Fractional Laser and Erbium Treatment Protocol

Pre-Treatment Recommendations:

No direct sun exposure for at least two weeks prior to the treatment other than normal sun exposure. Do NOT intentionally tan or spend significant time in the sun without total sunblock, not sunscreen.
Do not use self-tanners. Your skin should be as light as possible prior to the treatment.
Prepare your skin for surgery with Alastin Nectar. Use 1 pump (pea size) for each side of the face and spread a THIN layer all over face twice daily. Begin 14 days before your procedure date.
Make sure your room is free from direct sunlight. (Blinds and drapes are sufficient.) Use freshly laundered (non-precious) linens on your pillow. Use disposable pads or clean, soft towels to protect pillows/pillowcases. - Have all prescriptions, supplies, and your skin care products ready.
Stay away from yard work, soil, plants, flowers for the week after treatment. Please review below carefully and make sure all of your questions are answered.

2 WEEKS BEFORE TREATMENT:

Discontinue use of topical retinols, Retin-A/Renova/tretinoin, glycolic or other hydroxy acids, and any anti-aging products.
Discontinue excessive sun exposure: you should not have sunburn or significant suntan. Wear minimum SPF 30 daily and follow other sun protection measures such as avoiding midday sun and wearing a hat and sunglasses.
Avoid spray tanning in the treatment area.
Begin 5% Hydroquinone cream prescription (if needed)

1 WEEK BEFORE TREATMENT:

Discontinue aspirin or other nonsteroidal anti-inflammatory medications such as Motrin, Ibuprofen, Aleve. You may take Tylenol (acetaminophen) for discomfort.
Discontinue Vitamin E, omega 3 fish oil supplements, and let us know if you are on any other herbal or non-prescription supplements. - Be sure to purchase supplies needed for post-procedure care.

DAY OF TREATMENT:

Start prescription antiviral medication: Valacyclovir 500 mg twice daily x 7 days.
Start antibiotic: Doxycycline Monohydrate 100 mg twice daily x 7 days. Alternative if allergy to Doxcycycline then Bactrim DS (if no sulfa allergy) twice daily x 7 days.
Start Diflucan 200 mg 1 daily x 7 days.
Start Prednisone 20 mg 1 daily x 5 days.
Start ondansetron 4 mg at time of procedure.
Take 1 x 5mg Valium as instructed at the facility. PLEASE BRING MEDICATION TO PROCEDURE. - Take all medications with food and separately.
Please come to the office with no makeup, no contact lenses, and your hair back away from your face and neck in a band or tie. Wear a lower-cut, buttoned shirt or one that easily comes off.
Bring a wide-brimmed hat or scarf and sunglasses. It is ok to eat prior to the procedure.

WHAT TO DO: DAY 1-2

Avoid hot water, strenuous exercise, hot tubs, swimming pools.
No direct shower to face and neck for 48 hours after the procedure.
No face cleansers, use dilute vinegar soaks ONLY.
Hand-washing is the most important thing you can do to prevent infection. Wash your hands every time before you touch the treated area.
Begin diluted vinegar soaks every 3-4 hours. You will space these out over the week. (Follow the given instructions attached.) Focal areas with crusting/bleeding may be gently dabbed with additional vinegar-water-soaked gauze, and then patted dry. Do not rub or scrub during this time.
After the vinegar soaks, apply a thin layer of Alastin Soothe and Protect to the entire treated area.
Soothe and Protect can be reapplied additionally between soaks as needed for hydration. (Skin should be maintained with a thin slippery layer of Soothe and Protect until healed).
Keep your head elevated as much as possible (on 2 to 3 pillows) for the first few nights to help reduce swelling and promote healing.
Finish all of your oral medication as prescribed.
For any itching, take Benadryl 25 mg at night during the first 48 hours - Tylenol 500 mg, every 6 hours (not to exceed 3,000mg/24 hours) for any discomfort.

REMAINDER WEEK 1

Remember to finish all of your oral medication as prescribed.
Taper off vinegar soaks at the end of the first week.

WHAT TO DO: WEEK 2-4

TWICE DAILY:

1. Clean entire laser areas thoroughly with cool water and Alastin Ultra Calm Cleanser. Pay close attention to all scabs and crust – these must be loosened with gauze or Q-tips. It is better to have new oozing that to leave the crust/scab.
2. After cleansing, apply Alastin Nectar over treated areas and blend. Let dry for 2 minutes.
3. After drying, apply Soothe and Protect over treated areas. Use pea size amount but spread thoroughly to provide moisture and seal to the Nectar.
4. You may also use Soothe and Protect on lips and upper eyelids as needed.
5. Important: Practice sun avoidance and start applying Alastin Silk Sheild SPF. Restart 5% hydroquinone cream once or twice daily as tolerated. - It is okay to use cover up makeup if needed to conceal, avoiding liquid foundation as this may clog pores.

