FRAXEL TREATMENT GUIDELINES By Shaun Patel, M.D.

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1 FRAXEL TREATMENT GUIDELINES By Shaun Patel, M.D. Fraxel is a laser skin resurfacing procedure that provides for a safe, effective and noninvasive way to treat hyperpigmentation, sun-damage, fine lines, wrinkles, scars, and unwanted textural irregularities. Dr. Patel offers Fraxel treatment for the following: Fine lines and wrinkles Sun spots Enlarged pores Acne/surgical scars Sun damage Stretch marks Uneven pigmentation Melasma PRE-TREATMENT INSTRUCTIONS FOR FRAXEL: 1) Please stop using the following skin products 7 days before your treatment (read labels on your skincare products to avoid these ingredients): a) glycolic acid b) salicylic acid c) retinoids (retinol, Retin-A, Tazorac, Differin) d) acne medications e) exfoliating scrubs and brushes f) skin bleaching agents (hydroquinone) 2) Two weeks prior to your treatment, stop: a) tanning or sun exposure 3) Avoid the following procedures for two weeks prior to your treatment: a) microdermabrasion b) hair waxing c) chemical peels d) laser hair removal e) IPL 4) If you have ever had a cold sore, please call our office and Dr. Patel will write you a prescription for Valtrex to help prevent cold sore recurrence from your treatment. Patients will be asked to take Valtrex 500 mg twice daily starting the day prior to the procedure and continuing for 10 days after the procedure. 5) In some cases, an acne breakout can occur after treatment. If you have a history of acne or would like to prevent the chance of developing acne, you will be given a prescription for antibiotics to take for 2 weeks after the procedure.

2 6) If you have a history of melasma or other issue with hyperpigmentation, we may opt to start a skin lightening cream such as Advanced Pigment Corrector for 4 weeks prior to your procedure. We asked that you stop this 1 week prior to your procedure. This product is available for purchase in our office. We can also send a prescription for hydroquinone to your pharmacy. ON THE DAY OF PROCEDURE 1) Avoid wearing makeup to your appointment. 2) Drink water and eat something prior to your appointment. 3) Arrive to your appointment 60 minutes prior to your scheduled appointment time. We will use this time to apply a topical anesthetic to keep you comfortable during your treatment. 4) While most patients tolerate the procedure well, it can be uncomfortable. We offer our patients oral pain medication or anxiolytic prior to the procedure. If you decide to take a medication for pain or anxiety, you will need a driver. POST-TREATMENT INSTRUCTIONS FOR FRAXEL: 1) For the first few days after treatment, cleanse your skin using a gentle cleanser and moisturize using a bland moisturizer. Once the sloughing starts, please allow your skin to heal and do not scrub, rub, or use exfoliants. 2) Avoid excessive exercise, perspiration, swimming or exposing skin to heat and sun for the first week after treatment. 3) All of your skin care products should be non-irritating and non-clogging for the first week or so after treatment. Please see post treatment product list below. 4) Avoid scrubs, toners, glycolic acid, and retinoids for the first week or so after treatment. Your skin will be sensitive after the treatment. Do not use products that will cause irritation during this time. 5) You can return to a normal skincare regimen once the sloughing is complete as long as the products are tolerable to you. Listen to your skin and resume normal skincare products slowly. 6) It is very important that you use sunscreen to prevent sun damage to the skin. The sunscreen you use should offer broadband protection (UVA and UVB) and have a sun protection factor (SPF) of 30 or more. Reapply sunscreen every 2 hours. If direct sun exposure is necessary, wear a hat and clothing that covers the treated area. Your practice of diligent sunscreen use may lower the risk of laser-induced hyperpigmentation (darker color).

