Lasers: Safety and Complications

Key Safety Pearls

Omar Ibrahimi, MD, PhD
  • Lasers are extremely powerful methods for delivery of light. A basic understanding of laser safety is mandatory for anyone operating a laser
  • The major risks associated with laser use in dermatology include: eye injury, infectious hazards, medication overdoses, fire, and electrical shock
  • Lasers in the visible light and near infrared range are absorbed by melanin and can damage the retina (can cause blindness)
  • Lasers in the mid-far infrared range are absorbed by water and can damage the cornea
  • Use of appropriate eye goggles can minimize the risk of eye damage (remember that eyewear is wavelength-specific)
  • There are risks with topical anesthesia

Complications with Lasers

Matt Avram, MD, JD

As dermatologists, here are some clinical pearls to keep in mind with regards to lasers:

  • Practice good common sense
  • Know your limits
  • Examine the patient in the same day, if possible. If you are uncertain as to what is happening, consult a colleague
  • Do not abandon or avoid a patient with a poor outcome or side effect
What are some of the common reasons for litigations with laser treatment?

Dr Avram and colleagues revied 1,601 cases. They found that 75% of physicians in low-risk specialties will face a malpractice claim by age 65. Of the cases that were reviewed, they found 182 unique legal claims involving injury from a cutaneous laser treatment. These cases were mainly in California, New York, and Texas.

Most common litigated procedures
  • Hair removal
  • Rejuvenation
  • Leg veins
Most common injuries
  • Burn
  • Scar
  • Pigmentation
Most common reasons for litigation
  • Negligence
  • Informed consent
  • Fraud

In 50% of the cases, the courts ruled in favor of the plaintiffs.

Common Complications with Laser Treatment
  • Hypopigmentation
  • Pigmented lesions
  • Scarring

Remember that lasers can be an effective treatment for

  • Lentigines
  • Ephelides
  • Nevus of Ota/Ito

They should NOT be utilized for

  • Atypical nevi
  • Lentigo maligna
  • Melanoma

*When in doubt-perform a biopsy

 In Summary
  • Use common sense
  • If you can’t recognize or treat the condition- don’t use a laser
  • If you’re uncertain, call an experienced colleague