Complications in aesthetic medicine resulting from procedures that use fractional lasers in skin regeneration treatments

Main Article Content

Katarzyna Beutler https://orcid.org/0009-0000-4219-5676
Szymon Rzepczyk https://orcid.org/0000-0001-6330-1511
Bartosz Bijata https://orcid.org/0009-0005-5874-2183
Jędrzej Lewandowski https://orcid.org/0009-0006-0608-0154
Paweł Świderski

Keywords

fractional ablative lasers, fractional non-ablative lasers, complications, malpractice, litigation

Abstract

Fractional lasers are used in aesthetic medicine for skin resurfacing, the number of treatments that employ them is constantly increasing. They represent a safer alternative to the previously dominant full ablative and non-ablative lasers, due to the smaller area of skin exposed to the laser. Despite improved technology and increased safety of laser treatments, as well as their shortened recovery time, complications still occur. The most common ones include erythema or swelling, however serious and long-term complications also occur. Considering the risk of complications and their severity, the person performing the procedure should be well trained, use appropriate equipment with correctly selected parameters and follow the principles of antisepsis. The number of lawsuits against people performing laser treatments is growing significantly, as patients are suing for compensation. Due to the fact that the continuity of the skin is not broken during the procedure, in many countries there are no precise legal regulations regarding the principles of laser treatments, which significantly complicates the pursuit of such claims.


 

