Laser procedures can be high-risk

USA Today (Society for the Advancement of Education), Feb, 1998

Michael Kaminer, assistant professor of dermatology, Tufts University School of Medicine, Boston, Mass., and a dermatologist at the New England Medical Center, says he performs laser cosmetic surgery on just one out of three patients who request the procedure to get rid of their wrinkles. "Of all the cosmetic procedures available right now, [some forms of] laser surgery [are] probably the riskiest." Nevertheless, the widely popular procedure accounts for 20% of his clinical work.

Cosmetic laser surgery "erases" wrinkles or scars by using heat to burn off a thin layer of skin. It is especially popular among the middle-aged, who tend to be more concerned with wrinkles than with sagging skin, which is the focus of the more expensive, traditional plastic surgery that uses small, inconspicuous incisions to stretch facial skin.

Laser surgery carries a greater risk of infection than traditional face-lifts, Kaminer cautions, because a larger area of skin is exposed. It is extremely easy to burn too deeply, leaving permanent scars. The laser burn heals differently and is more sensitive to topical treatment than other types of scrapes or burns.

Despite the risks, laser surgery is popular because it works, lasts longer, and is less expensive than other cosmetic procedures. Laser surgery costs up to $5,000, compared to $9,000 or more for a traditional face-lift.

What worries Kaminer is that there is a widespread misconception -- among physicians as well as consumers -- that laser surgery is easy. "There are a lot of factors in doing laser well," including making sure the patient is a qualified candidate -- based on health. medical history, and motivation -- and ensuring he or she is fully informed of the pain, length of recovery, and risks.

The initial healing process takes as long as 10 days, including "a pretty miserable first 48 hours" of a burned and painful face, followed by up to three red-faced months. It also involves a significant risk of infection that. if not treated properly, can leave the face with scars that look much worse than wrinkles.

The long-term effects of cosmetic laser surgery are unknown, although there have been cases of infections or white spots appearing several months after the procedure. "I know of one person who is on daily IV antibiotics to try to clear up an infection that erupted two months after her surgery.," Kaminer says. He offers this advice to anyone considering laser surgery:

* Ask the doctor about the number of his or her patients who experience complications following the procedure.

* Insist on seeing before-and-after photographs of other patients.

* Talk with former patients of the physician.

* Make sure you understand your motivation for wanting cosmetic laser surgery and the risks involved. "If a person says, 'I'm getting divorced next month, and I need to look younger,' or 'It's laser so it must be easy and painless,' I usually won't do the surgery on them."