Products Recommended:

Alastin Procedure Enhancement Kit (Includes all Alastin products listed below):

Skin Nectar
Ultra Calm Cleanser
Ultra Light Moisturizer
Silk Shield SPF 30
Alastin Soothe and Protect

WHAT YOU MIGHT EXPERIENCE AFTER THE PROCEDURE:

Redness and swelling: are most common. While swelling may resolve within 1 week, redness usually becomes very faint by one month, and may last up to 3 months. Redness can be worsened by certain skin products and heat. Sun protection is very important.
Exudates/bleeding/crusting: Clear/golden fluid (exudates) or blood may ooze from your skin. Frequent wound cleaning and Soothe and Protect application during the first days post procedure is critical in preventing crusting. Do not rub/scrub.
Dry skin and sloughing: are usually experienced 2-7 days post procedure. After wounds close in 48 hours, you may continue with a thinner layer of Soothe and Protect to help relieve dry skin.
Acne or milia formation: Flare-up of acne or formation of milia possible and may appear 2-4 days post treatment. This is usually self-limiting and resolves within one week. Do not pick at any lesions
Heat/discomfort: may linger after the procedure is completed. This is typically self-limiting within hours, or the first few days.
Risk of infection: from bacterial, viral or fungal agents exists despite our best preventative effort. Wash your hands and keep your environment clean. Avoid touching your face other than instructed.
Scarring: may occur from crusting, infection, or simply being exposed to laser. This risk is extremely low with the Fractionated and Erbium laser.
Itching: usually occurs as a part of the normal wound healing process, but may occur as part of infection, poor wound healing, or contact dermatitis. This usually occurs 3-4 days post procedure and may last up to one week. Cold compresses (20 minutes on and off) as needed to alter sensation can help. An oral antihistamine such as Zyrtec or Benadryl can also help. A steroid cream such as hydrocortisone twice a day can help. These additional medications should only be used as directed by your practitioner.
Pigmentary changes: After treatment, skin may appear darker (hyperpigmentation) or lighter (hypopigmentation) than before. Although most changes are transient, it could be permanent.
Ectropion: Very rare is a downward pull of the eyelids that could result after treating the around-the-eye area. Again, this risk is extremely low with the Fractionated CO2 laser.
Non-responsiveness to laser treatment: Your skin condition may not be corrected or may worsen.

Call us if you experience any one of the following: If you cannot reach us and it is an emergency, call 911

If you are uncertain or have questions:

Pain that is not relieved by Tylenol.
Oozing beyond 48 hours or shallow ulcers.
Excessive redness, swelling, bleeding, and/or crust or scab formation.
Excessive itching, especially when accompanied by signs of infection.
Signs of infection: whitish to yellowish film on treated area, with or without foul odor.
You may also develop a fever of 100.4F or above.

VINEGAR SOAK INSTRUCTIONS:

What you need:
[ ] Dry gauze
[ ] Bottled water 16 oz
[ ] A clean container
[ ] White distilled vinegar 5%
[ ] Measuring spoon
[ ] Soothe and Protect

Steps:

Remove 2 tablespoons of water from the bottled water (making room for the vinegar).
Add 2 tablespoons of vinegar to the bottled water.
Shake gently to mix.
Mark the bottle as "vinegar water" to avoid confusion and place it in the fridge.
Place 10 – 20 gauze pads inside Tupperware. Sanitize the container between uses.
Carefully add in vinegar water until all gauzes are saturated.

To Apply:

Remove oozing/bleeding with gauze, using gentle pressure –
Keep vinegar water in contact with skin for at least 5 minutes, longer for areas with crusting.
Pat dry.
Apply Soothe and Protect after each cleansing.

Frequency:

First day, every 2-3 hours
Not necessary to set alarm to wake up during the first night for cleansing, only for comfort
After 24 hours, every 3 -4 hours
After 48 hours, soak three times a day and continue Soothe and Protect. After the second appointment, taper to two times daily.
For 1 week, continue vinegar soaks twice a day and then stop when skin condition returns to normal. if you have excessive swelling contact the office immediately at

512-339-1661 during business hours. For increased redness swelling or uncontrolled pain please visit an after hours medical provider.