safe for you to do so. The period of burning and discomfort lasts about 48 hours.

Redness and swelling take 3-6 days to settle.

You will be able to see dots from the laser treatment which may look skin coloured, red or white. These dots may form scabs in the days to come which which will look darker and naturally lift – it is important not to pick any scabs but to let them separate naturally. The laser pattern will eventually fade.

Oozing of clear or slightly yellow fluid is to be expected in the first few days. With Erbium laser, there can be some pinpoint bleeding too. The discharge will begin to form crusts.

With Halo laser, swelling worsens on day 2 and 3 before improving. You may also see brown spots and bronzed patches following Halo laser, which temporarily appear darker and more noticeable on the second and third days. Some bronzed areas may flake off over the next week. This is called the MENDS (microscopic epidermal necrotic debris). In individuals with heavily pigmented skin, or in areas where sun damage has produced pigmented lesions, the microscopic wounds, known as MENDS, contain large amounts of melanin. Because there are so many MENDS, they can make the skin look bronzed and small areas appear crusted (do not try to scratch them off). This is part of the healing process where treated tissue is working its way out of your body as new fresh skin is regenerated.

Itching is common after day 4 and antihistamines may help.

The deeper and more dense the laser treatment, the longer it takes for the healing to occur.

What to expect after TCA cross and spot laser resurfacing treatment

Any areas treated with TCA cross will look white for a few hours and then they will be red and form a scab.

Any areas treated with spot resurfacing will look like a graze on the first day and then form a scab. These areas take 7 to 10 days to heal. They should be treated in the same way as areas that have been treated with laser as described below.

Skin care and general advice after treatment

On the day of treatment

Icepacks or cold compresses, for 5-10 minutes at a time can help minimise discomfort.

Take Paracetamol and Ibuprofen to control any discomfort.

Apply Vaseline or Aquaphor every 4 to 6 hours – starting 6 hours after your treatment.

Ensure pets and small children do not contact the skin surface during the entire healing process.

Days 1 to 3

Very simple skincare should be used. This will consist of gently washing the face twice a day and applying Aquaphor or Vaseline every 4 to 6 hours.

Face Washing

Gently wash the area twice a day, morning and night to get rid of any crusts, dirt or fluids or excess residue. Washing of the face should commence the morning after your procedure.

Using cold or lukewarm water, and Dermol 500 or Cerave Moisturising Lotion, cleanse the face to remove crystalised crusts and dirt.

It is recommended that face washing occurs in the shower, as using a sink may not allow to splash enough water over their face to thoroughly cleanse the skin. It is important to use lukewarm water as hot water will sting.

Once in the shower, use water to rinse the face thoroughly. If the shower pressure is too high, then cup water in the hands and rinse the face. Then gently massage in 3 pumps of any prescribed face wash over the face, leaving it for up to one minute. This is to soften and loosen off any crystalised crusts. Use a gentle circular motion. This is known to typically sting slightly, but this is normal.

While in the shower, it is permitted to shampoo the hair. Allow water to run through the hair, backwards, loosening off any debris that has accumulated on the hairline. Any shampoo used should be rinsed backwards with the head tilted, ensuring shampoo does not contact the face. Use tepid water in the shower and keep showers short.

When drying the skin, it is recommended to use a disposable paper towel or to let the skin air dry as towels are not clean enough to typically dry skin after treatment and can promote cross-contamination. Use an ultra-absorbent kitchen towel and pat the skin dry (avoid rubbing).

A skin barrier cream is applied as soon as the skin has been dried.

If you have only had TCA cross or spot resurfacing you can gently cleanse the areas once a day as described above.

Skin barrier cream

The skin is very fragile and prone to drying out easily. Do not allow the treated area to dry out.  Aquaphor or Vaseline should be applied regularly so that the skin that has been treated is covered in a shiny layer of barrier cream at all times. Reapplication of a further layer of Aquaphor is required when the skin is felt to be drying out or approximately every 4 hours. It is possible to suffocate the skin and apply too much barrier cream (which can cause an acne flare) so it is better to apply thin to moderate layers more frequently so the skin is always shiny, with a slightly heavier layer at night.

Oozing

Weeping is common in the first few days after fractional laser treatment and it is best to put a towel down on the pillow when you sleep and over the chest and shoulders when you are sat to absorb this. Use a new towel every day. The fluid that weeps is often mixed with the barrier cream to create a gloopy residue.

Days 5 to 10

The redness and swelling will reduce and some flaking of the skin will occur. You only need to wash the face once a day and can change to a lightweight moisturiser four times a day instead of the heavier barrier cream.

Oozing will stop and scabs will separate. Your skin may appear slightly pink.

You can usually apply make up at this stage.

Most individuals are sufficiently healed to be able to return to work in a week’s time. Retinoids and other skin care can be resumed 14 days after treatment.

Avoid strenuous exercise until the skin has fully healed at around 7 to 10 days. The same applies for swimming, sauna and hot tubs.

3 months after treatment

Avoid strong treatments like scrubs, microdermabrasion, waxing, or chemical peels for at least four weeks.

It is important to continue protecting your skin from the sun meticulously for at least 3 to 6 months after treatment to reduce the chance of post-inflammatory hyperpigmentation

Redness following laser treatments can sometimes persist for a number of weeks or months.

When to seek medical attention

If you experience one of the following, you should contact the office:

  • Redness becomes more day by day rather than less
  • Pain becomes severe rather than gradually improving.
  • There is pus discharging from the skin
  • Cold sores appear on the skin

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