SAN DIEGO (FRONTLINE MEDICAL NEWS) – The way Mathew M. Avram, MD, JD, sees it, the best way to avoid complications from using lasers for aesthetic procedures is to trust your own eyes, not the laser device itself.

“Lasers are never perfect,” he said at the annual Masters of Aesthetics Symposium. “The same device made by the same manufacturer may produce highly different outputs at the same setting. Moreover, lasers produce much different energies after they’ve been serviced. So, if you have two devices sitting right next to each other, don’t assume that the energy output on one device is exactly the same as the other device.”

The advice comes from one of two articles about the optimal use of lasers that Dr. Avram and his associates published in the Journal of the American Academy of Dermatology ( 2016; 74[5]:807-19); ( 2016; 74[5]:821-33 ). At the meeting, he told attendees that, in dermatology, the performance of lasers varies up to 20% on any given day. “So, if your device has been serviced, or if something is happening that is different than previously, take a look and see what’s going on,” said Dr. Avram , who directs the Massachusetts General Hospital Dermatology Laser and Cosmetic Center in Boston.

He also warned clinicians against taking a “cookbook approach” to using lasers, such as memorizing settings or using ones recommended by a colleague or a device manufacturer. “Some lasers are not externally calibrated,” said Dr. Avram, who is codirector of the Massachusetts General Hospital/Wellman Laser and Cosmetic Fellowship. “Safe and unsafe laser endpoints and close clinical observation are the best means to avoiding complications. Learn your endpoints. This is true with the selective photothermolysis lasers: the pigment lasers, vascular lasers, and laser hair removal. Unfortunately, when you use nonablative fractional lasers, there really isn’t an endpoint, so it’s going to be more difficult to discern in that case. The key clinical finding is the endpoint, not the energy setting.”

When treating pigmented lesions and tattoos, for example, immediate whitening is the desired endpoint, not tissue splatter. “So, if you see the epidermis fly off with your first pulse, dial it down,” Dr. Avram said. “It sounds obvious, but sometimes, if you’re working quickly, you figure it will be all right. Just stop and make sure you’re seeing what you’re supposed to be seeing.”

The desired endpoints for vascular lasers, meanwhile, include purpura, transient purpura, or vessel clearance. “What you don’t want to see is gray,” he said. Desired endpoints for hair removal include perifollicular edema and erythema. “What you don’t want to see is epidermal change or dermal tightening,” he added. “Observe the skin and the patient. If the skin is reacting strangely, stop and check all of your settings. If the patient is having an inordinate amount of pain, stop and check all of your settings. These are often the clues that can help you avoid harming a patient.”

Dr. Avram disclosed that he has received consulting fees from Allergan, Merz, Sciton, Soliton, and Zalea. He also reported having ownership and/or shareholder interest in Cytrellis, Invasix, and Zalea.


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