Fraxel re:store™ FOR LASER RESURFACING

NATURE OF THE PROCEDURE

Just as a damaged painting is delicately restored one small area at a time, or a photographic image is altered, pixel by pixel, Fraxel re:store™ Laser Treatment improves your appearance by affecting only a fraction of your skin at a time with thousands of tiny microscopic laser spots.

Fraxel re:store™ Laser Treatment produces thousands of tiny but deep columns of treatment in your skin, known as microthermal treatment zones (MTZ). This treatment eliminates old epidermal pigmented cells. It also penetrates deep into the dermis. Just as important, though, are the areas of skin the Fraxel re:store™ laser leaves untouched. For every microthermal zone the laser targets and treats intensively, it leaves the surrounding tissue unaffected and intact. This “fractional” treatment allows the skin to heal much faster than if the entire area were treated at once, using the body’s natural healing process to create new, healthy, tighter tissue to replace skin imperfections. With fractionated resurfacing, there is less down time than with the CO2 laser, and there is less chance for abnormal pigmentation whether lighter or darker. The disadvantage of the Fraxel re:store™ compared to CO2 is that one does not obtain quite as much as the deep thermal heating, so the overall tightening of the skin is less, but the trade off is less risk of abnormal pigmentation, and quicker healing.

At your initial consultation, our staff will determine the best treatment plan for your desired results. By design, each Fraxel re:store™ Laser Treatment targets between 20 and 25 percent of the skin’s surface. Clinical studies suggest that on average, an effective treatment regimen is 3 to 5 sessions, spaced about 2 to 4 weeks apart. Depending upon your condition and schedule, we may choose to space treatment sessions even further apart. Results are immediate and progressive. Optimal improvement is usually visible in about 2 to 3 months. Because Fraxel re:store™ Laser Treatment spares healthy tissue, it is effective even on delicate skin areas such as the neck, chest, and hands.

Fraxel re:store™ resurfacing can be used to treat the following:

Neck and décolleté
Photoaging
Skin resurfacing
Hands
Freckles anywhere
Scarring
Acne scarring

FEES:

Full face $1000
Face 1 Area $500
Face 2 Areas $750
Neck $800-$850
Chest $1200
Hands $650-$700
Forearms $1000
Face/Neck $1500
Hands/Forearms $1500

This is an all inclusive fee that includes pre-operative care, the treatment itself, and extensive, close and careful post-operative monitoring. These fees are PER SESSION - EACH SUBSEQUENT SESSION REQUIRES A FULL FEE. We do offer reduced fees if packages of three, four or five sessions are fully prepaid.

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

A visit with our staff is required. If you are seeing us for pigment, mild wrinkling or scarring, or general mild retexturing or resurfacing, we will have you see our aestheticians, Christi Gonzales or Tammy Hunt. Please indicate this to our front office staff when you call.

Because there will be obvious inflammation and redness, please plan your school, social, travel, and business calendars around this. You may certainly return to school or work the next day - you will be red but not necessarily weeping, oozing, or blistering. It will look like a sunburn. After that there may be a period of obvious peeling and flaking - depending upon your work circumstances, there is no reason you couldn’t be back at work even with this.

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.

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PRETREATMENT

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

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TREATMENT DAY

Just prior to the treatment we will call you back and wipe off the numbing cream. You may feel a warm sensation, and in some cases, despite adequate cream you may feel a somewhat unpleasant tingling or burning sensation. Normally this is completely tolerable, but if at any point you find this is not so, we certainly encourage you to tell us and we can inject a local anesthetic. We will be making three passes over your face at 90 degrees each time and the treatment wand literally "rolls" over your skin. During this time, a very precise pattern of MTZ’s will be laid down and the computer figures all of this out. Technically it is very easy to perform and you don’t have to do anything but lay there.

The actual procedure takes about one hour. You will be wide awake. You can talk to us during the procedure.

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POST TREATMENT

At the conclusion of the procedure we recommend that you go right home and stay out of the sun that day and the next. We recommend you apply a sun block when you leave and certainly for the next three to four days at a minimum. Wear broad brimmed hats rather than baseball caps and use common sense. Avoid the sun and sunburn! Do not use any other products other than what we gave you for healing - certainly no anti-aging products which may contain Retin A or alpha-hydroxy acids which will burn and sting.

For general comfort we recommend Elta!

You will experience a mild sunburn sensation for 1-2 hours afterward. You may notice redness and swelling which will resolve in 2-3 days. This is normal. Your skin will have a pinkish tone for 5-7 days after that. New epidermal skin will be developing immediately, usually within the first 24 hours. This repair involves:

Bronzing: Your skin may have a bronze appearance for 3-14 days.

Flaking: Your skin will naturally and vigorously exfoliate as the reorganized skin replaces dead tissue. Flaking is similar to a mild sunburn but without the pain.

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.

COMPLICATIONS

Any laser treatment, and any attempt at resurfacing the skin whether by laser, peels, Retin A and so forth is ablative. Technically this is a "burn" to the superficial layers of your skin, but with Fraxel re:store™ it is a controlled burn and only 20% of your skin is treated at any one time. Still however there could be pigmentary changes (whether lighter or darker), mottled pigmentation, scarring, flare of underlying herpes, or infection. There is no guarantee of what percentage of improvement there will be in your underlying condition per area, per treatment session, or overall after all treatment sessions. There is the rare chance of hair loss in the treated areas, and there may be a line of demarcation between the treated areas and the untreated areas. Actually, one of the beauties of fractionated resurfacing is the likelihood of this line of demarcation being dramatically less than with the CO2 laser or any peel.

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FOLLOW-UP

If you haven’t already scheduled your full series of treatments, please do so as you leave each visit. It is best to finish this treatment on a predetermined schedule. Again, we recommend sunscreen by itself if you simply must be out in the sun for prolonged periods of time, but otherwise we prefer you stay indoors as much as possible.

The following regimen is highly recommended:

- Dove Beauty Bar or other extremely mild soap.
- No acne, aging, or any other over-the-counter creams or soaps, astringents and so forth.

If anything doesn’t seem right - CALL US! If there is weeping, oozing, or excess redness or discomfort, please call us. If it is after hours you may reach Dr. Coverman or Jennifer Jordan through the Medical Exchange at 458-1121.

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