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    Surgeon offers tips for avoiding unwanted scarring following laser therapy


    Dr. Pozner
    It's crucial that physicians have intimate knowledge of the laser devices they use — including a complete understanding of the appropriate settings needed — in order to avoid complications, says Jason Pozner, M.D., F.A.C.S.

    "Complications can vary greatly depending on the laser device used and the work done in the cosmetic patient. Physicians may sometimes push the limits and try to over-please their patients to achieve spectacular laser treatment outcomes, but this approach can backfire and cause complications," says Dr. Pozner, Sanctuary Plastic Surgery, Boca Raton, Fla.

    If more invasive resurfacing procedures, such as deeper peels, are performed inappropriately, the complications will likely be more severe than those that can result from lighter, more superficial peels. Though the deeper resurfacing peels result in a far superior cosmetic effect, they are associated with a greater risk, Dr. Pozner says.

    When using vascular lasers, physicians need to be wary of complications such as dyspigmentations, burns and scarring, especially on the face. These complications can arise not only from inappropriate settings or from inadequate cooling (the common denominator being overheating of the tissues); they can also arise if the vessels are located too superficially in the skin. This is particularly true for burns, as all too often laser settings can be set too high.

    IPL ISSUES According to Dr. Pozner, complications following intense pulsed light (IPL) treatments may arguably be the most common.

    "Intense pulsed light devices are probably one of the most popular devices currently on the market; however, they are also associated with the most frequent complications. In my opinion, complications likely arise when the physician simply uses the wrong device in the wrong skin type," Dr. Pozner says.

    Lip-scar complication in a 65-year-old patient who underwent deep erbium resurfacing to the full face. This photo was taken two months after the laser resurfacing treatment. (Photo credit: Jason Pozner, M.D., F.A.C.S.)
    Similar to all aesthetic devices, IPLs are safe if used appropriately, Dr. Pozner says. However, if a too-aggressive stance is taken in any skin type (but especially in darker skin types), complications such as hyperpigmentations and even burns can occur. Here, it is paramount to use the right settings, the right filters, the right pulse widths and the right device.

    RESURFACING RISKS Resurfacing lasers such as erbium, CO2, fractional and ablative technologies can all cause complications, the most common of which can include burns, dyspigmentations and scarring. Viral, bacterial and fungal infections can also result following treatments with these lasers and technologies.

    "While bacterial infections are extremely rare, viral infections are the most common, followed by yeast infections, the latter of which can be a common source of nonhealing wounds. I believe these complications are more common in a moist/humid environment and can often be the reason for nonhealing laser wounds. Following positive tests, antifungals can easily solve this problem, and wounds will quickly heal," Dr. Pozner says.



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