2017-18 HSC Section 4 Green Book

WU AND FITZPATRICK

tetracaine, for approximately 45 minutes prior to the procedure. Nerve blockade with 1% lidocaine and epinephrine at the supratrochlear, supraorbital, infraor- bital, and submental regions was also applied. When deemed necessary and to further improve anesthesia, light conscious sedation consisting of 2–4mg of midazolam and 25–50 m g of fentanyl was administered intravenously just prior to the procedure. Notable telangiectasia and erythema were then treated with the 595 nm long pulsed dye laser (10mm spot, 3–6ms, 6–8 J/cm 2 ). Next, discrete superficial pigmentary lesions were targeted with the Q-switched 755 nm Alexandrite laser with focused spot and spot size varying by distance from the skin (10 J/cm 2 , 5Hz). We then applied superficial fractionated CO 2 laser (Active FX) to treat fine lines noted to the peri-oral region, the cheeks, and the eyelids (100mJ, 600Hz, 1,300 m m spots distributed utilizing a computer-generated square pattern measuring between 2 and 11mm 2 ). The density used to the peri-oral region was 100% coverage, and one or more passes were applied with wiping away of epidermal debris between passes. The density used to the cheeks was 91%/ 72%/55% coverage sequentially, and the eyelids 72% coverage. Further sculpting of peri-oral lines and any scars was then achieved with the pulsed erbium YAG laser

Fig. 1. Baseline patient characteristics. Clinical parameters were rated according to a four point scale as shown in Appendix 1. Patients presenting for facial rejuvenation had an average pigmentation score of 2.9 1.0. Rhytides were measured at 2.4 1.2. Telangiectasia were 2.1 0.9 and skin texture was 2.6 1.0. N ¼ 50 with data represented as mean SD.

Fig. 2. A – D : Before and after photographs of patients treated with multi-modal laser rejuvenation. The patient in Figure 2C also received 20 units of Botox to the glabella and 90 units of Dysport to the left platysmal band as a one-time treatment during the study.

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