Concurrent use of laser skin resurfacing and punch excision in the treatment of facial acne scarring.

BACKGROUND: Laser skin resurfacing has added to the numerous treatment options available for acne scarring. Adjunct modalities such as punch excision should be considered to enhance treatment outcomes. Traditionally, punch excision and grafting have been performed, followed 1-2 months later by dermabrasion. OBJECTIVE: To determine the effectiveness of laser skin resurfacing and the concurrent use of punch excision performed at the same treatment session in the treatment of acne scarring. METHODS: Twenty-one patients with skin types I-III with mild to severe facial acne scarring were treated with a combination of laser skin resurfacing and punch excision of acne scars in the same treatment session. Baseline, postoperative, and follow-up photographs were taken and evaluated by an independent dermatologist and a laser nurse blinded to patient treatment. In addition, subjective patient assessments of improvement were obtained. RESULTS: There was a range of clinical improvement by the independent assessor of 25-50% in skin type I, 50-75% in skin type II, and 50-75% in skin type III. There was a patient subjective improvement of 25-50% for skin type I, 50-75% for skin type II and 75-100% for skin type III. Postoperative hyperpigmentation was noted in five patients and postoperative hypopigmentation was not seen in any patients. There was no wound dehiscence, evidence of infection, or hypertrophic scarring of treated areas noted on follow-up. CONCLUSION: Laser skin resurfacing with the concurrent use of punch excision improves facial acne scarring. This newly described method negates the need to delay additional resurfacing for a future visit.

Pulsed laser treatment in children and the use of anesthesia.

BACKGROUND: The rationale for choosing certain anesthetic options in children when they are being treated with pulsed lasers is unclear. OBJECTIVE: Our purpose was to assess the safety and side effects of general anesthesia in the treatment of vascular lesions and to compare this to treatment outcome in the office setting. METHODS: We carried out a retrospective chart review of 179 patients, with an age range of 5 weeks to 18 years, who received laser treatment and underwent different anesthetic modalities. The age of the patient and the size, location, and severity of the vascular lesion were also noted. RESULTS: The factors determining the type of anesthesia to use included (1) the age of the patient, (2) the number of treatments, and (3) the size and location of the lesion. Our data showed minimal risk and sequelae of general anesthesia in the treatment of vascular lesions in children. CONCLUSION: Proper selection of anesthesia is a key factor in dealing with children. Office surgery can be performed safely when small lesions are treated. The use of general anesthesia in the treatment of port-wine stains in children does not appear to be accompanied by increased risk.