You have scheduled a delicate cosmetic laser procedure. The following information is intended to assist you in preparing for your procedure. Below are the instructions you need to follow to prepare for your procedure. If you have any questions, please do not hesitate to call the office.

• Your DOT laser procedure is scheduled on ________________ at ____________.

• Arrive at __________________.

• Remember to start taking your acyclovir two days before the above date ____________.

• Please arrive one hour prior to your procedure to allow Dr. Rieger to take your photos, review and have you sign a consent, apply the topical anesthetic, and review your post procedure treatment. The topical agent takes approximately 45 minutes to take full effect.

• Please wear a form of upper clothing that zips or buttons in the front. Present with clean skin and no make-up. If you have make-up on, you will be asked to remove this prior to the photos or topical application.

• Please refrain from the following activities within 30 days of your scheduled procedure:

• Tanning in the sun or in a tanning bed
• Chemical peels, microdermabrasion, waxing
• Using retinols, retin-A, vitamin C /A, glycolic acids and St. John’s Wart, herbals

• Please notify the physician if you have any of the below:

• you have been on Accutane in the past year
• you are taking oral tetracycline, doxyclycline, or sulfa medications
• you are pregnant or think you may be pregnant, you are NOT a candidate for the laser
• you have an active cold sore, you MUST reschedule your procedure.
• you have had chemical Peels / microdermabrasion / wax treatments to the areas
• you use retinols, Retin-A, Vitamin C /A, glycolic acids and St. John’s Wart, herbals
• you are taking anti-coagulant medications (such as Aspirin, Heparin or Coumadin).
• you have a history of keloid scarring
• you have a history of bacterial infections especially skin infections or active acne
• you have a pacemaker or internal defibrillator
• you have connective tissue disorder or immune comprised disease
• you have suspicious skin lesions or history of skin cancer

The following is a list of skin care products that we wish you to bring with you on the day of your procedure. Some of these products will be applied to your skin for the first time immediately after the laser resurfacing. Dr. Rieger will apply some of the products and review them with you.

1. Boiron Calendula Cream , click here to purchase, is a great product to use after the laser. Please bring to your appointment. It is a Homeopathic Medicine. Paraben Free. Calendula officinalis (Garden marigold) has been used topically for generations to naturally heal skin irritations. Calendula Cream is ideal for use on sensitive skin, i.e. the face or children. Use it on dry skin, scrapes of chafing. Soothes, moisturizes & heals. Paraben free        
2. Neutrogenia Healthy Defense SPF 45 Daily Moisturizer – purchase at any store
3. Neutrogenia Fresh Foaming Cleanser – purchase at any store
4. Motrin or Tylenol
5. Acyclovir – start taking 2 days prior to your procedure and 5 days afterwards – purchase  at your pharmacy.  A prescription will be given to you at your pre procedure appointment for acyclovir. Remember to start the Acyclovir 2 days prior to your procedure.

Post Procedure Information

      You have just had a delicate laser procedure.  The following information is intended for your well-being and will assist you during your recovery period. Each procedure receives special and individual thought.  If you have any questions, please do not hesitate to ask or call the office. If you need immediate attention, or for some reason you are unable to contact me, go to the emergency room nearest your home.

Some reasons to call:

• Fever
• Pain not relieved by medication, severe pain
• Severe or asymmetric swelling
• Redness, warmth, drainage or odor from the treated areas
• Pustules ( red or white dots or blisters )
• Persistent nausea and vomiting, inability to urinate or constipation.
• Itching not relieved by Benadryl (short term use only) – Do not scratch. Call
• If you have any yellowish or greenish drainage from the incisions or notice a foul odor
• If you have an oral temperature over 100.4 degrees

• If you notice any hepatic lesions on the lasered surfaces.
• If you have any sign of abscesses, open sores

What to expect after laser resurfacing:

• The day of surgery your skin will appear to be deep pink to red, as with a sunburn. This will increase in severity on the second day.
• You will have a weeping discharge from the lasered areas. This discharge will be light pink/gold in color.
• Swelling is expected and may be more pronounced in the lips and around the eyes.
• You will experience a stinging sensation immediately after the procedure. This may advance to a burning discomfort later in the day and evening but will improve over the next few days.
• Your skin will heal over the next 2 weeks, leaving the lasered areas with a bright pink coloration.
• Your skin will feel tight and smooth. Continue to use the recommended moisturizing agent to the skin surface.
• You will experience increased sensitivity to makeup and acute sun sensitivity.
• Return of pigmentation and light sun exposure in 6-12 months.
• Pinkness or redness of skin may remain up to 6 months.
• Usually, your skin will be free of crusts in about 10 days postoperatively.
• Final results of surgery may take several months to appear.

