What is CO2RE Laser?

CO2RE by Candela is a Carbon Dioxide (CO2) fractionally ablative laser which removes small columns of skin and stimulates growth of new collagen to help reduce fine lines, wrinkles, sunspots, liver spots, freckles, scarring, acne scars, uneven coloration, skin laxity, textural irregularities, dull tone, and thinning collagen on the face, neck, chest, and hands. CO2RE can also be used to improve traumatic or surgical scars.

CO2RE is the best treatment if you desire to get the most results with one treatment. It is the best non-surgical, non-invasive single treatment for advanced skin damage and wrinkling.

CO2RE is an in-office procedure with a healing time of 10-14 days. Although this procedure produces a dramatic result, the recovery process is demanding. The recovery process is simple, but many patients are confused on exactly what to do. It is important to keep in mind that the care of your lasered face influences your final result, so the better you do, the better you look.

Who should NOT have CO2RE laser?

• Isotretinoin use within the previous six months
• Active bacterial or viral infection in the area to be treated
• History of keloid formation or hypertrophic scarring
• Ongoing ultraviolet exposure – skin should not be treated until 4-6 weeks after active sun exposure
• Prior radiation therapy to treatment area
• Collagen vascular disease
• Avoid treatment in hair-bearing areas in men if hair reduction is not desired
• Caution in patients with dark skin tones (Fitzpatrick phototypes V-VI)

What should I do prior to my procedure?

• Be prepared – Review these instructions in detail and ask any questions to your provider.
• Prep for the recovery and healing process: gather clean soft washcloths, gauze, distilled white vinegar, distilled water, clean old pillowcases, Tylenol, Ibuprofen, and Benadryl.
• Use zinc oxide sun block SPF30+ 2-3x per day for at least 3 weeks prior to treatment.
• Moisturize the skin morning and evening for 7 days prior to treatment. Drink 8 glasses of water per day to hydrate the skin and optimize treatment results.
• Discontinue topical irritants (retinol, retinoids, hydroquinone) 3-4 days prior to procedure.
• Shower the morning of the procedure and tie hair back into a bun or ponytail away from the face.
• Do not apply any make-up, lotion, or hairspray to the treatment area.
• Take oral medications as prescribed by your provider
• Plan to have 10-14 days of downtime to heal following the procedure.
• Quit use of cigarettes, vaporizers, or nicotine containing substances.

What is the procedure like?

• For your comfort during the treatment, we may apply a topical anesthetic or inject local anesthetic to reduce discomfort. Topical numbing may need to sit for 30-60 minutes.
• You will be awake and lying down comfortably during the entire procedure.
• Eye protection must be worn by both the patient and staff.
• The procedure can take 45-60 minutes depending on the size of the treatment
  area.
• Ice packs or a cooling device may be used throughout the procedure to soothe discomfort.
• Once complete, a layer of emollient cream or Aquaphor will be applied over the
  treatment area. No bandages or wound dressings are needed.

What are the post-procedure and wound care instructions?

In order to heal properly, the patient must follow some basic daily steps of skin care. It is important that you follow these directions exactly and not substitute your own products, devices or care regimen.

Week 1

Clean:

• • Starting the day following treatment, wash the area gently 2-3 times daily with lukewarm water, your fingertips, and a gentle cleanser – Alastin Gentle Cleanser, Cetaphil Gentle Cleanser to Vanicream Gentle Cleanser
  • Gently blot dry with a clean, soft cloth.
  • Most patients find it convenient to wash their face in the shower where they can let the shower water soak and soften ointment residue and crusts, then gently wash with cleanser.
  • Men should not shave for 14 days.
  • There are no restrictions on bathing except to treat the skin gently, avoid scrubbing or trauma to the treated area. Your skin will be sore, so only use your fingertips and do not scrub with abrasive washcloths or mechanical devices.

Soak

• • Many patients find white vinegar soaks cleansing and soothing.
  • Soaks can be done at any time but may be most effective after a shower or cleansing, and before reapplying ointment.
  • Mix 1 teaspoon of white vinegar with 1 cup of tap water. Do not use more than 1 teaspoon, you can use less than 1 teaspoon if it burns.
  • Soak gauze in the mixture and then apply and let rest on face for 10-15 minutes.
  • Soaks help sooth pain, dissolve residue, and are anti-microbial to help prevent infection.