Abstract 154 | PDF Downloads 95

References

1. Mysore V, Goel A, Krupashankar D, Aurangabadkar S, Nischal K, Omprakash H. Fractional lasers in dermatology - Current status and recommendations. Indian J Dermatol Venereol Leprol. 2011; 77(3):369.
2. Halepas S, Lee KC, Higham ZL, Ferneini EM. A 20-Year Analysis of Adverse Events and Litigation With Light-Based Skin Resurfacing Procedures. J Oral Maxillofac Surg. 2020; 78(4):619-628.
3. Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: Nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol. 2008; 58(5):719-737.
4. Saedi N, Jalian HR, Petelin A, Zachary C. Fractionation: Past, Present, Future. Semin Cutan Med Surg. 2012; 31(2):105-109.
5. Jih MH, Kimyai-Asadi A. Fractional Photothermolysis: A Review and Update. Semin Cutan Med Surg. 2008; 27(1):63-71.
6. Brightman LA, Brauer JA, Anolik R, et al. Ablative and Fractional Ablative Lasers. Dermatol Clin. 2009; 27(4):479-489.
7. Kauvar ANB. Fractional nonablative laser resurfacing: is there a skin tightening effect? Dermatol Surg. 2014; 40 Suppl12:S157-S163.
8. Ong MWS, Bashir SJ. Fractional laser resurfacing for acne scars: a review: Fractional laser resurfacing for acne scars. Br J Dermatol. 2012; 166(6):1160-1169.
9. You HJ, Kim DW, Yoon ES, Park SH. Comparison of four different lasers for acne scars: Resurfacing and fractional lasers. J Plast Reconstr Aesthet Surg. 2016; 69(4):e87-e95.
10. Cohen SR, Goodacre A, Lim S, et al. Clinical Outcomes and Complications Associated with Fractional Lasers: A Review of 730 Patients. Aesthetic Plast Surg. 2017; 41(1):171-178.
11. Sureddi PS, Parker V, Palesty JA. Laser Treatment. In: Ferneini EM, Castiglione CL, Banki M, eds. Complications in Maxillofacial Cosmetic Surgery. Springer International Publishing; 2018:131-140.
12. Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg. 2007; 33(3):295-299.
13. Kalashnikova NG, Jafferany M, Lotti T. Management and prevention of laser complications in aesthetic medicine: An analysis of the etiological factors. Dermatol Ther. 2021; 34(1):e14373
14. Neaman KC, Baca ME, Piazza RC, VanderWoude DL, Renucci JD. Outcomes of fractional co2 laser application in aesthetic surgery: a retrospective review. Aesthet Surg J. 2010; 30(6):845-852.
15. Fractional Laser Market – Global Industry Trends and Forecast to 2030 | Data Bridge Market Research. Accessed December 13, 2023. https://www.databridgemarketresearch.com/reports/global-fractional-laser-market
16. Cameli N, Mariano M. Complications of Fractional Lasers (Ablative and Non-ablative). In: Fabbrocini G, De Padova MP, Tosti A, eds. Nonsurgical Lip and Eye Rejuvenation Techniques. Springer International Publishing; 2016:117-123.
17. Metelitsa AI, Alster TS. Fractionated Laser Skin Resurfacing Treatment Complications: A Review. Dermatol Surg. 2010; 36(3):299-306.
18. Saedi N, Petelin A, Zachary C. Fractionation: a new era in laser resurfacing. Clin Plast Surg. 2011; 38(3):449-461.
19. Al-Niaimi F. Laser and energy-based devices’ complications in dermatology. J Cosmet Laser Ther. 2016; 18(1):25-30.
20. Mamelak AJ, Goldberg LH, Marquez D, Hosler GA, Hinckley MR, Friedman PM. Eruptive keratoacanthomas on the legs after fractional photothermolysis: report of two cases. Dermatol Surg. 2009; 35(3):513-518.
21. Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg. 2008; 34(3):301-307.
22. Alster T, Khoury RR. Treatment of Laser Complications. Facial Plast Surg. 2009; 25(05):316-323.
23. Fife DJ, Fitzpatrick RE, Zachary CB. Complications of fractional CO2 laser resurfacing: Four cases. Lasers Surg Med. 2009; 41(3):179-184.
24. Karsai S, Czarnecka A, Jünger M, Raulin C. Ablative fractional lasers (CO2 and Er:YAG): A randomized controlled double‐blind split‐face trial of the treatment of peri‐orbital rhytides. Lasers Surg Med. 2010; 42(2):160-167.
25. Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. an evaluation of 500 patients. Dermatol Surg. 1998; 24(3):315-320.
26. Wright EJ, Struck SK. Facelift combined with simultaneous fractional laser resurfacing: Outcomes and complications. J Plast Reconstr Aesthet Surg. 2015; 68(10):1332-1337.
27. Carniol PJ, Hamilton MM, Carniol ET. Current Status of Fractional Laser Resurfacing. JAMA Facial Plast Surg. 2015; 17(5):360-366.
28. Kaur J, Sharma S, Kaur T, Bassi R. Complications of fractional ablative carbon dioxide laser in various aesthetic procedures: a retrospective study. Int J Res Dermatol. 2019; 5(4):664.
29. Habib N, Saedi N, Zachary C. Cold-Induced Urticaria After Fractional Carbon Dioxide Laser Resurfacing of the Face. Dermatol Surg. 2011; 37(11):1700-1703.
30. Fife DJ, Zachary CB. Delayed Pinpoint Purpura after Fractionated Carbon Dioxide Treatment in a Patient Taking Ibuprofen in the Postoperative Period. Dermatol Surg. 2009; 35(3):553.
31. Tanzi EL, Alster TS. Single-pass carbon dioxide versus multiple-pass er:yag laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates. Dermatol Surg. 2003; 29(1):80-84.
32. Goldman MP, Fitzpatrick RE, Manuskiatti W. Laser Resurfacing of the Neck with the Erbium:YAG Laser. Dermatol Surg. 1999; 25(3):164-168.
33. Yalcin Balcik P, Cakmak C. The evaluation of malpractice cases arising from aesthetic intervention in Turkey based on Supreme Court case law. Int J Health Plann Manage. 2019; 34(1):e885-e895.
34. Vila-Nova Da Silva DB, Nahas FX, Bussolaro RA, De Brito MJA, Ferreira LM. The increasing growth of plastic surgery lawsuits in Brazil. Aesthetic Plast Surg. 2010; 34(4):541-542.
35. Matthews- Kozanecka M, Cieślik K. Aesthetic medicine treatments in terms of patient rights. J Face Aesthet. 2020; 3(1):9-15.
36. Hibler BP, Avram MM. Protecting Yourself: Legal Issues in Aesthetic Medicine – Informed Consent, Discharge, and Lawsuits. In: Rieder EA, Fried RG, eds. Essential Psychiatry for the Aesthetic Practitioner. 1st ed. Wiley; 2021:175-188.
37. Park BY, Kwon J, Kang SR, Hong SE. Informed Consent as a Litigation Strategy in the Field of Aesthetic Surgery: An Analysis Based on Court Precedents. Arch Plast Surg. 2016; 43(05):402-410.
38. Schmitz L. Legal Framework. In: Kautz G, ed. Energy for the Skin. Springer International Publishing; 2022:67-74.
39. Hibler BP, Eliades PJ, Kagha KC, Avram MM. Litigation Arising From Minimally Invasive Cosmetic Procedures: A Review of the Literature. Dermatol Surg. 2021; 47(12):1606-1613.
40. Gansel RW, Schwandt A. Side Effects: A Worldwide Literature Search. In: Kautz G, ed. Energy for the Skin. Springer International Publishing; 2022:369-384.
41. Moura SP, Shaffrey EC, Lam CS, Wirth PJ, Attaluri PK, Rao VK. Out-of-scope Cosmetic Surgery: A Review of Malpractice Lawsuits against Nonplastic Surgeons. Plast Reconstr Surg Glob Open. 2023; 11(3):e4873.
42. Kudeikina I, Palkova K, Losevica M. Aesthetic Medicine as Global Trend in Public Health: Concept of Legal Problems and Liability Issues from Latvian Perspective. Med Res Arch. 2022; 10(9).
43. Vila-Nova Da Silva DB, Nahas FX, Ferreira LM. Factors influencing judicial decisions on medical disputes in plastic surgery. Aesthet Surg J. 2015; 35(4):477-483.
44. Jalian HR, Jalian CA, Avram MM. Common causes of injury and legal action in laser surgery. JAMA Dermatol. 2013; 149(2):188-93.
45. Johnson J, Carron MA. Malpractice in Aesthetic Surgery and Procedures. In: Eloy JA, Svider PF, Baredes S, Kelly SP, eds. Litigation in Otolaryngology. Springer International Publishing; 2021:161-171.
46. Oshiro FHJ. Evaluating judgments and decisions related to lawsuits involving aesthetic plastic surgery. Rev Bras Cir Plástica RBCP – Braz J Plast Sugery. 2019;34(4).
47. Kautz G, Kautz I. Photo Documentation and Digital Skin Analysis for Medical/Aesthetic Procedures. In: Kautz G, ed. Energy for the Skin. Springer International Publishing; 2022:387-393.