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Lasers in Dermatological Practice
Kabir Sardana, Vijay K Garg
SECTION 1: CONVENTIONAL LASER INTERVENTIONS
CHAPTER 1:
Basics of Laser-Tissue Interactions
LIGHT
Types of Light Devices
Light Device Terminology
BEAM PROFILES: TOP HAT VERSUS GAUSSIAN
WAVELENGTH RANGES AND CLINICAL APPLICATION
LASER-TISSUE INTERACTIONS
Absorption
Chromophores
Scattering
Practical Implications
Reaction Mechanisms
1. Photothermal Reactions
2. Tissue Ablation
3. Photodisruption
Application
Effect of Cooling
4. Selective Photothermolysis (SPT)
Practical Clinical Applications
How to use the Knowledge Practically?
Exceptions
CONCLUSION
CHAPTER 2:
Ablative Lasers
OVERVIEW
CARBON DIOXIDE LASERS
Principles of Carbon dioxide Lasers
Pulse Duration of Carbon Dioxide Lasers
Types of Lasers
How do the Different CO2 Lasers Compare?
Can a Cw CO2 be Used Like an UltraPulse Laser?
What is the Comparison of UltraPulse CO2 with Conventional Cosmetic Procedures?
Technique Tips
End Points
ERBIUM:YAG LASER
Introduction
Laser-Tissue Interaction
Technique Tips
End Point
Comparison (CO2 vs Er:YAG)
Combination of Er:YAG/CO2
ERBIUM:YSGG LASER RESURFACING
PLASMA SKIN REGENERATION
INDICATIONS
Skin Lesions
Scars
Acne
Post-traumatic/Chickenpox Scars
Dyspigmentation
Wrinkles
TREATMENT
Preoperative
Patient Selection
Smoke Evacuation
Anesthesia
Medication
Intraoperative
Principles
Techniques
Types of Resurfacing Techniques
End Points
Dosage and Settings
Wound Care
Dressings
Post Wound Care
LIMITATIONS OF ABLATIVE LASERS
Er:YAG
CO2 Lasers
CONCLUSION
ABLATIVE LASER TREATMENT OF COMMON CONDITIONS
VARIATIONS IN LASER SETTINGS AND TISSUE EFFECT
High Power Density (PD), Short Exposure Time (Resurfacing mode)
What to look For?
Low–Medium Pulse Duration (PD), Long Exposures in Cw (Defocused Mode)
Lower PDs with Long Exposure Times
Cw (Repeat Mode)
Very Low PDs and Short Exposures
High PDs with Small Spots (0.1–0.3 mm)
Use
Disadvantages
Advantages
TECHNIQUE PEARLS
Cw Vaporization
Cutting Mode
INDICATIONS OF ABLATIVE LASERS
1. Scars
a. Acne/Chickenpox Scars
b. Post-traumatic and Surgical Scars (Elevated Scar)
2. Acne Keloidalis Nuchae
Level of Difficulty
3. Actinic Cheilitis
Step By Step Approach (Fig. 2.15)
Level of Difficulty
4. Rhinophyma
Background
Principle of Surgery/Lasers Used
Step by Step Approach
Pitfalls/Pearls
Level of Difficulty
5. Nevi (Epidermal and Dermal)
a. Epidermal Nevi
Laser Used
Step by Step Approach
Pitfalls/Pearls
Level of Difficulty
b. Nevus Sebaceous
c. Melanocytic Nevi
6. Benign Tumors
Principles
a. Adenoma Sebaceum
b. Neurofibromas
c. Pearly Penile Papules
d. Syringoma
e. Seborrheic Keratoses
f. Sebaceous Hyperplasia
g. Steatocystomas
Step by Step Approach
h. Trichoepitheliomas
i. Xanthelasma
7. Warts
Lasers Used
Step by Step Approach (Plantar Wart)
Step by Step Approach (Common Wart)
Step by Step Approach (Periungual Wart)
Step by Step Approach (Condylomata Acuminata)
Pitfalls/Pearls
8. Excisional Surgery/Debridement
a. Nail Matrixectomy
b. Keloids
c. Hair Transplants
9. Pyogenic Granuloma
Step By Step Approach (Fig. 2.24)
Pearls/Pitfalls
10. Lymphangioma Circumscriptum
11. Vitiligo Surgery
12. Miscellaneous Conditions
CO2 LASER
Preoperative Considerations
Preoperative Regimen
Intraoperative
Technique
Postoperative Care
Pitfalls/Pearls
ERBIUM:YAG
Patient Selection
Pretreatment Regimen
Intraoperative
Treatment Technique
Postoperative Care
Pearls/Pitfalls
CHAPTER 3:
Pigmented Lesions and Tattoos
OVERVIEW
Laser-Tissue Interactions in Pigmented Skin
Wavelengths
Indications
Epidermal Pigmented Lesions
Dermal Pigmented Lesions
TREATMENT APPROACH OF PIGMENTED LESIONS/TATTOO
Prerequisites
Pretreatment Preparation
Steps of Therapy
Dose/Method
Subsequent Sittings
Number of Sittings
Postoperative Course
INTRODUCTION
PIGMENT-SPECIFIC LASERS
LASER-INDUCED RESOLUTION OF TATTOO PIGMENT
VARIABLES EFFECTING TATTOO REMOVAL
Patient-dependent Factors (Kirby et al.)
