Dermatologic Laser Side Effects and Complications: Prevention and Management
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REVIEW ARTICLE
Dermatologic Laser Side Effects and Complications: Prevention and Management Tina S. Alster1 · Monica K. Li2
© Springer Nature Switzerland AG 2020
Abstract The evolution of modern laser and light-based systems has mirrored the demand for clinically effective treatments and the need for safer technologies with reduced postoperative recovery, side effects, and complications. With each new generation of lasers, more selective tissue destruction can be achieved with reduced unwanted sequelae. Patient selection and preparation, operator technique, and expeditious recognition and management of post-treatment side effects are paramount in avoiding complications and patient dissatisfaction. An overview of important variables to consider for dermatologic laser treatments are presented in order to provide a framework to reduce the severity and duration of possible post-treatment side effects and complications.
Key Points Anticipated and non-anticipated side effects and complications are possible after any therapeutic endeavor. Strategies to limit or avoid complications include careful patient and device selection, application of appropriate laser parameters and techniques, and initiation of prophylactic therapies when needed. When recognized and managed expeditiously, the severity and duration of side effects and complications will be minimized.
1 Introduction Laser technologies have evolved dramatically over the past 6 decades enabling expanded clinical applications with improved outcomes [1]. While early lasers emitted continuous-wave (CW) energy to destroy targeted tissue, they also generated heat that conducted to the surrounding * Tina S. Alster [email protected] 1
Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
City Medical Aesthetics Center, Vancouver, BC, Canada
2
non-targeted skin resulting in nonselective thermal injury with significant side effects and complications [2, 3]. Revolutionary work performed by Anderson and Parrish in the 1980s paved the foundation for the development of safer and more effective laser systems [4]. The theory of selective photothermolysis proposed by these two pioneers describe the mechanism in which specific tissue destruction occurs with minimal adjacent tissue injury through the application of specific laser wavelengths and controlled delivery methods [4]. This is achieved by exposing a tissue target (or chromophore) such as hemoglobin or melanin to laser energy for an interval shorter than its thermal relaxation time (the time required for a target to cool to half its peak temperature after laser irradiation). Modern laser platforms that incorporate selective photothermolysis principles are highly effective with a robust safety record. Despite their high specificity and ability to selectively destroy targeted tissue, side effects and complications remain a risk [5]. While postoperative side effects are typically transient, anticipated, and largely unavoidable, complications are often persistent, unfavorable clinical consequ
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