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Preparing
your
patients
for Fraxel
Laser
treatments
Cameron
Rokhsar,
MD
Misguided
expectations
are some
of the
greatest
causes of
patient
dissatisfaction.
With every
treatment,
the
ability to
have an
informative
and
interactive
dialogue
between
physician
and
patient is
critical.
After nine
months of
experience
with the
Fraxel SR
Laser, and
more than
130
patients
in 600
patient
sessions,
I can now
better
address
patient
expectations.
Heres
what I
have
learned:
1.
Clinical
Results.
Patients
can expect
to see
immediate
improvement
in
texture,
fine
rhytides,
and
dyschromia.
Perhaps
the most
immediate
result is
improvement
in texture
noticeable
by most
patients
after just
one
treatment.
Improvement
in fine
lines
around the
eyes and
dyschromia
usually
takes a
few
sessions.
While we
see some
change
initially,
the
improvement
continues
over 3 to
6 months.
2.
Returning
to normal
activities.
In
discussing
the
procedure,
I do not
say no
downtime
I say
little,
to no
downtime.
In my
experience,
90% of
patients
are able
to resume
normal
activities
immediately
following
the
procedure.
Invariably,
100% of
patients
experience
erythema
in various
degrees
based on
the
parameters
utilized.
This
usually is
not a
factor in
patients
resuming
their
normal
activities.
However,
some
patients
who have
severe
erythema
as a
result of
more
aggressive
treatment
wait to go
back to
work the
next day.
3.
Discomfort.
All light
based
procedures
that are
effective
have some
degree of
pain
involved.
I do not
tell
patients
Fraxel
Laser
Treatment
is pain
free. In
my
experience,
90% of
patients
will
tolerate
the
treatment
nicely
with the
use of
topical
anesthetic.
Average
pain
scores are
4 to 5.
There are
some
patients
with low
pain
thresholds
and some
who are
very
nervous
about the
treatment.
For these
patients,
I consider
either
using oral
medications,
or in some
cases,
using
blocks. I
have had a
handful of
overanxious
patients
who have
asked me
for pain
supplements.
Ativan 1mg
and
Clonidine
0.1mg have
a nice
synergistic
anxiolytic
and
calming
effect.
This
regimen is
very safe
and I
commonly
use it in
tumescent
liposculpture,
having
learned it
from Dr.
Jeffrey
Klein. I
have only
had one
patient
out of 130
who
required
IM
Demerolฎ
(50mg).
The most
painful
area is
the
perioral
region. I
have
discovered
that for
patients
who have
difficulty
tolerating
more
aggressive
procedures
in the
perioral
area,
adminiSitering
a mental
block
(similar
to when
using
Restylane)
makes the
treatment
much more
tolerable.
One can
also
consider
forehead
blocks
similar to
the ones
used in
hair
restoration
surgery by
injecting
around the
supraorbital
and
supratrochlear
nerves.
Dr.
Cameron K.
Rokhsar
recently
completed
a
dermatologic
surgery
fellowship
with Dr.
Richard
Fitzpatrick
in La
Jolla, CA.
Working
with Dr.
Fitzpatrick,
he treated
more than
130
patients
with the
Fraxel SR
Laser. He
is now in
private
practice
in New
York.
Dr.
Rokhsar:
Patients
can expect
to see
immediate
improvement
in
texture,
fine
rhytides,
and
dyschromia.
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