NEW ORLEANS – Patients must be psychologically stable to tolerate laser resurfacing procedures, according to Dr. Ronald L. Moy, a board-certified cosmetic surgeon and dermatologist.
“It’s difficult for patients to go through a laser resurfacing, because the skin on their face will look bad for 3 to 4 days, compared to a facelift where things are hidden behind an ear, sutures are neat, and there is very little bleeding,” Dr. Moy said at the annual meeting of the American Academy of Cosmetic Surgery. “Out of all the procedures that we do, it is perhaps most important to screen patients prior to resurfacing procedures.”
It is important to get to know patients and to become familiar with issues that bother them about their appearance. Patient concerns such as skin wrinkling, lax brows, asymmetry, and brow positioning should be discussed. “We as physicians tend to lecture people, but the consultation is the time to get to know them – this is the time you might find out how fragile someone is,” said Dr. Moy, who is based in Beverly Hills, Calif.
Dr. Ronald L. Moy
Having another person in the room might be beneficial, and the use of a mirror can aid in getting patients to talk about skin concerns such as wrinkle lines. “What really bothers them might not be what really bothers us,” he advised. “So these tools can be valuable in addressing the issues that arise from a communication gap.”
Stretching the skin, particularly around the mouth, can simulate the outcome of some laser resurfacing procedures. Simulation programs and before/after photographs also can be used to manage patients’ expectations. It is important to also show photos of results that are not ideal, Dr. Moy advised.
“It’s always better to undertreat and do the procedure again, and to even do a free treatment if you have to, than it is to overtreat and give the patient a scar.” Showing a photograph of your best work might sell the procedure to a patient, but it is important to prepare patients by showing them an average result as well, he added.
Having the patient lie back can simulate blepharoplasty by causing the fat pads to fall backward and flatten. This method is not ideal to simulate the results of laser resurfacing but can be beneficial when procedures are being combined. “In truth, laser resurfacing is usually done with another procedure,” Dr. Moy said. “In my practice, the most common scenario is laser resurfacing and an isolated neck lift, as the popularity of facelifts seems to be decreasing.”
“After you listen to the patient, it’s time to explain to them what the process is going to be like and to warn them of the risk of depression on day 2 or 3 after a resurfacing procedure,” Dr. Moy recommended.
Patient medical history to consider includes any physical or psychological diagnosis, history of medication (over-the-counter, prescription, and herbal), allergies, history of scarring, tolerance for local anesthesia, recent sun exposure (natural or artificial), recent resurfacing procedures (laser, chemical, and/or mechanical), history of herpes simplex (cold sore), current skin care regimen, radiation exposure, and history of tattoo in the area to be treated.
History of isotretinoin (Accutane) also should be discussed. Evidence in the literature of isotretinoin suggests use causing scarring after a resurfacing procedure, so it might be best to advise patients to discontinue its use for several months before resurfacing, he advised.
Certain patients should be ruled out when it comes to laser resurfacing, Dr. Moy stressed. These patients include those who are psychologically unstable, have a history of money troubles, and threaten lawsuits. In addition, avoid rude, unfriendly patients who talk negatively about other surgeons. Patients who do not smile or make eye contact also might be poor candidates, although that isn’t always an accurate assumption, he added.
Other patients to avoid include those who do not listen and only talk, and patients who “know more” than the surgeon. “Often, patients will try to lecture the surgeon based on what they’ve researched on the Internet,” he said. Additionally, those who request surgeries normally reserved for older patients, patients with unrealistic expectations, and those seeking to have surgery for the wrong reasons, such as saving a marriage, should be avoided, Dr. Moy said.
Social factors to consider include a patient’s work and living situation, hygiene, and history of medications, particularly antidepressants. But perhaps most paramount is a patient’s ability to cope, Dr. Moy said. “In the end, screening a new candidate for a laser resurfacing procedure is really about getting to know them, and also using and trusting your gut instinct,” he added.