LASER FOR AGE SPOTS, FRECKLES, PIGMENT, AND "LIVER SPOTS"

NATURE OF THE PROCEDURE

The laser is a beam of light that will selectively target certain tissues based on the wavelength chosen. We know from experience that brown color selectively absorbs a wavelength of 511 to 532 nanometers (billionths of a meter).

When that happens, the light turns into heat and the heat selectively destroys just that targeted tissue. The skin both above and below is spared. Rather than burning, or more typically freezing, which kills everything in its path, the laser only treats the unwanted pigment that we choose. The laser gives us precise control of the wavelength, depth of treatment, pulse width, duration of treatment time, and targeted tissue.

FEES

The fee is based strictly on the size and number of lesions that you have. This is based on how much time it is going to take. The minimum fee for any treatment session is $300. Other fees are listed below:

Face $350

Both hands $300

Forearms only $400

Below the knees $450

Forearms and hands $450

Upper chest $400

Thighs and knees $450

ALL FEES ARE PER SESSION.

All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No "verbal" quotes are accepted.

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SCHEDULING

There is a $150 non-refundable fee for missed appointments without a 24 hour notice. If you need to cancel, please record the date, time, and name of the person you spoke with.

PRETREATMENT

Dr. Coverman strongly recommends that a numbing cream be applied prior to treatment. This will help blunt any discomfort up to approximately 50%. You may purchase these over-the-counter and at pharmacies and so forth, but they often are not strong enough. LMX is available for purchase at our office. Please apply this thickly one hour prior to your treatment session. If the treated area is small, you may occlude this with some saran wrap and tape the edges (even though it looks a little funny).

Never occlude any area larger than one palm print, and never apply this product to any area with or without occlusion that exceeds 25% of your back.

We can and will apply the material for you here at the office at no charge if you arrive early enough. Please come to our front desk and inform our staff about this when you check in for your procedure, and we can apply it then while you are waiting. The advantage of purchasing this ahead of time is that you can apply this liberally in comfort at your home and have it on and effectively working before you even get here. Do not apply over make-up - it is best to wash your face and apply it to the fresh and clean skin. Never apply this to any fresh burns, infected skin, inflamed skin, or any weeping, open, or oozing skin. Do not apply this to any other rashes. If you have any questions, please ask our staff.

If you have ever had herpes in or near the area of proposed treatment, or think you may have (cold sores or fever blisters), inform Dr. Coverman or our staff prior to scheduling your appointment. If you are a pre-existing patient, we will give you a series of anti-herpes pills to take the day before the treatment, the day of, and the day after. This should help or suppress or prevent herpes from flaring, but there are no guarantees. A herpes flare could cause pain, pigment, infection, and scarring.

DO NOT apply any artificial or self-tanning agents for three days prior to the procedure. Do not sunburn or tan! It is best if you are pale and the lesions to be treated remain dark.

You should not have any laser or any light based therapy if you have any photosensitive diseases such as lupus erythematosus, porphyria, or albinism. You must stop any photosensitive medicines at least two days before your treatment unless your prescribing doctor told you not to. Always check! These include anti-arthritis drugs such as gold or methotrexate: any antibiotic from the tetracycline group including Tetracycline, Minocycline, Doxycycline, Vibramycin, Doryx, Solodyn, and Dynacin; acne medicines including Accutane, Cipro, or any of the "quinolone medications"; oral antifungals including Griseofulvin; anti-arrhythmia drugs including Chlorpromazine; St. John’s Wort; diuretics.

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TREATMENT DAY

You will be wide awake and just wearing goggles. You will feel a series of pinprick sensations as the laser beam begins to work, and this is generally tolerable by everyone. This sensation is over with almost as soon as the laser stops, and you may just feel very mild tingling for a few minutes after that.

POST TREATMENT

Special wound care instructions will be given to you, and generally we ask you to keep the treatment sites moist at all times with an antibiotic ointment such as Neosporin. Do not use if you are allergic to Neomycin. There may be a purplish bruised appearance which will be visible to others. There is no way to avoid this, and you must plan your school, work, travel, and social calendar accordingly. It is not necessarily bloody or oozing although sometimes the lesions may be moist particularly with application of the ointment. Do not sunburn while you are healing. This reaction generally fades in 7-14 days. It will be visible to others.

In most cases when using the FotoFacial, the spots just temporarily turn browner or darker but stay dry. In about 1-2 weeks they just flake off. No ointment is needed.

POST-TREATMENT PAIN

For normal post-operative pain following most of the procedures that we perform in our office, we do not recommend nor prescribe any of the stronger pain medicines including hydrocodone (Lortab; Darvocet N100; Mepergan Fortis; Ultram). We feel that a combination described below of over-the-counter medicines will be enough. This is what we recommend:

Take one Aleve or Advil pill every 4-6 hours with food. Wash it down well with liquid. Breakfast, lunch, dinner and bedtime snack.
Do not take Aleve or Advil if you are allergic to aspirin, ibuprofen, naproxin, these pills, or have any type of aspirin sensitivity or the syndrome of nasal polyps, allergies, atopic eczema, and aspirin-allergy. Likewise, do not take this if you have any bleeding problems, or have ever had any ulcer disease or similar stomach disease.
We also recommend that you take two Extra Strength (500 mg) Tylenol tablets every 4-6 hours as well at the same time.
Please remember that the side effects of Tylenol have nothing to do with the side effects of Aleve or Advil, thus these may be taken together.

If you have any liver disease or potential liver problems, do not take the Tylenol. Do not take Tylenol if you are allergic to it or acetaminophen. DO NOT DRINK ALCOHOL WITH THIS REGIMEN! Otherwise, follow the schedule below:

8:00 a.m. - Breakfast
One Aleve or Advil with breakfast and plenty of water.
Two 500 mg Tylenol for adults.
Noon to 2:00 p.m. - Lunch
One Aleve or Advil with lunch and plenty of water.
Two more 500 mg Tylenol.
6:00 p.m. - Dinner
One Aleve or Advil with dinner and plenty of water.
Two more Tylenol.
10:00 p.m. to midnight - Bedtime
One Aleve or Advil at bedtime and plenty of water.
Two more Tylenol.
Benadryl (diphenhydramine) 25-50 mg for sleep.

The Benadryl is a great idea. It is the main component of most over-the-counter sleeping pills. (Tylenol PM), and is not addicting. Never drink alcohol before or with this, and plan on going right to sleep and sleeping 8 hours. DO NOT take with any other sleeping pill, anti-depressant, MAO inhibitor, or anti-anxiety drug (Xanax, Valium, etc.). Do not drive or operate dangerous equipment.

Thus, in any given day you should never take more than the total of four Advil or Aleve or eight Tylenol total (two every four to six hours).

Normally you should be able to safely do this for one to three days - but never more. If the pain ever worsens or this fails to control it - call our office during normal office hours or the medical exchange (458-1121) after hours.

This combination of Aleve or Advil plus Tylenol is safe, covers you around the clock, and allows you to take two different pain medicines whose side effects don’t cross react with each other assuming you are not allergic to either.

FOLLOW-UP

Usually none is necessary. We cannot guarantee what percentage of improvement there will be per lesion per treatment session or overall. Some of the lesions will fade 100% with just one session, most will fade very visibly and often to your complete satisfaction. Because we cannot predict how your body will handle any residual pigmented tissue, and because we don’t want to overtreat and create any excess burn or scarring, we realize that it is always better to undertreat rather than overtreat. There will be full charges for any repeat treatment sessions.

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