Clinical Roundtable Supplement Cynosure July 2012 : Page 7

“The use of RevLite (or other follow-up treatments) following surgery has also helped me to build a closer rapport with my patients, and this, I believe, can make my patients happier.” Dr. Wong – I use the MiXto fractional CO 2 laser from Lasering for the nasolabial and marionette region, and around the mouth, while covering the remaining areas of the face with RevLite during the same session. For those who come to me seek-ing treatments for facial aging, I consider the effects of chronological age and physiological changes, wear and tear from external agents including sun damage, body weight changes and gravity. The overall effects of these factors may require different modalities of treatments. For example, I can perform a face-lift to “pull up” and tighten the face. While this will reduce the droopiness and folds, the quality of skin will remain, including the wrinkles and pigmentation. This is where RevLite, dermal fi llers and other non-surgi-cal treatments can play a role in enhancing the overall result. In this way, a holistic approach to dealing with the multiple problems of an aging face will enhance the fi nal outcome. The use of RevLite (or other follow-up treatments) following surgery has also helped me to build a closer rapport with my patients, and this, I believe, can make my patients happier. Can you provide tips for achieving the best outcomes ? Dr. Bekhor – For tattoo removal, adjust the power level according to variations in the pigment intensity. Always aim for a mild endpoint. I had a patient where eyeliner was tattooed too deeply resulting in a migration of the pigment under the whole lower eyelid, which gave her the appearance of having smeared eye make-up. The RevLite was able to clear this subcutaneous pigment completely. Dr. Xin – Treatment options and outcomes differ from patient to patient. First, be careful when you consider the parameters and endpoints of treatment. The main analysis should take into account the age of the patient, skin condition and color, and depth selection parameters. Dr. Rajendran – I perform a lot of revision work. For example, a physician might use a radiofrequency-based device or a CO 2 laser to remove pigmentation, but this only complicates matters and makes it worse for the patient. Dr. Suwanchinda – The key to success is choosing the right endpoints. Immediate whitening or lightening – but not too much – should be seen. Another important point is the cooling of the skin and the cream used to soothe the skin immediately after the treatment. For Asians, PIH is very common, and rebound hypo-or hyperpigmenta-tion is diffi cult to treat. Without these complications, RevLite would be very impres-sive treatment for a recalcitrant condition like melasma. I do both pre-and post-cooling to make sure that there is no excess heat ac-cumulation. I also use an ointment containing botanic ingredients to help in re-ducing infl ammation and speed healing. Recalcitrant melasma can be treated well with RevLite and it can also be used as a way to prevent recurrence. The interval between treatments is also important. If you treat too frequently this could cause more complications. Hori’s Nevus before Tx Hori’s Nevus after RevLite Tx Photos courtesy of Philip Bekhor, M.D. THE Asian Aesthetic Guide 2012 -Volume 2 7

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