Section 4 Plastic and Reconstructive Problems

care to patients to optimize facial skin health

before procedures. Sun should be avoided when

possible, and mechanical and chemical blockade

(broad-spectrum A and B sunscreens) should be

used daily. Acne vulgaris can be treated with

topical and oral antibiotics, hormonal treatments,

and isotretinoin safely in all skin types and should

be optimized before starting laser rejuvenation

therapy.

However, all isotretinoin should be

avoided for 6 to 12 months before starting laser

therapy due to the possibility of poor healing. In

addition, all herpes simplex virus (HSV) outbreaks

should be treated with antivirals, and prophylaxis

antivirals should be given to patients with HSV

before starting laser treatments.

Additional topical treatments with melanin sup-

pressors, such as hydroquinones, kojic acid, aze-

leic acid, or emblica, may be considered for

treatment of dyspigmentation and melasma before

laser treatments, particularly in dark phototypes

where nonablative laser therapies require a series

of treatments to achieve satisfactory results.

When considering laser treatment on a patient

with dark skin, a test spot adjacent to the intended

area of treatment may be performed, as individ-

uals of the same ethnicity and phototype may

react differently to the laser depending on variable

skin characteristics.

Test spots should be

started at low-density, low-fluence, and longer-

pulse-duration settings. Full response and side ef-

fects should be observed at 1 month, at which

point scarring and pigment changes will likely be

evident.

PROCEDURAL APPROACH: CHOOSING A

LASER

For historical reasons, one should note the ablative

nonfractionated lasers, including the 10,600-nm

carbon dioxide (CO

) laser, the 2940-nm erbium-

doped yttrium aluminum garnet (Er:YAG) laser,

and the combined CO

Er:YAG laser (see

Table 3

These lasers target the water molecules in the

dermis and vaporize the epidermis. This laser

has the most significant outcomes with significant

improvement of fine wrinkles and acne scars.

However, side effects are a significant issue with

this category of devices and include acne, perma-

nent hypopigmentation, temporary hyperpigmen-

tation, skin infections, and scarring. For these

reasons, ablative nonfractionated lasers should

be used with extreme caution in patients with

Fig. 2.

Dyschromia may present as hyperpigmentation

or hypopigmentation and is one of the most common

treatment goals of laser therapy in ethnic

populations.

Fig. 3.

Laser hair removal. Lasers can be used for treat-

ment of hypertrichosis in all skin types by targeting

the melanin chromophore in the hair follicle with a

low risk of dyspigmentation.

Laser Skin Treatment in Non-Caucasian Patients