Non-Ablative Lasers and Avoiding Complications with Them

Non-ablative lasers offer numerous benefits and potential in aesthetic treatments, but they must be used with care. Three key factors are important to understand when using any energy-based device on a patient: the skin, the technology, and the potential complications that could arise. Medical directors for practices have a responsibility to ensure all of their providers who use energy-based devices are appropriately trained to provide safe and adequate care to patients.

UNDERSTANDING THE SKIN AND TECHNOLOGY

Classifying a patient’s skin type is essential when performing a treatment with an energy-based device. I use the Pantone SkinTone, a program that helps ensure that the colors seen on devices accurately represent the patient’s skin tone. Classifying the skin type is crucial because complications can arise with inappropriate use of the device on patients with darker skin.

Patients’ age, previous experience, and thickness of skin are important factors in determining how much energy should be delivered during treatment. Dyschromia plays a particularly significant role with intense pulsed light (IPL) treatments.

Providers must understand the technology they are working with and the chromophore. The most common chromophores are water, tissue proteins, hemoglobin, and targeting. Understanding the chromophore exemplifies what is being targeted during the treatment. You must understand the indications for each device and companies will provide recommended settings as guidance for beginners. It’s imperative to understand the power energy-based devices contain. For example, IPL devices are among the most underestimated and can cause damage to people’s skin; in reference to litigated devices, IPL is likely second only to laser hair removal because it is a broad-spectrum device. It can be adjusted to target certain pigments and treats redness, brown spots, and skin rejuvenation.

Another energy-based device to use with caution is the Nd:YAG laser. It emits infrared light at a wavelength of 1064 nm. The laser targets hair follicles by heating them to damage the cells responsible for growth, in addition to treating vascular lesions, such as spider veins and hemangiomas. It can also be used to improve the appearance of wrinkles and acne scars. The device has the power to cause considerable dimpling and other issues on something as simple as an angioma if the user does not understand how to deliver the energy.

ISSUES OF CONCERN WITH NON-ABLATIVE LASERS

Understanding a patient’s skin type and the technology you are using could save you from experiencing serious problems. Severe burns, scarring, and dyspigmentation can occur if appropriate precautions are not taken. Cooling the skin is imperative to prevent a burn. Burns can result from long pulse durations, excessive fluence (the amount of energy being delivered over the targeted area), or improper deliver of cooling. Considerably less energy should be used for the neck and chest. Failure to understand that principal can cause burns to the skin and stamping to the chest, which can be extremely difficult to manage.

Dyspigmentation, both hyper- and hypopigmentation, after laser treatments can be a frequent complication. The risk of dyspigmentation is highest in darker-skinned or tanned individuals and one way to reduce the changes is to avoid sun exposure before and after treatments. Hyperpigmentation more commonly occurs. It is normally temporary and can be treated with several resources. Some treatments include topical 4% hydroquinone, retinol, azelaic acid, superficial chemical peels with glycolic or salicylic acids, concealment with cosmetics, avoiding sunlight exposure, and IPL, pulse dye lasers, or Er:YAG lasers.

Hypopigmentation can be more difficult to treat because the epidermal melanocytes become damaged, and the likelihood of reviving coloration is much lower. It can be caused by excessive fluence or too many laser treatments. Treatment options include concealment with cosmetics, treatment with ultraviolet light, topical steroids, fractionated carbon dioxide lasers, and topical prostaglandins—which entered the industry within the last 5 to 6 years. It is likely that the prostaglandins stimulate prostaglandin receptors, such as the FP receptor, to initiate melanogenesis and tissue darkening.

Ocular injury is a risk for not only the patient but also the provider conducting the treatment. The possibility of infection must also be taken under consideration.

APPROPRIATE OVERSIGHT OF PROVIDERS

The aesthetic industry has experienced exponential growth in the past 20 years and has been projected to surpass $270 billion in 2024. As the industry grows, it is no longer just physicians, nurses, and physicians’ assistants handling laser devices. In some states, estheticians are allowed to operate them. Excessive oversight is a safe rule when you are instructing colleagues working with laser devices. In my office, the practitioners conducting these treatments are constantly being trained and certified on every single device they use. Prior to seeing a patient, our team gets certification on all devices and then we continue educating. I perform good faith examinations on every patient receiving an energy-based treatment. While this may be time consuming, my incidence of complications is almost zero. Plus, it’s an opportunity for active learning where the provider can determine the settings and in turn, I can agree or disagree before giving expert guidance. It’s also beneficial to take photographs of patients to document and follow improvement or new instances.

CONCLUSION

Laser devices are powerful tools that have the potential to cause significant harm to patients and healthcare providers if not deployed correctly. Lasers should be used by trained medical professionals in medical settings, providing high-quality care with a lower risk of adverse effects and subsequent litigation. Physicians, and other clinicians, should understand the risks and complications that come with laser procedures and be educated on how to manage them. Complications are a daily battle that all practitioners fight; you should expect to have some complications arise. Rushing through the day leads to greater chances for problems. Take your time with these treatments and when complications arise, don’t minimize them. If you don’t know how to treat something, referring the patient to a practitioner who does is the best option.