Treatment of Laser Complications

ABSTRACT

Modern lasers and light-based sources that were developed based on the theory of selective photothermolysis are capable of destroying specific tissue targets while minimizing the risk of scarring and pigmentary changes. This is accomplished through the use of a wavelength and pulse duration that is best absorbed by a specific chromophore such as melanin or hemoglobin. However, not all lasers and light sources adhere to this principle. Continuous wave (CW) lasers are least selective and may produce unwanted tissue damage and scarring through heat conduction to normal skin. Quasi-CW lasers limit excessive thermal destruction by delivery of a series of brief laser pulses but still pose a higher risk of nonspecific tissue damage and thermal injury. The pulsed and Q-switched (QS) systems adhere most closely to the principles of selective photothermolysis and result in the highest degree of selective destruction with the lowest risk of scarring from excessive thermal diffusion. Certainly, any laser system potentially can result in scarring and tissue damage when used incorrectly; therefore, adequate operator education and skill are essential. Side effects and complications that occur as a consequence of laser treatment can be significantly reduced if diagnosed and treated in an expeditious manner.

Laser - complications - cutaneous - skin - surgery - treatment

REFERENCES

• 1 Anderson R R, Parrish J A. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation.  Science. 1983;  220 524-527
• 2 Alster T S, Tanzi E L. Complications in laser and light surgery. In: Goldberg D Lasers and Lights. Vol. II. Philadelphia, PA; WB Saunders 2007: 101-114
• 3 Alster T S. Cutaneous resurfacing with CO₂ and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations.  Plast Reconstr Surg. 1999;  103 619-632 discussion 633-634
• 4 Tanzi E L, Alster T S. Single-pass carbon dioxide versus multiple-pass Er:YAG laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates.  Dermatol Surg. 2003;  29 80-84
• 5 Alster T S, West T B. Effect of topical vitamin C on postoperative carbon dioxide laser resurfacing erythema.  Dermatol Surg. 1998;  24 331-334
• 6 Alster T S, Nanni C A. Pulsed dye laser treatment of hypertrophic burn scars.  Plast Reconstr Surg. 1998;  102 2190-2195
• 7 Nanni C A, Alster T S. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients.  Dermatol Surg. 1998;  24 315-320
• 8 Bhatt N, Alster T S. Laser surgery in dark skin.  Dermatol Surg. 2008;  34 184-194; discussion 194–195
• 9 West T B, Alster T S. Effect of pretreatment on the incidence of hyperpigmentation following cutaneous CO₂ laser resurfacing.  Dermatol Surg. 1999;  25 15-17
• 10 Tanzi E L, Wanitphakdeedecha R, Alster T S. Fraxel laser indications and long-term follow-up.  Aesthet Surg J. 2008;  28 675-678
• 11 Alster T S, Zaulyanov L. Laser scar revision: a review.  Dermatol Surg. 2007;  33 131-140
• 12 Alster T S, Tanzi E L. Laser skin resurfacing: ablative and nonablative. In: Robinson J, Sengelman R, Siegel DM, Hanke CM Surgery of the Skin. Philadelphia, PA; Elsevier 2005: 611-624
• 13 Manstein D, Herron G S, Sink R K, Tanner H, Anderson R R. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury.  Lasers Surg Med. 2004;  34 426-438
• 14 Graber E M, Tanzi E L, Alster T S. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments.  Dermatol Surg. 2008;  34 301-305; discussion 305–307
• 15 Manstein D, Zurakowski D, Thongsima S, Laubach H, Chan H H. The effects of multiple passes on the epidermal thermal damage pattern in nonablative fractional resurfacing.  Lasers Surg Med. 2009;  41 149-153
• 16 Fife D J, Fitzpatrick R E, Zachary C B. Complications of fractional CO₂ laser resurfacing: four cases.  Lasers Surg Med. 2009;  41 179-184
• 17 Alster T S, Wanitphakdeedecha R. Improvement of postfractional laser erythema with light-emitting diode photomodulation.  Dermatol Surg. 2009;  35 813-815
• 18 Radmanesh M. Paradoxical hypertrichosis and terminal hair change after intense pulsed light hair removal therapy.  J Dermatolog Treat. 2009;  20 52-54