Cosmetic Laser Surgery, Is It For You? (cont.)

Other risks are more serious, and possibly permanent, including hypopigmentation, or lightening of the skin. "Somewhere between one to two years after treatment it becomes clear that there is a permanent lightening of the skin color where the resurfacing was done," he says.

And scarring may occur in about 2 percent of the cases, he adds, from poor postoperative care, during which time an infection may develop. Or a surgeon may go too deep during the procedure, creating an injury the skin cannot repair, says Alster.

Because both qualified and unqualified practitioners are flooding the cosmetic laser surgery field, consumers may face some real hazards. "All of a sudden, there's widespread use of lasers by unqualified people," says Perkins, who notes that some laser manufacturers are so eager to sell their products that they stage one- or two-day meetings, or courses, for training. That means that even dentists, obstetricians, gynecologists, and family doctors are now offering laser surgery, says Alster.

"The person planning to do laser surgery must understand the basic physics of how laser energy is absorbed by tissue and how tissue responds," warns FDA's Felten. The best people to work with lasers on skin conditions are the professionals who best understand skin and surgery of the skin: dermatologists and plastic surgeons.

"Sometimes people may choose the wrong laser, or a surgeon may believe more is better, which can lead to significant burning," says Alster. And some operators don't know they must keep wiping off the partially desiccated skin or that they must keep moving the hand holding the laser instrument during the procedure.

To date, no national policy exists for credentialing those planning to practice laser surgery. Felten says FDA is responsible for granting individual manufacturers permission to market their lasers for the specific indications requested. FDA also often recommends training needed to operate the lasers.

But credentialing is a state function, since states are responsible for the licensing of doctors and nurses, and standards for laser training vary from state to state.

A case example is a woman, who's husband is a doctor, and went to a well respected local plastic surgeon to remove some mild acne scars. After 5 months, she realized something had gone terribly wrong. Her face was red, with scar tissue all over. She went to an ophthalmologist who had extensive laser knowledge, and he told her that the surgeon who had performed the laser surgery had not used the correct settings, and thus her skin had retained too much heat and had been severely burned. Two years after her procedure, she has spent nearly $70,000 for both the initial surgery and subsequent consultations and corrective surgeries to remove the scarring. She says she has partially reclaimed her life. But she bitterly regrets undergoing the initial surgery. She said she would never have a procedure like this done again.

Finding the Best Surgeon

Selecting a laser surgeon is just like picking a qualified doctor for any medical treatment. "Consumers ask more questions of auto mechanics," says Alster. "This is surgery and with it comes inherent risks and complications. While it is perceived as easy, it is not. When you are talking about skin, it is harder to treat than eyes."

The Internet is a good place to start the search. Consumers can find thousands of Websites, including those for specialists, laser and plastic surgery societies, and information pages. But consumers should be wary of assuming the accuracy of any information taken off the Internet because the unscrupulous can put up their own Web pages just as easily as can the qualified.

Alster suggests interviewing several doctors and evaluating their answers and their credentials. After all, she adds, it's the doctor's skill that counts--the laser is just the doctor's tool.

The next step is crucial: asking the right questions. Alster advises asking where the doctor has trained and if he or she owns or rents the equipment--those who own have likely made a commitment to training and to laser surgery. Ask to see before and after pictures of the doctor's cases, and find out how many different types of lasers the doctor owns and how often each piece of equipment is used. "There is not one laser that does everything," she says, cautioning patients to select a surgeon whose practice offers more than one laser system. "One needs to use [the right] laser for the right lesion. So the person examining you must make the correct diagnosis," she says. Alster herself has at least 10 different lasers in her office.

Of course, the final decision may be difficult, since no doctor can guarantee perfection or complete safety, but well-informed patients with reasonable expectations may be one step closer to younger, fresher-looking skin.

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Portions of the above information has been provided with the kind permission of the Food and Drug Administration Consumer Magazine, May-June 2000 (

Last Editorial Review: 9/25/2002

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