Patients: Know your laser surgeon

By Michele Dula Baum
CNN.com Writer

(CNN) -- Hundreds of thousands of people undergo laser cosmetic treatment every year in the United States. And some pre-surgical homework can save a lot of potential problems, physicians say.

Along with finding out your selected doctor's certification and experience level with the procedure, it's important to know whether he or she owns or rents the laser equipment, says dermatologist David Goldberg.

"People take for granted that a laser is a machine that puts out light, and that it's pinpoint," explained Goldberg, director of Skin Laser & Surgery Specialists of New York and New Jersey. "But in fact, some of the worst scarring that we see is in the areas of laser use for wrinkles and hair removal that have occurred in physician practices where they rent lasers."

There are just 20 major full-time laser surgery centers in the United States. While many doctors do hundreds of such procedures a year, others may be using equipment that they've practiced with infrequently because it only comes to their office once a month.

"Experience is what counts," Goldberg noted. "You want someone who does this every day, not someone who rents for a day to do a couple of surgeries. You don't want to be the guinea pig for an obstetrician delivering his first baby, or a doctor doing open-heart surgery for the first time, right?"

Dermatologist Richard Fitzpatrick, president of the American Society for Laser Medicine and Surgery Inc., said estimates on the number of laser cosmetic procedures for skin resurfacing in the past year range from 150,000 to 350,000.

"I'd guess it's more probably 200,000," says Fitzpatrick, who practices in Encinitas, California. "But when you look at blephoroplasty (eyelid tucks), which is the second-most popular procedure, there were about 250,000, and I'd say that about half of those were done with lasers."

Laser treatment for broken capillaries on the face is about five times more common, accounting for up to 1 million cases, he added.

"The problems that have occurred from these laser procedures are related to physicians not understanding lasers," says Fitzpatrick. "Either the treatment is too aggressive, there is poor post-operative care or there's something that extends the wound deeper -- an allergic reaction or infection."

Lasers "are incredibly powerful machines," said Goldberg, who is also a lawyer and on the faculty of the Fordham University School of Law in New York. "And in the cosmetic area, maybe people don't take it as seriously (as necessary). Lasers can be more dangerous than the scalpel."

Lasers use a variety of light wavelengths and gases to do the job intended. They target wrinkles, spider veins, age spots, birthmarks and hair and tattoo removal. "They're all out there, and they've really evolved," Goldberg continued.

Fitzpatrick said physicists and theorists he's met have told him "we haven't even penetrated the first 5 percent of where we're going" with laser technology. "I'm very optimistic about the potential of things changing."

But with the new technology comes a learning curve. "You can harm someone so easily," Goldberg said, warning that patients should ensure their doctor is well versed in the use of these tools, which are truly capable of astonishing results.

"Now we have lasers that can improve the quality of skin without removing a layer of skin," explained Goldberg. "It's called the lunchtime laser procedure."

Such lasers penetrate the surface skin layer and are absorbed in the thick under-layer of connective tissue, nerve endings, blood vessels and muscle fibers called the dermis. "It boosts collagen production," Goldberg said, explaining that rubbing a finger along the skin's surface after the procedure may detect "little bumps," that are not visible.

"There's no down time," he added. "We're treating people in their 30s for anti-aging."

Because there is no centralized reporting of undesirable outcomes, Fitzpatrick said he could only estimate the proportion of surgeries that may go wrong.

"Looking at various studies and paying attention to reports from colleagues, we can say that, in skin resurfacing, scarring is unusual -- probably less than 1 percent," he noted. "Now, this is assuming the physician knows what he's doing."

Some 25 percent of people who have skin resurfacing laser surgery can expect some pigment loss -- and about 3 percent may have significant pigment loss, Fitzpatrick added, describing the look as "porcelain white." Such loss is "related to the degree of sun damage and how deeply the skin is resurfaced."

Infection rate is about 1 percent, as is the incidence of allergic reaction or other irritation. Allergic reaction results from topical applications of medicine rather than actual laser light.

"One of my goals as president of ASLMS is to try to establish some criteria for certification of who's qualified to do specific procedures," said Fitzpatrick. "As you might guess, it's politically charged."

Indeed, with cosmetic procedures costing in the thousands of dollars, more and more physicians are drawn to the work. In many states, dermatologists and ophthalmologists have joined the ranks of plastic surgeons and others who work with lasers. Most cosmetic work is not covered by insurance, so patients pay out of pocket. There is tremendous income potential.

"By and large, (bad results) are not happening with dermatologists and plastic surgeons," said Goldberg. "But we now have podiatrists doing this."

Safeguarding your chances for a good result depends on asking the right questions, he continued.

-- Do you own or rent?

-- How many days a week do you do laser procedures?

-- Ask to speak to former patients

"Most patients who have been treated by a rental laser don't know it until it actually happens," said Goldberg.

The simple fact of laser rental is not enough to call the whole thing off, but it is a potential problem, physicians concede.

"Lasers are very much like computers. They don't like to get bounced around," explained Goldberg. "And a rental laser is in a van going from doctor's office to doctor's office every day."

To be sure, buying laser equipment can be a big investment for a physician's practice. Machines can cost up to $150,000 each, but it's an investment that will invariably pay for itself in case volume.

Fitzpatrick estimated that 80 percent of his current surgical work is done using lasers -- up from 60 percent five years ago.

"Every time we think we've reached the limit of where you can go with lasers, somebody has a new idea," he said.

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American Society for Laser Medicine and Surgery (ASLMS)
The American Academy of Dermatology
Plastic Surgery Information Service
Skin Laser & Surgery Specialists of N.Y. & N.J., L.L.C.

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