Baylor Dermatology Clinic

What Patients Need to Know About Laser Surgery

As a dermatologic laser surgeon, the most common question I answer when giving a lecture to a non-medical audience is about selecting a proper venue for laser surgery. Unfortunately, patients often do not know there is very little regulation in this field and, as a result, many places offer laser surgery that may not have enough experience or training. It doesn't help that there is no standard definition of "enough" training or experience in regards to cosmetic laser surgery. Training can range from a couple of hours spent in a lecture to entire year-long laser specific fellowship after a three-year dermatology residency. Choosing the right place involves becoming an educated consumer and investigating the person and facility offering the procedure. Below, I will try to address some of the common issues in the field of cosmetic laser surgery.

Laser surgery is so common, does it really matter who does it?

The answer is a resounding yes. The best predictor of a good outcome is treatment with good technology operated by a practitioner with excellent training and plenty of experience. Poorly trained laser technicians with minimal experience are at much higher risk of unanticipated side effects. Studies published in medical journals indicate that laser treatments not supervised by physicians were much more likely to have poor outcomes. In the event of a blister or burn, immediate access to a physician trained in skin care to expedite healing and identify and treat infection is extremely important. Although rare, I have seen disastrous complications from poorly performed laser surgery including vision loss and large and disfiguring scarring. In reality, the most common complaint shared by patients is a lack of results, a problem much more common with inadequate training and experience. Excellent training and a great deal of experience is key in having the best odds for a great result.

As long as the treatment is supervised by a physician is it safe?

The answer is not necessarily. Many spas and franchise type laser centers have a doctor as a medical director but that does not means that they are on-site or even specialize in treatment of the skin. Depending on state law, supervision can be loosely defined as available by telephone a thousand miles away. Due to declining insurance reimbursement for non-cosmetic procedures many non-dermatologists are now offering laser services. Many times these supervising physicians have not had any experience in general skin care, let alone laser treatment of the skin. Treatment should be performed or supervised by a physician with expertise in skin care, usually a laser trained plastic surgeon or dermatologist. If it is difficult to ascertain what training the practitioner has, it is most likely not applicable to laser surgery of the skin. Lastly, beware of memberships in cosmetic societies or organizations, most require only a fee to join.

How can I tell which laser treatment is right for me?

A consultation is required to assess the skin type and lesion or problem to be treated. While most laser companies claim their technology will treat everything, in reality lasers are fairly specialized and treat a limited number of conditions most effectively. At our laser center we use many different lasers to treat a variety of conditions because one laser technology does not adequately treat everything. Lasers are tools and picking the right tool makes the procedure safer and more effective. For example, patients with dark skin should be treated with certain laser hair removal systems as many laser hair removal devices are much more likely to cause blistering, discoloration or scarring in dark skin. The right choice of laser depends on factors such as skin type, type of target, and allowable downtime.

If I have the best possible technology administered by the best possible practitioner is it guaranteed to be safe and effective?

Doing such dramatically improves safety and effectiveness, but in reality every laser procedure has risks. Even the best technology in the best hands can cause unanticipated side effects. Fortunately, those risks are extremely low when treated by a well trained laser surgeon using good technology.

What are the important things to address before laser surgery?

According to the American Society for Laser Medicine and Surgery these are general guidelines:

  1. Know who is performing the surgery and, if not a physician, whether the physician is on-site during treatment.
  2. Inform the practitioner of your medical and surgical history as well as current medication regimen.
  3. Before and during the consultation investigate the training, experience and specialty of the practitioner and/or physician.
  4. Discuss the suitability of the proposed laser treatment in regards to your skin type, body area and target (hair caliber and color for example). Also ask about expected side effects and the risk of unanticipated side effects.
  5. Consider a test area if warranted.

Ramsey F. Markus, M.D. 
Director of Laser Surgery 
Department of Dermatology 
Baylor College of Medicine