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    Wrinkles and acne: What device works best?


    Dr. Troell’s Laser Skin Resurfacing Treatment Protocol

    “This is my current validated clinical treatment protocol that practicing aesthetic physicians may find useful in their own practice,” Dr. Troell says.


    • Timing of laser treatment is best between September 15th and April 15th to avoid summer sun.
    • Four to six weeks prior to treatment, if Fitzpatrick skin classification IV or V (VI is not treated by CO2 laser), test patches are performed at four different energy settings (two behind each ear).
    • One week prior: Cleansing facial with extractions and either a combination of chemical peels (usually mandelic and salicylic), dermal planning, and/or microdermabrasion (in that order if multiple esthetician treatments).
    • Two days before treatment: Acyclovir 800 mg twice daily. 

    Day of Treatment

    • Patient does not wear makeup.
    • Gentle facial cleansing in office.
    • Confirmed laser treatment anatomical areas (face, neck, décolletage).
    • Review home skin treatment regimen (written instructions included).
    • Look at laser test patch areas (if performed) to assess the absence or presence of hyperpigmentation to guide laser treatment settings.
    • Application of topical anesthetic cream for two hours (7% tetracaine/7% lidocaine). (Use of Pliaglis (Galderma) topical anesthetic cream appeared to achieve better anesthesia and is easier to remove, since it hardens to a thin film.)
    • Blood draw for platelet rich plasma (PRP) centrifugation.
    • Administration of oral sedation and analgesic medications (hydrocodone 5-10 mg and lorazepam 1-2 mg) 30 minutes prior to treatment.
    • Topical anesthesia is removed.
    • Trigeminal sensory nerve blocks are performed. 1-2 cc of local anesthesia is injected into each nerve (supra-trochlear, supra-orbital, zygomatico-facial, zygomatico-temporal, infra-orbital, anterior superior alveolar and mental nerves bilaterally). Local anesthetic (10 cc) is composed of 4 cc 1% lidocaine with epinephrine, 5 cc 0.25% bupivacaine with epinephrine and 1 cc of 8.4% sodium bicarbonate.
    • CO2 laser settings decided. This is the most important aspect to optimize treatment outcome. Per physician experience with the specific type of CO2 laser, the maximum energy settings are chosen given the underlying skin pathology (wrinkle severity/acne scarring) and Fitzpatrick skin classification. Laser energy levels are lower in darker skin patients to minimize risk of hyperpigmentation. Laser energy levels are higher in severe wrinkle or acne scarring patients to optimize outcomes.

    Immediate Posttreatment

    • Apply iced moist cold towels (towels soaked in water and placed in freezer for about ten minutes) topically for about five minutes.
    • PRP (6-7 cc) is mixed with 2 cc of calcium gluconate for activation (not required if injecting).
    • Topical PRP is placed on the treated area and massaged into the skin.
    • Moisturizer is placed topically.
    • Patient is discharged home.

    Posttreatment Skin Care Regimen

    • Acyclovir 800 mg twice daily for eight days posttreatment
    • Sun avoidance (as much as possible)

    DAY 1 to 3

    • Gentle skin cleanser: Use twice daily.
    • Alastin Skin Nectar
    • Alastin Occlusive Moisturizer (Vaseline or Aquaphor alternatives)

    DAY 4 to 14

    • Gentle skin cleanser: Use twice daily.
    • Alastin Skin Nectar
    • Alastin Moisturizer (non-occlusive moisturizer alternatives)
    • Alastin Broad Spectrum Sunscreen (SPF 30+ sunscreen alternative)

    Day 14 to 6 weeks

    • Human Stem Cell cytokine cream (Stemulation or Regenica, Suneva Medical), if chosen by patient in the treatment regimen. Cost sometimes limits addition.
    • Alastin Moisturizer (non-occlusive moisturizer alternatives)
    • Alastin Broad Spectrum Sunscreen (SPF 30+ sunscreen alternative)

    Weeks 3 to 8

    • If observed hyperpigmentation occurs (most common time to observe start of hyperpigmentation) or for at-risk patients Fitzpatrick type III, IV or V), add IS Clinical White Lightening cream [Innovative Skin Care] at night to resolve or prevent hyperpigmentation.

    Disclosure: Dr. Troell has relevant financial relationships with Venus Concept, Eclipse Aesthetics and Sound Surgical Technologies (Valeant). He’s on the speakers’ bureau for Alastin Skincare.

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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