17 Maximizing Safety with Nonablative Lasers



10.1055/b-0040-177259

17 Maximizing Safety with Nonablative Lasers

E. Victor Ross, Erez Dayan, and Rod J. Rohrich


Abstract


Nonablative lasers are commonly used to treat a variety of conditions such as dyschromia, fine rhytids, acne scars, tattoos, burn scars, hair removal, and striae. Through selective photothermolysis, lasers are able to target specific tissue chromophores based on their absorption wavelength (i.e., hemoglobin, water, melanin) while being minimally absorbed by adjacent nontarget tissue. The goal of nonablative laser resurfacing, and its primary difference compared to ablative lasers, is to restore damaged collagen without injuring or removing the overlaying epidermis. Nonablative lasers typically lead to less downtime compared to ablative laser treatments but are also associated with less dramatic results.




Key Points




  • The most common nonablative lasers used in facial aesthetics include: Nd:YAG, Q-switched Nd:YAG, Diode, Erbium glass fractional, visible light, and intense pulsed light devices. 1 , 2 , 3 , 4



  • Nonablative lasers are variably and moderately effective at reducing fine rhytids. Deeper rhytids are difficult to improve, and may require ablative lasers, chemical peel, and/or soft-tissue fillers. 3 , 5 , 6



17.1 Safety Considerations




  • Wavelength-specific safety equipment (i.e., eye protection) is required. When performed in the operating room, a laser-safe endotracheal tube must be used, and the lowest possible FiO2 should be given. Wet towels are applied around the treatment area to absorb heat energy and reduce risk of fire. 4 , 7



  • A test area can be used to identify the optimal fluence for the patient’s skin.



  • There are usually no visual endpoints for nonablative lasers used for the treatment of rhytids. 8 , 9 , 10



  • For hypervascular lesions, the treatment endpoint is mild purpura, persistent bluing of the vessels, or stenosis of the vessels. 1 , 7



  • For tattoo removal, the treatment endpoint is skin whitening. 11



  • Hypopigmentation (10–20%) is thought to be caused by melanocyte destruction secondary to heat injury. This is often transient and self-limited. Rarely delayed hypopigmentation can present 6–12 months after treatment. 1



  • Scarring is rare with nonablative lasers. Blistering may occur and is typically treated with antibiotic ointment until healed. 3 , 4 , 7 , 10

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Jul 18, 2020 | Posted by in Dermatology | Comments Off on 17 Maximizing Safety with Nonablative Lasers
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