“DO”

1. Minimize direct sunlight for several weeks. Light sun exposure for the first year. Protect the treated area from the sun until all color has returned to normal. Shade face with hat/visor whenever you go out into the sun. If resurfacing was done around the eyes, wear good quality sunglasses with UVA and UVB 100% filters.
2. Completely finish your medications Acyclovir according to the directions.
3. Keep the areas moist by apply the ointments and moisturizers as noted in the instructions.
4. Use ice packs/frozen peas over a towel to help with swelling and discomfort. To prevent frost bite the cool compress should only be on for a few minutes and off for 5-10 minutes each time.
5. Resume mineral make up products and mineral cosmetics after redness gone and when healed
6. Shower the next day. Avoid direct spray on the face; instead let the water steam down the face. Use the Neutrogenia Fresh Foaming Cleanser for the face – lather, gently clean and rinse with water.
7. Take Motrin or Tylenol for discomfort. Call if is severe discomfort.
8. Return to work the next day, depending on the type of work you perform (clean environment). Ask Doctor Rieger about returning to work if the work environment if not clean.
9. Continue to use Neutrogenia SPF 45 moisturizer every day or similar SPF product in the future.
10. Have a responsible person stay with you for the first 24 hours following your procedure

“DO NOT”

1. Do Not go into the direct sunlight without sunscreen (SPF 45) and hat until all redness subsides.
2. Do Not bathe in a tub or swim for 3 – 4 weeks and when healed
3. Do Not use hot tubs for 6 – 8 weeks.
4. Do Not allow the treatment areas to become dry.
5. Do Not use regular skin products ie glycolic, retinol, retin A, vitamin C or A, or hydroxyl acids or any exfoliating products for at least several months and until redness gone and completely healed.
6. Do Not use any cosmetics or make up products until at least 5 days and when healed.
7. Do Not drive or operate machinery if you are taking narcotics or valium.
8. Do Not participate in contact sports for a few weeks.
9. Do Not scratch or touch the treatment areas. You may use Benadryl by mouth for itching.
10. Do Not smoke.

1. Do Not Tan for one month after laser procedure.

Follow the instructions below after your laser treatment:

Day 1

Step 1        Cool:                apply cold compress as needed

Step 2        Hydrate:           apply Boiron Calendula Cream  click here to purchase. First cleanse the area with Neutrogenia Fresh Foaming Cleanser, rinse and dry. Then apply  thin layer of Calendula Cream to affected area 3 times a day or as needed.

Step 3        Protect:            avoid sun exposure; apply Neutrogenia SPF 45 Moisturizer

Step 4        Prevent:           take the acyclovir as directed on the bottle     

Day 2 – 4

Step 1        Cool:                apply cold compress as needed

Step 2        Cleanse:           wash with Neutrogenia Fresh Foaming Cleanser

Step 3        Hydrate:            apply Boiron Calendula Cream .  First cleanse the area with Neutrogenia Fresh Foaming Cleanser, rinse and dry. Then apply  thin layer of Calendula Cream to affected area 3 times a day or as needed.

Step 4        Protect:            avoid sun exposure; apply Neutrogenia SPF 45 Moisturizer

Step 5        Prevent:           take the acyclovir as directed on the bottle     

Day 5 – 30

Step 1        Cleanse:           wash with Neutrogenia Fresh Foaming Cleanser

Step 2        Hydrate:           apply Boiron Calendula Cream .  First cleanse the area with Neutrogenia Fresh Foaming Cleanser, rinse and dry. Then apply  thin layer of Calendula Cream to affected area 3 times a day or as needed.

Step 3        Protect:            avoid sun exposure; apply Neutrogenia SPF 45 Moisturizer

Step 4        Make Up:         may use a mineral only make up        

Future

Step 1        Protect:             Click here to see products to use for the future

Step 2        Detection:        skin surveillance checkups with a dermatologist at least yearly.         

Step 3        Sun Exposure Care:     avoid excessive sun exposure

REMEMBER:

• This laser procedure is purely cosmetic and does not treat or prevent skin cancer. Therefore routine checkup with your family doctor and dermatologist are strongly recommended.
• The swelling, bruising, tightness, itching, discoloration, cracking, peeling will leave in time, the majority within a few days. Please be patient.  How quickly these resolve depends on your health and healing quality, as well as a quiet, careful and calm convalescence.