Cover:

• • Always wash your hands before touching your face.
  • Apply Alastin Nectar
  • Apply a greasy covering with ointment continuously – Aquaphor, Plain Vaseline, Vaniply Ointment

**DO NOT APPLY ANYTHING ELSE TO YOUR FACE. DO NOT USE NEOSPORIN.**

• • Reapply continuously! It may be helpful to apply using a clean tongue depressor stick (available on Amazon). Apply a fresh layer after washing, using a cold compress, and whenever your skin begins to feel dry. Dry skin will delay your healing process.
  • Do not put excessive ointment on the forehead or eyelids as it can drip and irritate the eyes.
  • Keeping the area covered and moist will help prevent scabbing and crusting. If scabbing or crusting occurs, do not pick at the skin.
  • Refrigerating ointment can increase its soothing effect.
  • Use old pillowcases to prevent grease stains from ointment on bedding.

Ice

• • Icing for 10 minutes each hour will reduce pain and prevent swelling.
  • This is most helpful for the first few days, it does not need to be continued all week.

Cover again

• • Reapply a greasy ointment continuously! After you wash, ice, or soak!

Relax

• • Avoid exercise or sweating during this time.

If ever in doubt about your healing or instructions, please call our office.

Week 2

Clean, soak, cover, ice, and cover again as detailed above in week 1 instructions until new skin has grown back.

• • This generally happens between days 9-12.
  • When the new outer layer of the skin (epidermis) grows back, the face is no longer raw and the healing skin is smooth and pink. This healing process does not happen all at once. Some areas of your face will heal faster while other areas (eyelids especially) take longer.
  • By the beginning of the second post laser week, any raw areas should still be covered with ointment but any smooth and pink areas can be treated with the moisturizer only.

Moisturize smooth and pink areas where the skin has healed.

• • Use our recommended products and never anything with preservatives, fragrances, stabilizers, alcohol or other ingredients – Vanicream moisturizing cream, Cetaphil Gentle Moisturizer, Alastin Ultra Nourishing Moisturizer.
  • Dry skin will delay your healing and it is important to continually reapply the moisturizer at least every 2 hours as it really soaks up into the skin.

Protect with SPF

• • When you begin leaving the house, you will need sunscreen to protect your skin.
  • Not any sunscreen will suffice as many products have irritants that will delay your healing. We prefer these products as they have no irritants and also contain zinc oxide which promotes healing – Vanicream Sensitive Skin Screen, EltaMD Sunscreen, Alastin SilkSHIELD All-Mineral Sunscreen SPF 30
  • Protect the treated area from direct sunlight for the entire course of treatment. To avoid hyperpigmentation, tanning of any sort is not allowed during the entire course of treatment.

What is the healing process like?

Lasered skin can have a spectrum of different appearances:

Days 1-4:

• Immediately after treatment, most patients will experience sensations similar to a bad sunburn.
• Your skin will be red, inflamed, and sore with straw colored leakage.
• Small areas of pinpoint bleeding are normal and common with cleaning. o
• Moderate swelling is common.

Days 4-10:

• Slight swelling and a mild sunburn sensation are common
• Skin will begin to flake at 5-7 days on the face and neck; 7-10 days for the chest; and 10-14 for the hands.

Days 10-14:

• Skin will become pink and shiny as it heals. Raw areas will have faded away.

Day 15+:

• Skin may still have a hint of pink tones. Makeup with a green tint can help cover up red/pink tones.
• You may now resume your normal activities with the exception of any sun exposure. It is of utmost importance to wear sunscreen and strictly avoid the sun. Damage of UV rays can occur in winter through car windows and even on cloudy days.
• For the best possible result, SPF 30 sun block should be used daily for 6 months.

Do not allow yellow crusts or scabs to form. This can be prevented by keeping the skin very moist and covered with greasy ointments. Scabs and crusting can be removed using the vinegar and water soaks. It is normal to see a little bit of bleeding once the scab or crust has been broken away. Do not become alarmed.

Plan to have at least 10-14 days of downtime following the procedure.

