Laser and energy-based device complications, including scarring, can happen, but being aware of when and why they may occur as well as implementing proper post-procedure care can significantly cut down on the number of both complications and unhappy patients.

Most complications are heat related, whether too much heat, too little cooling, or a mismatch between heat and cooling. For this reason, the device settings that we choose play a big role in minimizing the chances of scarring and burning. More specifically, higher fluence generates more heat, as does a shorter pulse duration and shorter wavelengths.


Miami dermatologist Jill S. Waibel, MD discusses laser scar revision at CSF 2017

We know that scarring may occur with use of excessive fluences, more passes, and improper pulse stacking. In addition, prolonged erythema or eczematous changes during treatment can be early signs of scarring and red flags that this patient is at risk of a complication.

So the real question becomes, “What can we do to lessen the risk of scars and other complications irrespective of the chosen energy-based device parameters?”

Weighing Options

The go-tos to try to reduce scars and manage complications have been moisturizers, serums, and petrolatum products, but these have their own share of pluses and minuses. Petrolatum products are too occlusive, leading to increased heat and erythema. Other products often have substances in them that, when applied to open broken skin, may lead to contact irritant reactions. This is why there is so much enthusiasm for a new line of products by the Swiss company Stratpharma.

Stratacel is a film-forming wound dressing developed specifically for partially de-epithelialized skin wounds following fractional laser treatments, microneedling, and fractional radiofrequency treatments. Stratamed is the first film-forming gel-based wound dressing approved for immediate use on open wounds and fully , de-epithelialized skin. Both can be applied immediately after all dermatological interventions, including burns, for rapid re-epithelialization and abnormal scar management. The silicone gel creates an optimal environment for faster healing and reduced downtime. These dressing also have bacteriostatic properties to protect compromised skin from microbial invasion.

Strataderm is a once daily topical gel that can soften or flatten raised scars and reduce scar redness and discoloration. Unlike other silicone gel products on the market, Strataderm is applied once daily, which is a plus for convenience and compliance.

Keep Patients Happy

Paying attention to settings, early signs of complications such as prolonged erythema, and helping to create an optimal environment for enhanced healing will help minimize complications, maximize aesthetic outcomes, and keep your parents happy and coming back for more.

David J. Goldberg, MD, JD, is Director of Skin Laser & Surgery Specialists of New York and New Jersey, former Director of Mohs Surgery and Laser Research at the Icahn School of Medicine at Mt. Sinai, and an Adjunct Professor of Law, Fordham Law School. He originally presented this talk at Cosmetic Surgery Forum 2017 in Las Vegas.


Cosmetic Surgery Forum 2018 will be held November 28-December 1 at the Cosmopolitan, Las Vegas.

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