17 Maximizing Safety with Nonablative Lasers
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.
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.
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