Hi Dr. Irwin I hope you are doing well, 7 weeks ago I had a fractional CO2 laser. 7 days post-op after constantly moisturizing, the scabs were loose. I picked the scabs but with minimum force to pull as it seems to almost fall out on its own. There was no bleeding or anything. However, now my skin texture is so bad, the skin is bumpy with more pores with some depressed lines and red veins everywhere. Do you think this was caused by picking at the scabs? At the moment I am prescribed Differin and I am stressed if I made irreversible damage. From what I heard that the main issue with picking at scabs is when the area starts to bleed which could lead to scarring but that didn’t happen. So many of us are getting laser treatments now because we recognize they are one of the keys to keeping skin healthy and young looking as we age. And then….sometimes we have a bad experience and that generates fear, of course. You didn’t mention how old you are or where you live, but let’s assume you’re healthy and generally heal normally from skin injuries.
To reassure you, it’s unlikely that this will cause any permanent damage. But…did your dermatologist see you post laser at about 3-4 days? Please, if you haven’t already, go back to your doctor and have them look at you. Only that person knows for sure what they did with the laser since there are many ways to do a treatment. And, only that person can tell you if you are healing normally for the laser settings they used.
4 Keys to healing well after an ablative laser treatment.
Stay in close touch with your doctor. If the dermatologist doesn’t offer to see you post procedure as a routine thing, then please ask for and insist on it. I know it may not be convenient, but it’s key. Depending on the laser, day 3-5 post procedure works best. Telehealth is not a good idea. The colors and textures aren’t the same, and if your doctor needs to do a culture, for example to check for Staph, that can’t be done on video. Also, call the office if you’re not sure if something is normal. Ideally, you were given written post care instructions.
Obey the sun/light restrictions. Stay indoors, away from windows (transmit UVA) and use the post care you were given which ideally includes a 15-20% zinc only sunscreen. If you do go outside, a brimmed hat is key. Try to avoid doing the treatment the time of year you are likely to be outside the most.
Don’t pick! I know it’s soooooo tempting, but just don’t; even if it seems like the crusts/scabs are loose. It almost always leads to problems. Just cover those little loose spots with sunscreen and ignore them for a few more days. They WILL fall off on their own. Gentle cleanser with hands or a very gentle wash cloth is fine. Remember that when that crust falls off, there will almost always be a pink spot left behind for a while. Extra sunscreen is a must at this stage.
Get written post care instructions from your dermatologist. These are so helpful. The laser itself is usually confusing, and your doctor/nurse will go over the instructions in the office. But you will need written care instructions to care for your skin to refer to when you go home. We provide all the post care products needed after a Fraxel or CO2 laser so there’s no confusion about what goes on when, especially if it’s over a weekend. When you are considering booking the treatment, it’s good to ask if written post care is provided and can you see the instructions.
I hope this helps,
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