A total of 20 patients underwent aggressive Erbium:YAG laser resurfacing for rejuvenation of photoaged skin or acne scars. A 2.0 joule laser systems was utilized for all patients (Continuum Biomedical, Dublin CA). A variety of fluences were used, to produce varying depths of ablation, but most patients received 1-3 freehand passes at 20J/cm2 with the 3.5mm spot, with the exception of the periorbital region where fluences of 5-10J/cm2 were utilized.

Patients were anesthetized with Betacaine LA® (contains a eutectic mix of short and long acting lidocaines and a vasoconstrictor applied for 1 hour pre-op after degreasing the skin with Clinical Care solution 4.0% tetracaine spray was used as needed between passes. All patients used an AHA preparation (M.D. Forte I®) for at least 4 weeks prior resurfacing. All patients were prophylaxed pre-operatively with the application of Mupirocin® ointment (Bactroban®) to their nares for 3 days prior to their resurfacing procedure.

Post-operatively, the patients were treated with a biO2 Post Laser Recovery Program (Beverly Hills, CA). This system (Fig.1) consists of a surgical stainless atomizer connected to an oxygen tank. Treatment session takes 15 minutes and deliver a cool, soothing mist to the wounded skin. The protocol used in this series included immediate post-op application of biO2 oxygen mist spray (Oxy-Mist) containing AminoPlex® (amino acids, electrolytes, essential trace minerals, nucleotides, nucleosides, and oligopeptides, micellized Vitamin E and an activator), followed by application of blue tinted white petrolatum with dimethicone (Protective Recovery Balm).

Patients were instructed to avoid cleaning or traumatizing their skin the first day post-operatively to reduce bleeding and irration of their skin. Excess exudate was simply blotted off their face gently with sterile 4x4 gauzes and sterile water. Patients were seen on a daily basis post-operatively. Each day, their wounded skin was gently debrided with the gauze soaked with Clinical Care solution ( Care Tech Laboratories, St. Louis, MO., benzethonium chloride 0.1%, water, amphoteric 2, aloe vera gel, DMDM hydantoin, and citric acid), followed by Oxy-Mist Treatment and application of blue tinted white petrolatum (Protective Recovery Balm). After 24 hours, patients were allowed to gently cleanse their wounds at home with a mild cleanser, Rinseable Azulene Cleanser (wheat germ oil, azulene, PEG40 sorbitan perolate, parabens) that effectively removed gross excess exudate and petrolatum.

They were allowed to shower off after cleansing before each Clinical Care and Oxy-Mist session. This procedure was continued on a daily basis until re-epithelialization was complete. Meticulous post-op handwashing and hygiene was emphazised, and Protective Recovery Balm was applied to the skin with sterile Q-tips and clean hands to avoid contaminating the wound ointment.

Results: Patients in this series underwent Erbium:YAG laser resurfacing for either photoaged skin or acne scars (Tabled1). The procedure was tolerated, for the most part, without difficulty. A few patients noted mild stinging after the immediate post-op treatment session and occasionally during subsequent treatments, however, the majority found the treatments to be very soothing and cooling and looked forward to the treatment sessions. Three patients (Table1) reported significant reactions after Clinical Care solution debridement of the skin and developed intense erythema and edema, consistent with a contact urticarial-type reaction. These three patients were unable to tolerate further Oxy-Mist sessions and required short courses of oral steroids and open wound healing with Aquaphor Healing Ointment. Despite these reactions, wound healing in all cases was rapid with re-epithelialization occurring in 5 to 7 days without incident (Fig. 1-5). No complications of secondary infection or irritant allergic reaction were noted in the other 17 patients.