Prior to treatment, patients should meet with their clinician to discuss their medical history. For patients with a history of cold sores (oral herpes simplex), valacyclovir or acyclovir should be prescribed starting on or before the day of treatment. Medications, such as Accutane® should also be stopped 6-12 months prior to treatment, and topical retinoids and exfoliating products (i. e., glycolic or lactic acids) should be stopped 2 weeks prior to treatment [13]. Caution should be exercised in treating patients who have a history of impaired wound healing, keloids, are immunocompromised, have darker skin types (IV-VI), or are currently tanned.
For pain management during treatment, a topical, lipid-based anesthetic with lidocaine, such as 2.5% lidocaine/2.5% prilocaine cream (EMLA®) or 23% lidocaine/7% tetracaine ointment, is commonly applied approximately one hour prior to treatment. Care should be taken to prevent topical anesthetic from contacting the eyes, as incidents of corneal abrasions have been reported [13].
When performing ablative fractional treatments or when more aggressive treatment settings are used, nerve blocks (infraorbital and mental) are often administered using 4% articaine HCl with epinephrine or other dental anesthetic. Oral medications, such as anxiolytics and analgesics, may also be used. Anxiolytics also aid in preventing lidocaine toxicity [37]. Despite these measures however, mild to moderate pain is often experienced.
Eye protection is also required during treatment. For treatments off the face, protective goggles alone are sufficient. Metallic ocular shields or other protective eye shields should be worn for treatments on the face. When treating directly over the eyes, proper intraocular shields must be placed.