I use a CO2 fractional laser for skin resurfacing, Luminis AcuScan ®. Great results but very dissappointed in the comfort levels produced by BLT cream or 5% Lido. Tried compounds 20% benz, 7% lido, phenyleprine. and Benz 20 Lido 5 Prilo 2 and not happy yet.. Any suggestions? Patient comfort really would be a help for a really nice result. Anybody tried pre op single dose HC APAP or Oxycodone APAP prior ?

Have you tried Betacaine? Best topical I have found. It's lido, but vehicle works best.

What happened to the CLAIMS about PAINLESS laser treatment, that graduated to "like a hit from a rubber band" (Yeah, one from a truck inner tube). More like a hit from a wet towel in the locker room, to deaths reported by FDA, caused by lidocaine as it also affects the heart. Patients who were healthy yesterday have been known to get sick the next day. That possibility exists all the time. I had a "silent stroke" that was discovered when I had a second stroke. IT IS STILL A STROKE. reported to me that the scan showed evidence of an earlier stroke. Mild ones are called TIAs (transient ischemic attacks) Still a stroke. A sharp diagnostician can pick it up but scans are diagnosed by the X-ray department. Then your doc can look it up.
You can look up any DIAGNOSIS IF THE DIAGNOSIS IS CORRECT and learn as much about your problem as there is to know, ALMOST.

LOL!!!! Lefty, they're talking about a CO2 fractional. You don't use fractional lasers for hair removal. Comfort levels vary depending on how course the hair is, color of the hair, intesity of the laser settings (how high or low pulse width/jewels are set in according to skin type), the patient's pain tolerance, how close they are to their menstrual cycle, and several other factors. Most patients don't even numb for hair removal treatments. CO2 fractionals are for RESURFACING and are more intense. Those are also covered under an Illinois esthetic license, by the way ;)

Nerve blocks + sedation are usually required for all but the most conservative settings in my experience or there's just too much discomfort and movement during the procedure.

Nerve block is administered by NEEDLE isn't it? Therefore, it must be ordered by a doc even if it is administered by a nurse.
Allergies to all drugs that end in "caine" are very common. My doc said he would never give any of those drugs unless the patient was hooked up to a heart monitor. He does NO cosmetics.The side effects to laser treatments reported by FDA were as a result of the lidocaine or other "caine" product NOT the laser. They are listed here at the FDA web site and consisted, at that time, of 2 deaths, coma, seizures, and heart arrhythmias. and these are ALL NEUROLOGIC effects, not photo effects. Lasers do not cause them. They are considered laser side effects because if the patient did NOT have laser treatments there would not be any reactions. Most laser patients here had large areas treated after wrapping the patient in plastic to get faster and more effective pain relief. Direct laser effects usually are BURNS and similar reactions not DEATH or neurologic reactions..

Pain is difficult to treat because a patient who NEVER had a reaction to ANY OF THE CAINE products... may have been sensitized at that time, consequently, the second or subsequent dose is the one that sets off the reaction. Some give a "test" dose before a full injection, however, that can lead to a "false sense of security". ALL these products have side effects. It is merely a question of when and how severe it is going to be but sooner or later there are going to be allergy problems. If you are not prepared to handle it you have a real problem.

There was a dentist near here, who used gas for teeth cleaning and patients loved it. One day a patient who had many treatments over the years, had another treatment. This time she had cardiac arrest. The law says you have to have a "crash cart" in case the patient crashes. He had the cart, she crashed and died, the high school gal assistant ran out of the office screaming. His big problem was he had the cart, but never learned to use it. That is another reason a non-medical person has to have a doc OVERSEEING (supervising) the work. Sooner or later it will happen. The figures reported by FDA are NOT UP TO DATE. Nobody knows how many were NOT reported or how maqny were not recognized as being related to a laser treatment. Your Docs ALL have an EPI-PEN on hand incase such a reaction does happen in the office. Most times it works, however,some times it does NOT. The doc hass an excuse as he used the EPI-PEN and sometimes it is not enough or not fast enough. At least he tried with what was available. That is NOT negligence.

IF you Google "Betacaine ingredients" there is mucho info on the product and the TOXIC side effects. FDA has stepped in.
It seems there are "compounding pharmacies" who will compound almost anything you want. One problem is they are following the prescriber's recipe .The end product has NOT been tested for "safety and efficacy". Every time you make a new product ...FDA requires it be tested as all other drugs are so that new toxicities may be discovered as a result of interaction of ingredients that can occur. By mixing 5% lidocaine (which is approved for use) with additional "caine" products you are increasing the action on nerves because each of the "caine" drugs acts on the nerves, consequently, the effect is additive for pain relief at the site of administration, however, the allergy effect is multiplied many times over on the entire nervous system when it is absorbed because the skin reacts differently to the "caine" than the nervous system.

Do not use drugs differently than what the labeling OKs as that has been tested for "safety and effectiveness" before marketing. Compounded products have not been tested the same way. Also, quality control is more difficult in a pharmacy than when making large batches in a factory..

I can do Erbium with topical, but CO2 is too deep for just a topical. I suggest nerve blocks and sedation.

In our clinics we refer our patients to their general doctor with a guideline sheet on the procedure to be done. We allow their doctor to determine if sedation and or pain medicine is warranted and safe for them and if so to give an RX to them for the day of treatment.

Any doc who orders meds and was not be there for the procedure must be hungry for a few bucks. He prescribed the drug and should administer it for the particular purpose for which it was being used. I would never do that. Why should I be involved with a potential for a serious side effect and not even be there... just IN CASE SOMETHING HAPPENS ? SOONER OR LATER IT WILL HAPPEN AND THE DOC WHO ORDERED THE DRUG GOT PAID A PITTANCE FOR HIS EFFORTS BUT NEVER SHARED IN THE PAY OFF. I EXPECT TO GET PAID IN PROPORTION TO THE RISK JUST AS INSURANCE COMPANIES DO.. THAT IS HOW THEY DETERMINE PREMIUMS. IT IS ALL BASED ON EXPOSURE TO RISK.

SELLING THESE "TREATMENTS" is what this is all about. Risks are played down to the patient (liks the pain of a rubber band, HA HA). I bet many operators actually believe that even though they see and hear the patient's screams.. Does waxing hurt as much? I never had that done to me.