Maximizing results and safety of aggressive resurfacing procedures requires painstaking postprocedural care, says Dallas-based plastic and reconstructive surgeon A. Jay Burns, M.D. His favorite postoperative wound dressing is no longer available; so he says he has had to reconfigure this portion of his treatment regimen to include gas-permeable silicone gels.
Without meticulous postoperative wound care, the most careful, well-researched resurfacing technique will fail.1 He shared an anecdote following a teaching experience in France many years ago at which he said he resurfaced to 600-800 μ deep in places. Years later, the French surgeon hosting the conference told him he no longer performed such aggressive procedures because the two patients that Dr. Burns had treated developed thick postprocedural scarring along the mandible. He asked if the post-procedural care was carried out as he had showed but was told the patients were left to scab.
“Can you imagine going that deep and just letting them scab up?” he asks.
Dr. Burns says he was a huge fan and frequent user of Flexan (Polymedical Industries) occlusive dressing, which is no longer produced.
His post-procedural regimen, described in January 2019 in Plastic & Reconstructive Surgery,2 includes applying Flexan after aggressive erbium: YAG resurfacing. On postoperative day one, he would remove the flexible sheet, meticulously debride the underlying skin and replace the existing dressing. On day three, he would debride again and instruct patients whose wounds were healing well to use petrolatum or an EltaMD (Colgate-Palmolive) post-laser kit to keep the skin moisturized. If patients were noncompliant or had slow-healing wounds, he typically replaced the dressing on day three and removed it on day five.
Dr. Burns is a consultant for Sciton.
1. A Jay Burns MD. “Best Practice to Heal Compromised Skin Immediately after Deep Laser Resurfacing Procedures,” The Cosmetic Bootcamp. June 21, 2019. Aspen, Colorado.
2. Sanniec K, Afrooz PN, Burns AJ. Long-term assessment of perioral rhytide correction with erbium: YAG laser resurfacing. Plast Reconstr Surg. 2019;143:64-74.
3. Sriprachya-Anunt S, Fitzpatrick RE, Goldman MP, Smith SR. Infections complicating pulsed carbon dioxide laser resurfacing for photoaged facial skin. Dermatol Surg. 1997;23:527-35.
4. Gold MH, Biron J, Thompson B. Randomized, single-blinded, crossover study of a novel wound dressing vs current clinical practice after percutaneous collagen induction therapy. J Cosmet Dermatol. 2019;18:524-529.