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Lasers produce light that is collimated, coherent, and monochromatic, allowing precise delivery of energy to targeted tissues. Applications of laser devices in healthcare settings include vascular coagulation, pigment ablation, skin resurfacing, tissue ablation, and hair removal, each requiring a range of wavelengths and delivery systems. Each wavelength of laser light is preferentially absorbed by a specific molecular target, leading to variation in the potential complications associated with different laser systems. Complications may occur when laser energy is misdirected or delivered at excessive levels, resulting in unintended thermal injury to surrounding tissues during selective photothermolysis. Potential adverse effects include retinal injury, corneal injury, skin burns, dyspigmentation, and posttreatment infection. Modern laser systems help reduce risk by delivering energy in short pulses, allowing tissue cooling between exposures. Most of these complications are preventable when patients and healthcare personnel adhere to established safety protocols, conservative energy settings, and appropriate eye protection. Although prevention of many complications is straightforward, optimizing treatment outcomes requires clinical experience, careful patient selection, and precise management of laser device settings. This activity reviews the spectrum of complications associated with laser procedures, including prevention, recognition, and management strategies, to help clinicians provide optimal patient care should adverse events occur during or after treatment with laser devices. The activity also highlights the importance of appropriate training, adherence to safety protocols, and collaboration among healthcare team members to promote patient safety and improve treatment outcomes. Objectives: Identify clinical signs and symptoms of laser-induced complications to enable early recognition and appropriate intervention. Select appropriate laser devices, treatment parameters, and cooling methods to reduce the risk of adverse events. Implement evidence-based safety protocols, including proper eye protection and perioperative precautions, during laser procedures. Collaborate with the interprofessional healthcare team to monitor patients, provide appropriate follow-up care, and manage complications following laser therapy. Access free multiple choice questions on this topic.

Applications of laser devices in medicine and surgery continue to advance with the evolution of new devices and the expansion of laser therapy indications. By definition, LASER, an acronym for light amplification by stimulated emission of radiation, produces light waves that are collimated (parallel), coherent (in phase), and monochromatic (a single wavelength). These properties make lasers well suited for precise surgical procedures, such as excising vocal cord lesions under a microscope or correcting corneal curvature, as well as for selectively targeting tissues such as hair follicles or retinal blood vessels. Laser selection for particular indications depends on the characteristics of the target tissue, as chromophores within that tissue, such as water, cellular proteins, hemoglobin, or tattoo pigment, absorb electromagnetic radiation at specific wavelengths. Absorption of laser energy by a specific target molecule is termed selective photothermolysis, the principle that allows lasers to produce controlled effects within tissue. Lasers that primarily target water and interstitial proteins typically vaporize tissue and are classified as ablative. In contrast, lasers that target hemoglobin or other pigments generally do not cause direct tissue destruction and are classified as nonablative. Common ablative lasers include carbon dioxide (CO2) and erbium-doped yttrium-aluminum-garnet (Er:YAG). Common nonablative lasers include potassium titanyl phosphate, neodymium-doped yttrium-aluminum-garnet (Nd:YAG), and pulsed-dye lasers (PDL). Therapeutic laser devices are typically used for 5 indications: vascular coagulation, pigment ablation, skin resurfacing, tissue cutting or ablation, and hair removal.[1] Some complications are common to all laser systems; however, individual lasers present unique challenges and risks. In general, complications from laser surgery can be avoided or mitigated by combining proper technique with adherence to safety protocols and appropriate candidate and device selection.[2]

Laser procedures should be approached with caution, particularly because many are performed for cosmetic indications, where high patient expectations and low tolerance for adverse effects increase the potential impact of complications. Clinicians should carefully evaluate candidates for laser therapy and exercise caution when treating patients with darker skin tones, who are at increased risk of dyspigmentation and paradoxical hypertrichosis; these patients should be counseled regarding these risks. The Nd:YAG laser carries a lower risk of dyspigmentation in patients with darker skin tones but should be used only by experienced operators due to its potential for deep tissue penetration.[34] Strict sun avoidance for approximately 2 weeks before treatment can reduce the risk of postinflammatory hyperpigmentation. Although this condition typically resolves over several months, management may include continued sun avoidance, superficial chemical peels, and topical hydroquinone. Hypopigmentation may resolve spontaneously or be concealed with makeup. Melanin production may also be stimulated through controlled exposure to sunlight, fractionated CO2 laser therapy, or narrow-band UV light.[2][11][35][15] Laser devices are commonly operated by physicians, physician assistants, and nurse practitioners. As laser procedures carry an inherent risk of complications, optimal patient outcomes depend on a coordinated team approach that emphasizes careful patient selection, thorough patient education, strict adherence to safety protocols, and effective communication among members of the healthcare teams.