Tattoo-dependent Factors
Professional Vs Amateur
Color (Tables 3.3 and 3.4)
Location
Age
Skin Type
Scar/Granuloma
Paradoxical Ink Darkening
Non-responsive Tattoo Ink
Undesired Pigmentary Alteration
Laser-dependent Factors
Fluence
Ideal Interval
Sessions
Pulse Duration
Ideal Technique
COMBINATION LASER THERAPY
CONCOMITANT THERAPY
Imiquimod
CONCLUSION
LASERS USED
EPIDERMAL DISORDERS
Lentigines
Lasers Used
Pearls/pitfalls
Level of Difficulty
Labial Melanotic Macules
Laser Used
Level of Difficulty
Nevus Spilus
Level of Difficulty
Café Au Lait Macules
Lasers Used
Pearls/Pitfalls
Level of Difficulty
Ephelides (Freckles)
Lasers Used
Level of Difficulty
Seborrheic Keratoses
Level of Difficulty
Becker's Nevus
Lasers Used
Pearls/Pitfalls
Level of Difficulty
DERMAL DISORDERS
Acquired Melanocytic Nevi
Lasers Used
Protocol Used (Flow chart 3.2)
Pearls/Pitfalls
Congenital Melanocytic Nevi
Lasers Used
Combination of Lasers
Pearls /Pitfalls
Melasma
Lasers Tried
Literature Review
Pearls/Pitfalls
Post-inflammatory Hyperpigmentation
Lasers Used
Pearls/Pitfalls
Nevus of Ota/Ito
Nevus of Ota
Lasers Used
Qsw Lasers
Combination of Lasers
Literature Review
Pearls/Pitfalls
Acquired Bilateral Nevus of Ota-like Macules (ABNOM or Hori's macules)
Lasers Used
Congenital Dermal Melanocytosis
Lasers
Infraorbital Hyperpigmentation (dark circles)
Lasers Used
Qsw Lasers
Ablative Lasers
Fractional Lasers YSGG 2,790 nm
Other Options
Pearls/Pitfalls
Drug-induced Hyperpigmentation
Minocycline Pigmentation
Pearls/Pitfalls
Level of Difficulty
PATIENT SELECTION
PREOPERATIVE STEPS
INTRAOPERATIVE
End Points
Epidermal Disorders
Dermal Disorders
POSTOPERATIVE
PEARLS/PITFALLS
CHAPTER 4:
Fractional Photothermolysis
OVERVIEW
SCIENTIFIC LOGIC
FRACTIONAL VERSUS SELECTIVE PHOTOTHERMOLYSIS
CLASSIFICATION OF FRACTIONAL TECHNOLOGY
Nonablative Fractional Resurfacing (NAFR)
Systems and Devices
Ablative Fractional Resurfacing (AFR)
Systems and Devices
New Fractional Devices
Fractional Ablative Radiofrequency
Results
Intense Focused Ultrasound (Ulthera Inc.)
Fractional Thulium Laser
HOW TO INTERPRET DEVICE DATA ?
VARIABLES THAT AFFECT FRACTIONAL LASER TREATMENT
Size of Wound
Microwound
Macrowound
Wavelength
Pulse Number/Frequency
Pulse Duration
Energy (Fournier et al. and Kono et al.)
Density (Fournier et al. Kono et al.)