How often do I follow up?

• Follow up at 4-7 days, 4-6 weeks, and 12 weeks after treatment.
• Remember, the final result is seen at around the 3 month mark! Collagen takes time to build!
• Maintenance treatments may be required every few years.

What are possible complications?

Pain:

• • Tylenol Extra Strength 1-2 tabs every 4-6 hours
  • Ibuprofen 400mg every 4-6 hours
  • Cool compress or icepacks for 10-15 minutes per hour
  • Vinegar soaks
  • Keep ointment in the fridge for an extra soothing effect

Swelling

• • Areas most likely to swell are around the eyes and neck.
  • Keep the head elevated on pillows and do not lay flat for extended periods of time.
  • Cool compress or icepacks for 10-15 minutes per hour
  • If swelling is obstructing vision or breathing, please contact our office.

Oozing and bleeding:

• • A clear/straw fluid may be present in the lased areas and may create a crust (or scab) if the areas are not kept moist. This can be prevented by keeping the skin very moist and covered with greasy ointments. Scabs and crusting can be removed using the vinegar and water soaks.
  • It is normal to see a little bit of pinpoint bleeding after cleaning or when crust has been broken away. Do not become alarmed.
  • If bleeding is uncontrolled, please contact our office.

Itching:

• • Benadryl at nighttime
  • Non-drowsy Claritin or Zyrtec during daytime hours

Prolonged skin redness or pinkness:

• • Post laser Skin Pinkness is the most common complaint of post laser patients.
  • Pinkness is a normal healing process and is a sign of newly formed skin.
  • Pinkness is extremely variable and can last several weeks in some patients and several months in other patients. A general rule is that the longer the pinkness, the better the result as more collagen is being formed.
  • When pinkness is extreme or longer lasting than expected it can be a sign of over aggressive scrubbing or rubbing, or a sign of some irritating substance being applied. As stated numerous times, this is baby sensitive skin and patients have to be careful of what they apply. We have seen extreme irritation from aloe, baby oil, make up, and numerous topical products that patients applied.
  • After the initial healing period, pinkness can be covered with green tinted makeups.
  • If you think your pinkness is getting worse, please come into the office so we can evaluate your condition.

Skin darkening (hyper-pigmentation):

• • “Tanning” or pigmentation of the skin can occur in the treated areas. It usually presents between 20-30 days after laser, can be blotchy, and will eventually fade within a few months.
  • THIS CONDITION IS NOT PERMANENT and can be cleared up within several weeks with the use of prescription creams including bleaching creams, Retin-A, and sunscreen.
  • This reaction is more common in patients with olive or dark skin tones and can worsen if the laser-treated area is exposed to the sun.
  • Use sunscreen twice a day! It is important to use sunscreen, even indoors.
  • Overhead lighting in your office can increase pigmentation as can UV exposure when driving.
  • Don’t be alarmed, 40% of patients can experience this and it will resolve.

Skin lightening (hypopigmentation):

• • Light spots can appear in an area of skin that has already received prior treatment or can be a delayed response to the laser surgery. The pale areas can darken or re-
    pigment in several months but could be permanent.

Infection:

• • A skin infection in the postoperative period can result. This risk is minimized by good skin care, including frequent hand washing.

Allergic reaction:

• • It is possible that an allergic reaction to an anesthetic, topical cream or oral medication can occur. Please contact the office immediately.

Acne or Rosacea flare:

• • Flare-up acne or rosacea can occur in the postoperative period.

DO NOT:

DO NOT apply any products other than those recommended by your provider

DO NOT smoke or use nicotine products

DO NOT pick skin or scabs, or use any type of abrasive or mechanical exfoliation devices

If you have any questions or concerns, please call our office at 941.264.1161 and one of our nurses will be glad to assist you.

CO2RE Laser Patient Checklist

• Tubes of Aquaphor
• White Vinegar
• Extra Pillow cases (that can get stained)
• Extra wash cloths (that can get stained)
• Antibiotic Prescription
• Valtrex Prescription
• Tylenol
• Ibuprofen
• Benadryl
• Optional – tongue depressors for applying Aquaphor

*You will receive your Alastin Post Care Kit at your appointment