1. Ablative laser skin resurfacing Dr.Ali A. Maazil Plastic and reconstructive surgeon in Alssadar medical city In Al Najaf 2012

2. Years of damaging UV light exposure  Clinical  Histological

3. Clinical manifestations  Roughened surface texture  Variable degrees of dyspigmenations  Telangiectasia  Wrinkles  Skin laxity

4. histologically These extrinsic aging effects are usually limited to the epidermis and upper papillary dermis

5. Techniques for treatment of photo damaged skin  Derma abrasion  Chemical peel  Laser resurfacing

6. How we can choose the most appropriate technique  Severity of photo damage and rhytides  The expertise the laser surgeon  Expectations and life style of the patient

7. What is ablative laser resurfacing?  Initial vaporization of epidermis and or partial dermis  Resultant open wound with exposed dermis  Normal wound healing,exudate,edema and inflammation phases  New epidermis via re epithelialization from adnexal structures  New collagen and elastin production  Neo-vascularity

8. Where laser resurfacing excels  Periorbital region and lower eye lids  Perioral region and lips  Actinic chelitis  Acne scar

9. Patient CM : Right Eye SmartXide treated (Power) 30W Dot Mode Spacing 200 μm Scanning well Time 500 μS 2 passes under R eye with obvious reduction in rhytides and neocollagenesis

12. Who is the ideal patients for ablative resurfacing  Skin photo type I and II,  Cutaneous lesion amenable to treatment with resurfacing laser.  Realistic expectations of resurfacing procedure.

13. Preoperative preparation  Bleaching agent  Retinoic acid compounds  Antibiotics  Anti viral agents

14. Ablative skin resurfacing  Carbon dioxide 10,600  Erbium YAG laser 2,940

15. Characteristics of co2 laser  Invisible,mid infrared emission  Wave length 10,600  Water is primary chromphore  Collagen is secondary chromophore  Effect is independent of skin colour  Delivery by mirrored joints, articulated arms

16. Characteristics of co2 laser  Coagulation and cutting  Resurfacing is gold standard  Longer healing time, redness  Hypo-pigmentation

17. Erbium:YAG  Wave length 2940  More affinity for water than co2 laser  Less effective haemostasis  Less thermal diffusion  Less collagen contraction  Can combined with co2

19. Post operative care  Dressing  Pain killer  Anti inflammatory

21. Pitfalls and their management 1) Proper patients selection 2) Has patient ever had the areas treated before 3) What is the patients skin prototype? 4) Dose the patients had history of H.L.

22. Pitfalls and their management  Autoimmune or other immunological deficiency  Other Dermatological conditions  Any medication  History of hypertrophic scar and keloid  Patients prone to acne  Patients expectations

23. Side effect and complications of ablative laser resurfacing Expected side effect mildModerateSever erythemaExtended erythemainfectionshypopigmentation OedemaMila ad acehyperpigmentationHyper trophic scar pruritusContact dermatitisEctropin

25. Thank you