Splitting of laser beam into micro-spots so that multiple areas of skin can be affected at one period of time.
Cosmetic FractionalLaser UseImplications for Infection ControlGursevak Kasbia MSc. CIPHI(C)Special Thanks to Linda Cleroux(EOHU) and Collette Oulette (QCH)
OutlineIntroductionFractional LasersImplications for Fractional LasersComplications of Fractional Laser UseInfection ControlSummaryQuestions/Answers
IntroductionLASER: Light Amplification byStimulated Emission of RadiationDifferent classifications for differentfunctional purposes of lasers(Class 1 and 2 are quite safe,class 3b and 4 are moredangerous)Fractional Lasers are consideredClass II lasersFRACTIONAL LASERS:A type of laser device that can beboth ablative and non-ablativeand can emit anywhere from 1550to 10600nm and used to treat aFigures 1 & 2: spectrum of wavelengthfor different laser based procedures
What is a Fractional Laser?Fractional Lasers are typicallyNon Ablative FractionalLasers that generatemicrothermal treatmentzones (small holes 7*7 or12*12) (MTZs)Small columns of thermallydenatured skin ofcontrolled width and depth.(i.e. 1550nm)These small holes signal stemcells from the dermal layer ofskin to reproduce and rise tosurface replacing the olderdisintegrated ones.Figure 3: Fractional Unit: contains arm, computerized controlsystem, scanner which delivers the micro-spots in a varietyof patterns and sequences (Solta Medical Inc, 2010)
Fractional Laser Skin TherapyFractional Laser technology is newer(1998) than CO2 based lasers thatwere released in the 1980sAblative vs. Non-AblativeSome Ablative lasers use a higherwavelength and require anesthesia.Typically ablative devices are used fordifferent medical conditions such as forremoval of Begnin malignancies ofskin.Non-Ablative lasers require noanesthesia and can be medicallydelegated.Figure 1: Laser Wavelength Spectrum (BCCDC)Figure 4: Anasthetic Cream used in procedures(courtesy drugline.org)
Laser Devices used for SkinIntense Pulse Light Sources (550-1200nm):1) Targets both blood vessels andmelanin2) Aids in neo-collagenesisMid-Infrared Laser(1320-10600nm):1) Targets water in epidermal anddermal layer of skin.2) "Rejuvinates skin"2) Aids in neo-collagenesisVisible Laser(400-700nm): uses aconcentrated beam of light thattargets blood vessels in theskin.i.e. Pulsed Dye laser and KTP1) Used to treat pigment relateddisorders such as port stains,freckles, rosacea etc.Figure 5: layers of skin and fractional laser impact, fractionallasers will typicall ablate the skin in 7*7 or 9*9 formations
Medical Uses of Fractional LaserFractional Laser treatment can beprescribed for:1) Cosmetic use such as removal ofscars, wrinkles, dis-pigmentationetc.2) Medically prescribed for actinickeratosis, scarring, wrinkles andpigment discolouration (vitiligo)3) Certain stages of tatoo and scarremoval (combination of ablativeFigure 6: Different medical conditions of skin includingacne, vitiligo.
Potential ComplicationsCases of transmission of herpes and MRSA infectionhave been noted (Alster et al. 2010)Goldman et al (2011) found that 4% of proceduresproduced herpes zoster outbreaks (1.07%),contact dermatitis (4.6%) and acne eruption(3.48%) and erythema (1.07%).Graber et al (2008) found in a clinical study of over 960procedures that the 1550 nm fractional laserproduced significantly less cases of infection asopposed to CO2 lasersGraber’s study concluded thatfractional procedures using the1550nm wavelength seemed toproduce less skin infection.
Skin Dammage and RepairFigure 7. Fife et al (2009) foundthat erosion and crustingoccurred in this patient 1 weekpost-operative, however themajority of patients do recoverwell in the long term and mostsever cases occur with CO2based lasers.
Infection ControlInfection Control:1. Does the clinic have a detailedquestionnaire before theprocedure (skin type etc)?2. Is there informed consent?3. Is there postoperative careprocedures?4. Is there appropriate ventilation inrooms (Laser Plume Safety)?5. Are appropriate masks being worn(n95)6. Are proper consulation formsused (not all skin types are thesame!)7. What are steps for disinfection ofthe scanner? Is it disposable?Laser Safety1. Has the operator had training(Delegation)?2. Is the operator knowledgeable ofLaser Safety?3. Are UV/wavelength specificeyewear available to protect boththe operator and patient?4. Does the room have signage forwhen laser is in use (rememberthis is radiation)5. Are the scanner componentscleaned? Is the scanner headreplaced (single use) ordisinfected.
Summary• Lasers are used for many different types of medicalprocedures in in-patient and outpatient formats• Infection control should include a checklist of itemsrequired including anasthetics/creams, pre/post-operative procedures, equipment cleaning.• Safety of the patient and the healthcare worker isimperative (ie. Exposure to radiation, eye damage)• While generally safe fractional lasers do pose harm ifused improperly or without proper consultation
References• BCCDC: Laser Hair Removal Devices. Accessed May 23rd2013.http://www.health.gov.bc.ca/library/publications/year/2011/Laser-hair-removal-guidelines.pdf• Behroozan, D. S., Goldberg, L. H., Dai, T., Geronemus, R. G., & Friedman, P. M. (2006). Fractionalphotothermolysis for the treatment of surgical scars: A case report. Journal of Cosmetic and Laser Therapy,8(1),35-38. Retrieved from www.scopus.com• Biesman, B. S. (2009). Fractional ablative skin resurfacing: Complications. Lasers in Surgery and Medicine, 41(3),177-178. Retrieved from www.scopus.com• Canadian Centre for Occupational Health and Safety: Laser Safety: Accessed May 23rd2013.http://www.ccohs.ca/oshanswers/phys_agents/lasers.html• Fife, D. J., Fitzpatrick, R. E., & Zachary, C. B. (2009). Complications of fractional CO 2 laser resurfacing: Fourcases. Lasers in Surgery and Medicine, 41(3), 179-184. Retrieved from www.scopus.com• Graber, E. M., Tanzi, E. L., & Alster, T. S. (2008). Side effects and complications of fractional laserphotothermolysis: Experience with 961 treatments. Dermatologic Surgery, 34(3), 301-305. Retrievedfromwww.scopus.com• Choudhary, S., McLeod, M., Meshkov, L., & Nouri, K. (2011). Lasers in the treatment of acne scars. Expert Review of Dermatology, 6(1), 45-60. Retrieved from www.scopus.com• Gold, M. H. (2007). Fractional technology: A review and clinical approaches. Journal of Drugs in Dermatology : JDD, 6(8), 849-852. Retrieved from www.scopus.com• Rinaldi, F. (2008). Laser: A review. Clinics in Dermatology, 26(6), 590-601. Retrieved from www.scopus.com• Saedi, N., Petelin, A., & Zachary, C. (2011). Fractionation: A new era in laser resurfacing. Clinics in Plastic Surgery, 38(3), 449-461. Retrieved from www.scopus.com• Tierney, E. P., Eisen, R. F., & Hanke, C. W. (2011). Fractionated CO 2 laser skin rejuvenation. Dermatologic Therapy, 24(1), 41-53. Retrieved from www.scopus.com• Images from ADAM medical images