Single/Multiple pass (Manstein et al. 2009)
Surface Cooling and Temperature (Laubach H et al. and Fournier et al., 2005)
Correlation of Energy and Depth (Farkas 2009, Sardana K)
INDICATIONS
Treatment
Principles
Preoperative Evaluation/Management
Intraoperative Procedure
Method of Use
Dose
Sittings
Post-operative Instructions
Side Effects
CONCLUSION
AFR vs NAFR
Gray Areas in Fractional Lasers
ACNE SCARS
How do Fractional Lasers Help in Postacne scarring?
Rolling Scars
Ice Pick Scars
Boxcar Scars
Literature Overview and Critique
PHOTODAMAGE SKIN
Mode of Action
Fractional Lasers Used
Literature Overview
Conclusion
RHYTIDES
NON-ACNE SCARS
Conclusion
ACTINIC KERATOSES
STRIAE
MELASMA
Mechanism of Action
Lasers Used
Results
Conclusion
OTHER PIGMENTARY DISORDERS
POIKILODERMA OF CIVATTE
MISCELLANEOUS CONDITIONS
FUTURE OF FRACTIONAL LASERS
PRINCIPLES
PATIENT SELECTION
PREOPERATIVE STEPS
INTRAOPERATIVE
POSTOPERATIVE
PITFALLS/PEARLS
CHAPTER 5:
Vascular Lasers
BACKGROUND
THEORY OF SELECTIVE PHOTOTHERMOLYSIS
LASERS COMMONLY USED TO TREAT VASCULAR LESIONS
Flashlamp-pumped Pulsed Dye Lasers
Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) Laser
Potassium Titanyl Phosphate (KTP) Laser
Argon Lasers
Intense Pulsed Noncoherent Light
INDICATIONS FOR VASCULAR LASERS
PORT-WINE STAIN
INFANTILE HEMANGIOMA
COMMON ACQUIRED VASCULAR LESIONS
Rosacea
Rosacea Staging
Other Facial Telangiectasia
Poikiloderma of Civatte
Venous Lakes
Varicose veins
STEP BY STEP APPROACH
Patient Selection
Preoperative
Intraoperative
Postoperative
PEARLS AND PITFALLS
1. Port-wine Stains
Factors Affecting Treatment Response
Argon Laser in PWS
2. Lasers in Hemangiomas
3. Telangiectasias
CONCLUSION
CHAPTER 6:
Lasers for Hair Removal
INTRODUCTION
Relevant Basics of Hair Anatomy and Physiology
Hair Growth Cycle
Classification of Excess Hair
BASIC PRINCIPLES OF LASER HAIR REDUCTION
Selective Photothermolysis
Ideal Wavelength
Selecting Important Parameters
Wavelength
Pulse Duration
Fluence
Spot Size
Skin Cooling
INDICATIONS OF LASER HAIR REDUCTION
CONTRAINDICATIONS OF LASER HAIR REDUCTION
HAIR REMOVAL: AN EVIDENCE-BASED OUTLOOK
Hair Removal Devices
Home Use Devices
Results of LHR
Evidence for Short-term Efficacy (Up to 6 Months After Epilation)
Evidence for Long-term Efficacy (Beyond 6 Months After Epilation)
PROCEDURE
Preoperative
Intraoperative
Postoperative
SIDE EFFECTS
PEARLS AND PITFALLS
SAFETY ISSUES
Standard Precautionary Measures
SPECIAL SITUATIONS
FUTURE ADVANCES
SECTION 2: ADVANCED LASER INTERVENTIONS
CHAPTER 7:
Nonablative and Subsurface Rejuvenation
INTRODUCTION
Mode of Action
CLASSIFICATION OF LASERS
VASCULAR LASERS
Study Results
INTENSE PULSED LIGHT
Study Results
Summary
LIGHT-EMITTING DIODES
Study Results
INFRARED LASER
Study Results
“In Motion Devices “
PLASMA RESURFACING
Mode of Action
Dose
Indications
Contraindications
Results
CONCLUSION
Do We have the Ideal Device for Skin Rejuvenation ?
How to Choose the Right Device ?
