Preventing and Managing Laser Complications

Dr. Jill Waibel:

Hi, I'm Dr. Jill Waibel from Miami, Florida, and I'm going to share with you a great publication that I was honored to be part of. It's the Consensus Statement on the Prevention and Management of Complications of Fully Ablative Laser Resurfacing of the Face. And this was really headed up by Dr. Kang and Dr. Ortiz. And there was a group of us as experts that did a very deep dive in the literature as well as all of our own surveys talking about how to navigate and understand everything that happens when you use a fully ablative laser.

Now, one of the things that's been very exciting in the laser world is we've really seen a resurgence of ablative fractional and fully ablative lasers. These are the gold standards for removing wrinkles, for removing photo damage, and of course, I'm going to put a plug in for scars. There's nothing else like the results that come from these.

And what we've seen now is we don't have to just take that 85-year-old Florida patient that looks like a prune and we can make her look like baby skin, which is still very fun to do. But we're now, especially in our office, we start in a much younger patient cohort, we can do a light resurfacing on a 30-year-old, we can do a medium resurfacing on a 55-year-old, and we can see amazing results across the way. You can resurface just one part of the face, like round the mouth or around the eyes that tend to age with static wrinkles or wrinkles at rest a little faster. And the patients, at least in my world, they want the results. We have a lot of devices out there, but at the end of the day, it's can you deliver great results and make your patients happy?

Now, when you do a resurfacing, I call it a black belt procedure, I've been lasering for almost 30 years, and I didn't resurface until I was eight years into my fully laser practice. That's all I do most days every day. You really have to understand the laser technology, the laser physics interactions, you have to understand your patient, their skin type, what their goals are, what their downtime is. But the most important thing is you have to be able to manage the complications.

And so this article really goes through expected complications, things that we expect to see like redness and swelling, bruising sometimes depending on your anesthesia. And then there's adverse events, again, some that are more common like focal infection because the barrier of the skin is down. And how to handle that, you want to culture it, you want to get them on the right antibiotics, antivirals, or antifungals as necessary.

We talk a lot about prophylaxis, what these different experts, I think there's about 20 to 30 experts that co-wrote this paper, and everyone weighed in on what they do personally. Again, and we weighed that with the literature search and the Delphi review that was done.

And then we give tips on if something goes wrong, reach out to a colleague, we all do it all the time with each other. And it could be another dermatologist, plastic surgeon, or an infectious disease doctor if you're unsure.

But we really want everyone happily lasering their patients with fully ablative lasers and really had a guide to understand when something goes wrong, what the next steps are. And all of us have complications. And I think my mentor, Dr. Alster, taught me it's not how good of a laser doctor you are, it's how well you can manage the complications.