Laser training issues can create complications

Boston - Avoiding complications from laser procedures begins with putting the equipment in the right hands, an expert says.

In the past five to six years, "Laser procedures have become increasingly popular, and the numbers and types of providers who perform these procedures have become fairly wide-ranging," says E. Victor Ross, M.D., who heads the laser section, division of dermatologic surgery, at Scripps Clinic in La Jolla, Calif.

Regarding laser hair removal, for example, he says that one state might allow medical assistants to perform this procedure. In another state, "One might have a full-fledged physician performing the same procedure. And then there's everything in between," including physician assistants and nurse practitioners, Dr. Ross says.

"In other words," Dr. Ross says, "what's the training threshold? That's probably the central issue as far as avoiding complications."

Whoever performs these procedures must be trained not just on the technical side, but also on the theoretical side, he says.

"The title of the person doing the procedure is not as important as that person's level of training," Dr. Ross adds. Such training might include the use of a pigment meter, which he says might help practitioners avoid treating a tanned patient by providing a more accurate pre-treatment reading than the naked eye.

Most common complaint

Dr. Ross says that because laser hair removal is the most popular laser procedure, overtreatment remains the most common source of complications seen by his practice. He adds that although many non-physicians perform the procedure successfully, laser hair removal generally tends to be the laser procedure performed by perhaps the least-trained personnel.

"These types of procedures have tended to be the ones relegated to medical spas and non-medical types of facilities. Rather than a medical procedure, it's become more like a visit to a hair stylist or manicurist," Dr. Ross says.

The underlying problem, he says, is that "There's no nationally recognized credentialing body or any sort of certification that allows the patient or client to know what's a good place versus a bad place." Therefore, he says, a facility's reputation represents probably the most important predictor of what type of care the facility provides.

Due to the increase in laser-related complications, Dr. Ross adds that medical boards and other groups such as the American Society for Laser Medicine and Surgery (ASLMS) are looking into the idea of credentialing for laser procedures. For most physicians who aren't based in hospitals, he says, "There's no way to be credentialed in these procedures."

Nor is there any avenue for cracking down on misleading advertising.

"Right now," he says, "the patient doesn't have a lot of solid information about whom to go to." If an ad claims that a provider is board-certified, but the provider is actually board-certified in neurology, Dr. Ross asks, "Does that make him a good cosmetic laser surgeon?"

Common complications

As for specific complications, he says the most frequent cluster his practice sees involves crusting, blistering and pigmentation changes.

"Usually it's in a scenario where the patient is possibly tanned, or the office has a new machine that hasn't been used much. There's something atypical about the case which makes it go awry," he says.

Overall, he says most complications stem from a practitioner's lack of understanding the basic physics of the laser-tissue interaction, and from unfamiliarity with a particular machine.

"It's like being in a rental car. At first, one gets in the car and turns on the lights and windshield wipers" by accident, Dr. Ross says.