PATIENT SELECTION
Pre-procedure
Procedure
CHAPTER 8:
Nonsurgical Tightening
INTRODUCTION
RADIOFREQUENCY
Combination Devices
Principles of RF
Mode of Action
Variables that Affect RF Penetration
MONOPOLAR DEVICES
Thermage
Mechanism of Tissue Heating
TREATMENT
Patient Selection
Exclusion Criterion
Procedure
Treatment Energy
Treatment Areas
Post-care
Side Effects
Results
Site Specific Improvement
Cellulite
Acne
EXILIS Elite Device
BIPOLAR RF
Aluma
eMatrix
ELOS
Combined Electrical and Optical Energy
HYBRID MONOPOLAR AND BIPOLAR RADIOFREQUENCY
Pelleve® Device (Ellman International, Oceanside, NY)
UNIPOLAR RF
The Accent (Alma Lasers, Inc, Ft Lauderdale, FL)
MULTIPOLAR NONCONTACT RF DEVICE
Vanquish (BTL Aesthetics, Prague, Czech Republic)
CONCLUSION
INFRARED LIGHT DEVICES
ULTRASOUND DEVICES
CONCLUSION
CHAPTER 9:
Aesthetic Intense Focused Ultrasound (IFUS): Clinical Perspective on Fitzpatrick Skin Types III–VI
INTRODUCTION
PHYSICS AND INSTRUMENTATION
TISSUE EFFECT AND CLINICAL APPLICATION
ULTHERA
PATIENTS OF COLOR (FITZPATRICK SKIN TYPES III–VI)
CONCLUSION
CHAPTER 10:
Noninvasive Body Contouring
INTRODUCTION
CELLULITE
Assessment Tools
Treatment of Cellulite
LASER LIPOLYSIS
Assessment Tools
INDICATIONS AND CONTRAINDICATIONS OF NON INVASIVE BODY CONTOURING
Indications
Contraindications
TREATMENT DEVICES
Suction/Massage Devices
Radiofrequency Energy Devices
How do they Work?
VelaSmooth® and VelaShape®
Unipolar RF Devices
Tripolar Radiofrequency
Conclusion
High Intensity Focused Ultrasound (HIFU)
How does it work ?
Ultrashape
LipoSonix™
Summary
Lightbased Devices and Laser-assisted Lipolysis (LAL)
How Does it Work ?
Devices Used
PROCEDURE
Contraindications
Preoperative Workup
Techniques
Advantages of Laser-assisted Liposuction
Limitations of Laser-assisted Liposuction
Summary
Selective Cryolipolysis
How Does It Work?
Results and Summary
Conclusion
Acoustic Waves
Indications
Results
ISSUES AND CONTROVERSIES WITH NONSURGICAL SCULPTING
CHAPTER 11:
Lasers for Scars, Keloids, and Stretch Marks
INTRODUCTION
ETIOPATHOGENESIS
Types of Scars
Hypertrophic Scars
Keloids
Atrophic Scars
Prescars
APPROACH TO THERAPY
Hypertrophic Scars and Keloids
PDL
Fractional Laser
Conclusion
Atrophic Scars
1. Ablative Lasers
2. Nonablative Lasers
3. Fractional Lasers
Prescars
CONCLUSION
STRIAE DISTENSAE
Role of Laser Treatment
Lasers Used
Fractional Lasers
Other Devices
Conclusion
SECTION 3: PRACTICAL ASPECTS AND ADVANCES
CHAPTER 12:
Miscellaneous Laser Responsive Disorders
INTRODUCTION
ACNE
Mode of Action
Summary
BENIGN TUMORS AND CYSTS
Epithelioma Adenoides Cysticum (Trichoepithelioma)
Fibrous Papule of the Nose
Koenen Tumors
Neurofibromas
Seborrheic Keratoses
VIRAL DISORDERS
Lasers Used
INFLAMMATORY DISORDERS
Angiolymphoid Hyperplasia with Eosinophilia (ALHE)
Laser
Darier Disease
Lasers Used
Dermatomyositis
Eczema
Elastosis Perforans Serpiginosa
Granuloma Annulare (GA)
Granuloma Faciale (GF)
Hailey-Hailey Disease
Lichen Sclerosus
Lupus Erythematosus
Necrobiosis Lipoidica
Nodular Amyloidosis
Sarcoidosis
Lasers Used
Conclusion
Psoriasis
Indications
Advantages
Summary
PIGMENTARY DISORDERS
Vitiligo
Lasers Used
Advantages
Disadvantages
Results
Other Indications of Excimer Laser
Conclusion
Lasers and Melanocyte Grafting
Lasers for Inducing Leukoderma
HAIR DISORDERS
Alopecia
Basic Science of LLLT
Conclusion
NAIL DISORDERS
Mode of Action of Lasers
Laser Used
Future
VASCULAR DISORDERS
Spider Hemangiomas
Angiokeratomas of Fordyce
Glomus Tumor
Telangiectasias
Venous Lakes
WOUND HEALING
Lasers for Acute Wounds
Lasers for Chronic Wounds
Conclusion
MALIGNANT AND PREMALIGNANT DISORDERS
Zoon's Balanitis
Basal Cell Carcinoma/Squamous Cell Carcinoma
1. Ablative Lasers (CO2 and Er:YAG)
2. Nd:YAG
3. PDT and Similar Approaches
Erythroplasia of Queyrat/ Bowen's Disease
Paget's Disease
Parapsoriasis/Mycosis Fungoides
CONCLUSION
CHAPTER 13:
How to Start a Laser Practice (Private Setup)
SYSTEM SPECIFICATIONS
DEALER RELIABILITY
AVOIDING COMMON MISTAKES
CONCLUSION
FURTHER READING
CHAPTER 14:
How to Set up a Laser Clinic in a Public Funded Institution
INTRODUCTION
WHY BUY LASERS?
