Don't let heat, cooling mishaps undermine laser success (Part One)

LAS VEGAS – The potential for complications is part of the package when physicians venture into laser medicine, so it is essential to be proactive in preventing the pitfalls that lurk, said Ranella Hirsch, M.D., at the annual meeting of the American Society for Cosmetic Dermatology and Aesthetic Surgery.

“Scars, dyschromias and textural changes can happen with any laser, light or radiofrequency source, even with the most experienced of surgeons,” said Dr. Hirsch, a cosmetic dermatologist based in Cambridge, Mass., and president of the ASCDAS.

“These problems can occur due to a variety of reasons, including poor understanding of how laser and light interact with skin, poor technique, failure to pay attention to detail, failure to accommodate pigment or a tan, and failure to pay attention to real-time changes in the skin,” she said.

In approaching any laser procedures, try thinking of heating and cooling the skin as separate processes, and remember that the skin doesn’t cool as fast as it can heat up, she suggested.

“If you think of treatments as cooling versus heat, a lot of things start to fall into place about prevention,” Dr. Hirsch said. “The ability we have to protect the epidermis by cooling it is very advanced, but it’s essential to remember that cooling the skin takes a whole lot longer than heating it, and that’s the step that can really get you into trouble, if you miss it. 

Use cooling judiciously, she recommended, and use back of your hand to test the temperature on the skin you’re about to treat. “You will feel and know where you’re supposed to be in terms of cooling.”

Don’t forget that every form of cooling can have a complication profile, including cryogen spray coolers, and sometimes the lowest-tech approach may be the best: “I’m a big fan of ice packs – they’re cheap, reliable and they work,” she said.

Regardless of the cooling system, a patient’s expression of pain should be the ultimate guide indicating when to put on the brakes.

“If patients tell you they are hurting, you need to stop right away. It’s critical to listen and act if patients tell you about disproportionate levels of pain.”

- Nancy A. Melville

More Laser Pearls