Lesson 1Complication recognition and management: infection, prolonged erythema, delayed healing, hyperpigmentation, hypopigmentation, and hypertrophic scarring protocolsThis section outlines recognition and management of complications after fractional resurfacing, including infection, prolonged erythema, delayed healing, hyperpigmentation, hypopigmentation, and hypertrophic scarring, with stepwise treatment algorithms and referral thresholds.
Early signs of infection and treatment stepsManaging prolonged erythema and flushingApproach to delayed epithelializationTreatment of PIH and hypopigmentationHypertrophic scarring prevention and therapyDocumentation, follow-up, and referral timingLesson 2Wavelength-specific tissue effects: controlled thermal columns (1540 nm) vs ablation and thermal zone (CO2) and implications for Fitzpatrick III with melasma historyThis section details wavelength-specific tissue interactions, contrasting 1540 nm thermal columns with CO2 ablation and coagulation zones, and explains implications for treating Fitzpatrick III patients with melasma history, including depth control and thermal load reduction.
1540 nm dermal thermal column formationCO2 ablation depth and coagulation profilesFractional patterns and microthermal zone densityImpact on melanocytes and pigment pathwaysStrategies to limit thermal load in type III skinDevice choice in patients with prior melasmaLesson 3Pre-treatment optimization for patients with melasma or prior hyperpigmentation: topical priming (hydroquinone, retinoids, tretinoin), sun avoidance, and test spot strategiesThis section focuses on pretreatment optimization for melasma and prior hyperpigmentation, including hydroquinone and retinoid priming, tretinoin regimens, sun avoidance, barrier support, and test spot design to predict PIH risk before full-face fractional resurfacing.
Hydroquinone protocols and cycling strategiesRetinoids and tretinoin: dosing and timingAdjunctive priming agents and barrier supportSun avoidance counseling and UV documentationDesign and interpretation of fractional test spotsWhen to delay or cancel treatment after primingLesson 4Parameter ranges: energy per microbeam, density/coverage, pulse stacking, spot sizes, and recommended conservative starting ranges for mixed phototypesThis section reviews practical parameter ranges for fractional devices, covering energy per microbeam, density and coverage, pulse stacking, and spot sizes, with conservative starting settings and adjustment strategies tailored to mixed and higher Fitzpatrick phototypes.
Energy per microbeam: concepts and unitsDensity, coverage, and treatment level selectionPulse stacking indications and safety limitsSpot size choice for face and focal lesionsConservative starting ranges for mixed phototypesTitration based on clinical endpoints and historyLesson 5Risk reduction for melasma recurrence and PIH after resurfacing: patient selection, parameter selection, adjunctive topical protocols, and staged treatment planningThis section addresses strategies to reduce melasma recurrence and PIH after resurfacing, including careful patient selection, conservative parameters, staged treatment plans, peri-procedural pigment suppression, and structured follow-up to detect and treat early darkening.
Risk stratification and patient counselingParameter selection to minimize epidermal injuryStaged and sequential treatment planningPeri-procedural pigment suppression regimensEarly detection of PIH and melasma relapseRescue protocols for recurrent pigmentationLesson 6Indications for non-ablative 1540 nm vs ablative fractional CO2 in facial photoaging, lentigines, texture, and pigmentationThis section compares non-ablative 1540 nm and ablative fractional CO2 for facial photoaging, lentigines, texture, and dyschromia, outlining indications, expected downtime, session numbers, and how to match device choice to skin type, lifestyle, and pigment risk.
Clinical indications for 1540 nm non-ablativeClinical indications for ablative fractional CO2Texture, rhytids, and pore-focused strategiesLentigines and mottled pigmentation approachesDowntime, recovery, and lifestyle constraintsDevice selection in higher Fitzpatrick typesLesson 7Post-treatment regimen: wound care for fractional CO2, use of occlusives, topical antimicrobials, pigment suppression strategies, rigorous photoprotection, and maintenance therapiesThis section explains structured post-treatment care after fractional CO2 and non-ablative procedures, including cleansing, occlusive dressings, antimicrobials, pigment suppression, strict photoprotection, and long-term maintenance to reduce PIH and optimize texture outcomes.
Immediate cleansing and barrier repair stepsUse of occlusives, emollients, and dressingsTopical antimicrobials and infection preventionPigment suppression agents after resurfacingPhotoprotection timing and sunscreen selectionLong-term maintenance and retreatment planningLesson 8Cooling and intra-procedure safety for ablative and non-ablative treatments: eye protection, smoke evacuation, real-time endpoint recognition (uniform erythema, petechiae, pinpoint bleeding)This section covers intra-procedure safety for ablative and non-ablative treatments, including eye protection, smoke evacuation, plume safety, cooling methods, and real-time endpoint recognition such as uniform erythema, edema, petechiae, and pinpoint bleeding patterns.
Eye protection selection and placementSmoke evacuation and plume safety standardsContact, cryogen, and air cooling optionsEndpoint recognition: erythema and edemaEndpoint recognition: petechiae and bleedingAdjusting passes based on real-time feedback