WHICH LASERS TO BUY?
Ablative Lasers
Pigment Specific
Vascular Laser
Fractional Laser
Hair Removal Lasers
Excimer Laser
Subsurface Lasers, RF, Laser Lipolysis, LLT
TO DELEGATE OR NOT TO DELEGATE?
LASER PROCUREMENT IN GOVERNMENT INSTITUTIONS
Regulatory Approvals
FDA 510(k) Clearances
Looking Beyond the Price
What Has Been Published on the System/Technology?
CONCLUSION
CHAPTER 15:
Therapeutic Pearls in Lasers
ACNE SCARS
Keloids
Epidermal Nevi
PIGMENTED LESIONS
Melanocytic Nevus
Freckles
Tattoo
HAIR REMOVAL LASER
Procedure
Postprocedure
COMPLICATIONS IN LASER SURGERY
Postinflammatory Hyperpigmentation
Hypopigmentation
TECHNICAL ASPECTS
CHAPTER 16:
Medicolegal Aspects of Lasers in Dermatological Practice
INTRODUCTION
TYPICAL COMPLICATIONS
WHO IS QUALIFIED TO DO LASER SURGERY?
VICARIOUS LIABILITY
CIVIL AND CRIMINAL NEGLIGENCE
Components of Medical Negligence
Duty
Dereliction of Duty
Damage
Direct Causation
HOW TO PREVENT MALPRACTICE CLAIMS
Patient Information and Documentation
Training
Do not Make Unrealistic Claims
Handling the Press
HOW TO HANDLE A MALPRACTICE CLAIM IF IT DOES OCCUR?
Countersuits
Alternative Dispute Resolution (ADR)
Mediation and Arbitration
Mediation
Arbitration
Pretreatment Arbitration Agreement
Benefits of Mediation and Arbitration
CONCLUSION
CHAPTER 17:
Complications and their Management
INTRODUCTION
COMMON DEVICES AND THEIR COMPLICATIONS
OVERVIEW OF COMMON COMPLICATIONS
Pain
Prevention and Treatment
Erythema and Edema
Prevention and Treatment
Crusting and Vesiculation
Prevention and Treatment
Purpura
Prevention and Treatment
Dyspigmentation/Post-inflammatory Hyperpigmentation (PIH)
Prevention and Treatment
Hypopigmentation
Scarring
Causes
Prevention and Treatment
LASER SPECIFIC COMPLICATIONS
Fractional Lasers
LASERS FOR HAIR REMOVAL
Hypertrichosis
Leukotrichia
Reticulate Erythema
Urticarial-like Plaques
Burns
LASERS FOR PIGMENTED LESIONS
Leukotrichia
Tissue Splatter and Pinpoint Bleeding
Pigmentary Alterations
Tattoos
Allergic and Photo-allergic Contact Dermatitis
Combustion
Paradoxical Tattoo Darkening
LASERS FOR VASCULAR LESIONS
Reticulated Purpura
ABLATIVE LASERS
CONCLUSION
CHAPTER 18:
New Aspects and Controversies in Lasers
INTRODUCTION
LASERS FOR PIGMENTED LESIONS
Are We Near a Perfect Method for Tattoo Removal?
Nevus of Ota
Melasma
Do We Finally Have Laser Treatments That Truly Work?
FRACTIONAL LASERS
Histological Depth
Aspect Ratio and Depth
Acne Scars
Is Nonablative Fractional Laser Inferior to Fractional Ablative Lasers ?
Complications of Fractional Lasers
Is Ultrapulse CO2 Better Than Superpulse CO2
Will Nonablative Rejuvenation Replace Ablative Lasers
Novel Wavelengths
1565 nm
1940 nm Nonablative Fractionated Laser
LASERS FOR SCARS
Traumatic Surgical and Burn Scars: What Have We Learned?
