Laser surge

SAN DIEGO — A decade ago, the increase in laser dermatologic surgeries prompted a steady rise in the quantity and variety of medical and cosmetic applications. While improvements have been made in the efficiency and safety of lasers, the number of people providing laser surgery is burgeoning. And that has some experts concerned.

"Today, we're seeing more complications simply because more people are using lasers," Edward V. Ross Jr., M.D., director of laser and cosmetic dermatology at Scripps Clinic in San Diego, tells Cosmetic Surgery Times .

"We have many new providers, so these procedures have become somewhat of a commodity. They're performed in spas and outside the normal medical environment, and often by nonphysicians — we have a lot of dabblers. So now there are a lot more people doing a little laser surgery, and people who do something less often are going to get in trouble more often."

"Using a setting that is too high on someone who is either tanned or browner than the provider thinks the person is, accounts for 40 percent to 50 percent of all complications and can result in burns and blisters," explains Dr. Ross.

To prevent this problem, he says providers need to become "intimately familiar with the device and with the skin, anatomy and physiology.Basically, we need to be very proactive about measuring the pigment."

While some pigment meters are available, they still have not entered the mainstream, he says. "Consequently, everybody uses their eyeball to measure how dark someone is. While that's fairly reliable, it's not always accurate," he says.

TOWARD TOOLS AND TRAINING Another problem is inconsistent training on the use of lasers.

"Training is often done by sales representatives within the venue of meetings," Dr. Ross says. "While that's not necessarily a bad thing, it's not the optimal way. Even though the people selling you a laser are probably well trained, their goal is to sell lasers. As a consumer, we don't really know the level of training that person has, and there is no credentialing certification or process that's nationally recognized for laser training. But we're working on that," he adds.

"Once a complication occurs, it's often a difficult challenge, like un-ringing a bell — the damage is done," he says. "But if you do your best to manage the complication by speeding up the healing and providing good wound care, you can at least put the odds in your favor that the complication will eventually resolve."

MYTH BUSTING Dr. Ross says that dispelling certain myths about lasers could also help lower the number of complications.

"One of the fallacies about lasers is that they can do everything," he says. "Another is that they can perform a facelift. No laser out there can do that. In addition, a lot of people believe that lasers can remove scars. They can reduce the appearance of scars, but the idea that a laser can remove a scar is false."

BUILT-IN SAFETY Dr. Ross hopes that in the near the future, better training will be available for all providers, and that more tools will be developed to more accurately assess patients.

"I'd like to see a device that gives us real-time feedback regarding choosing the settings," he says.

"A pigment meter built into the device could give you a number to assess skin pigment. You could place a probe on the patient and get a reasonable number of settings to choose from. It is something that will happen in future, but it too has to be framed in the context of proper training."

Dr. Ross also predicts that safety and user-friendly devices will continue to be manufacturing focuses.

"All of these can be helpful tools to make our lives easier," he says. "But if they aren't used in the context of proper training and a clear understanding of tissue interactions and how that laser works, you're on a really shaky boat that will eventually tip over."

For more information
Edward V. Ross, M.D.
[email protected]