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STEP-BY-STEP GUIDE
STEP-BY-STEP GUIDE
Every procedure should be preceded by patient education and informed consent. A good outcome depends on both an adequate medical response to therapy and a satisfied patient. Patient satisfaction depends not only on the technical success of the procedure, but also, and sometimes more so, on their expectations. The expectations of the patient and the doctor should be same before beginning any treatment.
Patients should be educated that there are risks associated with every procedure and that no procedure guarantees an excellent outcome every time. The patient must understand that medicine is not an exact science and that there is no guarantee he or she will be satisfied with the end results. Patients should be given time to ask questions and to receive complete answers. One should not proceed with treatment until one feels comfortable with the patientโs understanding and expectations. It is difficult to establish the appropriate physicianโpatient relationship with patients who are unreasonable, overly demanding, or unable to comprehend the basics of treatment planning and outcomes. These types of patients are also the most likely to complain about any aspect
of their treatment.
For the treatment of erythema and telangiectasias, standardized photos with proper and consistent lighting should be taken. Patient consents should be signed and dated prior to procedures. Potential risks include, but are not limited to, purpura, edema, blistering, pigmentary changes, and scarring. Clarification of patient expectations and review of the likely need for multiple treatments and possible maintenance treatments are necessary, and ultimately enhances the patient experience. In addition, patients should be instructed on proper sun-protective measures, particularly for erythema caused by rosacea and actinic damage.
On the face, neck, or chest, patients may or may not receive topical anesthesia. In general, vascular lasers and IPL are well tolerated, so topical anesthesia is not necessarily indicated. Some patients find treatment of large areas of the face sufficiently painful with PDL that they request topical anesthetic. If topical anesthesia is to be used, it is important that it does not contain phenylephrine, as this will cause vasoconstriction of the target vessels. If necessary, cold air blowing devices or application of chilled rollers (Cynosure, Westford, MA) allows comfortable treatment without topical anesthetic. As with any procedure, the skin should be clear of makeup, lotions, creams, or other topical products prior to commencing laser treatment. Patients may clean with soap and water followed by wiping the skin with alcohol pads.
Proper eye protection for patients, assisting staff, and the treating provider is critical. Laser goggles should have an optical density (OD) of at least 4. When treating on the face, it is best for patients to use metal goggles or disposable laser or IPL-rated eye adhesive pads. Treatment within the orbital rim requires the use of intraocular eye shields. Do not use the deeply penetrating Nd:YAG wavelength within the orbital rim.
A laser warning sign should be visible on the outside of the door. Prior to commencing the laser treatment, ensure that the proper foot pedal is in place and recheck the laser settings and cooling. For lasers that have more than one wavelength, recheck the selected wavelength, and that glasses are appropriate. Following treatment, some clinicians apply triamcinolone 0.1% cream and perform a light-emitting diode (LED) 40-second treatment using GentleWaves (LโOreal, Ile-de-France, France) to possibly decrease the inflammatory response.14 Patients should be instructed to call if they have unexpected swelling or bruising. If patients experience significant swelling following treatment, there are a number of adjunctive agents that may be used, including topical steroids, antihistamines, oral prednisone, and diuretics.