Striae Distensae
LASERS FOR HAIR REMOVAL
LASERS FOR VASCULAR INDICATIONS
NONSURGICAL SCULPTING
MICROFOCUSED ULTRASOUND WITH VISUALIZATION
Acne
NOVEL WAVELENGTHS
Sebaceous Glands
Wavelength 1210 nm
LASER TREATMENT FOR AXILLARY HYPERHIDROSIS
HOME USE DEVICES
Fractional Devices
Hair Growth Devices
Hair Removal Devices
Acne Therapy
TRASER
Applications
CONCLUSION
ACKNOWLEDGEMENTS
APPENDIX 1:
Laser Safety/Eye Care
CLASSIFICATION OF LASERS*
WARNING SIGNS AND LABELS
1. Display of Warning Signs
2. Inclusion of Pertinent Information
Eye Safety
IMPLEMENTATION OF LASER SAFETY
Eye Safety Standards
Laser Safety Standards
Understanding the Laser Safety Eyewear Rating
APPENDIX 2:
Consent Form
APPENDIX 3:
Procedure Checklist
PREOPERATIVE CHECKLIST
INTRAOPERATIVE CHECKLIST
POSTOPERATIVE CHECKLIST
APPENDIX 4:
Postoperative Care
COOLING
DRESSING
SCAR PREVENTION/INFECTION CONTROL
OVERVIEW OF POSTOPERATIVE CARE
1. First 2 Days
Interventions
2. Next 3 Days to 1 Week
Interventions
3. Next 14 Days
Interventions
4. Next 3–4 Weeks
Interventions
5. Beyond 4 Weeks
Interventions
APPENDIX 5:
Sample Operative Note
PROCEDURE
APPENDIX 6:
Sample Postoperative Instructions (Ablative Lasers)
CONTINUOUS WAVE AND PULSED CO2 LASERS
AFTER 1 WEEK
APPENDIX 7:
Patient Information Sheet
PATIENT INFORMATION SHEET (HAIR REMOVAL)
Which Methods of Hair Removal are Possible?
Laser Hair Removal
What is the Treatment like?
What Aspects Must be Considered Before the Treatment?
What Aspects Must be Considered After the Treatment?
PATIENT INFORMATION SHEET (PIGMENTED LESIONS/TATTOO)
What Happens if You Get a Tattoo?
How Does a Laser Device Function?
How Does the Laser Function in such a Treatment?
What Is the Treatment Like?
What Aspects Must be Considered Before the Treatment?
What Aspects Must be Considered After the Treatment?
PATIENT INFORMATION SHEET (VASCULAR LESIONS)
How Does a Laser/Flashlamp Treatment Works?
What is the Treatment Like?
What Aspects Must be Considered Before the Treatment?
What Aspects Must be Considered After the Treatment?
PATIENT INFORMATION SHEET (ABLATIVE LASERS/FRACTIONAL)
Which Skin Lesions can be Treated by Means of an Ablative/Fractional Laser?
How does the Laser Ablation Function?
What is the Treatment Like?
Fractional Lasers
What Aspects Must be Considered Before the Treatment?
What Aspects Must be Considered After the Treatment?
PATIENT INFORMATION SHEET (RADIOFREQUENCY)
What Does Skin Ageing Mean?
How Does a Radiofrequency Device Function?
How Does the Radiofrequency Treatment Function?
What is the Treatment Like?
What Aspects Must be Considered Before the Treatment?
What Aspects Must be Considered After the Treatment?
APPENDIX 8:
Local Anesthetics
LIDOCAINE
Mechanism of Action
Pharmacology
Absorption and Distribution
Clinical Use in Dermatology
Usage Guidelines
Infiltration
Special Considerations
Measures to Reduce Pain
Adverse Effects
Common
Rare
Special Groups
LIDOCAINE AND TETRACAINE
Classification
Chemical Class
Mechanism of Action
Pharmacology
Absorption and Distribution
Usage Guidelines
Important Note
EUTECTIC MIXTURE OF LOCAL ANESTHETIC (EMLA)
Chemical Class
Absorption and Distribution
Pharmacology
Clinical Use in Dermatology
Usage Guidelines (Box A8.1)
Special Considerations
Adverse Effects
Common
Rare
Skin
Methemoglobinemia
Special Groups
Children
APPENDIX 9:
Select Bibliography
JOURNALS
INDEX
TOC
Index
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