3 7) Do not start any bleaching creams or skin brighteners until after the skin has fully recovered and all sloughing is complete. 8) If you have a history of cold sores, Dr. Patel will prescribe an antiviral such as Valtrex to you. Continue taking the Valtrex for 10 days after the procedure. 9) If you notice any blisters, cuts, bruises, crusting/scabs, areas of raw skin, ulcerations, active bleeding, increased discomfort or pain, pigment changes (lighter or darker than usual complexion), or any other problems, please contact Dr. Patel s office as soon as possible. DR. PATEL S RECOMMENDED SKINCARE REGIMEN AFTER FRAXEL: Morning: 1. SkinCeuticals Gentle Cleanser 2. C E Ferulic (start at day 3 or as skin tolerates) 3. Phyto Corrective gel or Hydrating B5 Gel 4. Triple Lipid Restore 5. EltaMD sunscreen (Clear, Physical or Elements) 6. Sunforgettable brush by Colorescience for reapplication of sun protection Evening: 7. Gentle cleanser 8. Phyto Corrective gel or Hydrating B5 Gel 9. Triple Lipid Restore ***Apply Biocellulose Restorative Masque as needed throughout day*** Other products that maybe used: 1. Bland moisturizer from Cerave 2. Gentle cleanser from Cetaphil 3. Aquaphor (only if you develop any areas of raw skin after treatment) SIDE EFFECTS OF FRAXEL TREATMENT: The intensity and duration of your side effects depends on the treatment aggressiveness and your individual healing characteristics, but usually can last up to a week after treatment. 1. Swelling: You will notice most of the swelling the first morning after treatment, particularly under the eyes. Swelling usually lasts two to three days. To minimize swelling: a. Apply cold compressed to treated area for 10 minutes out of every hour on the day of treatment until you go to bed. b. Sleep elevated the first night. Use as many pillows as you can tolerate.

4 2. Redness: Most redness resolves during the first week after treatment, but a rosy color can remain for several weeks. If you wish, you can apply makeup immediately after treatment to minimize the redness. 3. Peeling/Flaking/Dry Skin: Your skin may feel dry, peel or flake. You may notice a sandpaper texture a few days after treatment. This is normal; it is the treated tissue working its way out of your body as new fresh skin is regenerated. 4. Bronzing, Crusting, and Small Dark Spots: These dark spots are a normal part of the healing process. They will slough off on their own usually within 7 days after treatment. 5. Raw Skin: If you develop areas of raw skin after treatment, keep them moist with an ointment like Aquaphor. Keep the areas moist and do not pick at them. They will heal very rapidly on their own. 6. Grid-Like Pattern: You may have a grid-like pattern on your skin, which is normal. 7. Papules/Pimples: Sometimes small papules can arise post treatment, if this occurs please call us for treatment advice. FREQUENTLY ASKED QUESTIONS ABOUT FRAXEL: How does Fraxel work? The technology behind Fraxel is as revolutionary as the results it delivers. Unlike other laser treatments, fractional lasers treat thousands of microscopic areas of the skin, using pinpoint laser beams that penetrate beneath the skin s surface to eliminate old, damaged skin cells. Fractional resurfacing treatments stimulate the body s own natural healing process, which replaces damaged skin with fresh, glowing, healthy skin. How many Fraxel treatments are recommended for optimal results? Your skin, genetic make-up, lifestyle and personal history are unique. They all contribute to how your skin looks and feels. For most people, maximum results are realized in 3-5 sessions that are usually spaced 4-6 weeks apart. During your initial consultation with Dr. Patel, he will develop a treatment plan that works for you. How much social downtime is required? Aggressive treatments require fewer sessions and result in more post treatment side effects, meaning a few days of social downtime. Less aggressive treatments accomplish the same results, with a few additional treatment sessions and less pronounced side effects. For some types of skin and skin conditions, gentle and/or fewer treatments are best. Expect about a week of social downtime with Fraxel.

5 Can Fraxel be used in delicate areas such as neck and chest? Yes! Since fractional resurfacing treatment is so precise, it is safe and effective on delicate skin areas like the neck, chest and hands, in addition to the face. What results should be expected with Fraxel treatment? You can expect two types of results, immediate and longer term. Immediately after the initial healing is complete, the surface of your skin will feel softer, look brighter, and the tone will start to become even. Longer term results occur over the next 3-6 months as the deeper layers of skin continue to heal and the body produces collagen in response to the Fraxel treatment. This increased collagen will result in reduced wrinkles and improved acne and surgical scars. Does Fraxel hurt? Topical anesthesia is applied before the procedure to minimize discomfort. The treatment itself can be compared to a rubber band snapping on your skin along with a feeling of heat. After the treatment, most patients report a heat sensation similar to having gotten too much sun. This sensation usually disappears after a few hours. How long do the results after Fraxel last? Fraxel turns back the clock for your skin by reversing sun related damage and restoring health, beautiful skin. How long the result last is dependent on you. While Fraxel turns back the clock, it doesn t stop the aging process. A good skincare regimen and maintenance treatments (such as Clear + Brilliant) combined with consistent sun protection will ensure long lasting Fraxel results. If you have any questions or concerns, please contact the office at (786) You can also reach Dr. Patel at [email protected].