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Nom de plume: Affaire risquée

DII small banner By Warren R. Heymann, MD
Dec. 28, 2016

Performing laser surgery is risky business for the patient and the laser surgeon. Potential hazards may be due to the beam itself causing ocular or cutaneous injury. Nonbeam hazards may arise from the laser device or its interaction with material in the surgical environment. Nonbeam risks include fire and electrical hazards, and complications of exposure to the laser plume (1).

Chuang et al questioned what composes the hair laser plume. They analyzed the chemical content of the laser plume by gas chromatography-mass spectroscopy and screened for aerosolized toxins using Environmental Protection Agency–certified methods. The ambient concentration of ultrafine particles during LHR was measured by condensation particle counters. They identified 62 organic compounds, of which 13 are known or suspected carcinogens and more than 20 are known environmental toxins, exhibited strong absorption peaks. Three chemicals had estimated daily exposures that exceed Occupational Safety & Health Administration daily permissible limits, and ultrafine particles emitted without a smoke evacuator exceeded levels considered safe. They concluded that the burning-hair plume that develops during laser hair removal should be considered a biohazard, warranting the use of smoke evacuators, good ventilation, and respiratory protection, especially for health care workers (2).
Certainly, responsible laser surgeons will do everything possible to protect patients, themselves, and the staff.

With the increasing development of home devices, how is patient safety taught and encouraged when patients become their own laser surgeons? If devices are efficacious, wouldn’t they have the same spectrum of risks that professional devices have, even if the fluences may be lower?

The following abstract by Town et al (3) addresses important safety issues as the use of home laser devices expands:

In the past 5 years since their U.S. introduction, there has been a rapid proliferation of light-based hair removal devices intended for home-use. In the last 2 years in Europe, sales already run into many tens of thousands of units with well-known multi-national companies entering the market. These guidelines provide a definition of light-based home-use technology, to inform healthcare professionals about home-use light-based technology and encourage manufacturers wishing to sell in Europe to adopt ‘best practice’. The review presents the current status on standards and regulation issues and considers home-use safety issues, encompassing human, device and electrical safety, given risks to the eyes and skin from optical radiation both to the consumer and persons in the vicinity. Proposed technical measurement methodology is considered with focus on recognized critical parameters for the safe use of light-based hair removal technology including recording the technical performance and safety claims of a range of home-use hair removal devices. The literature review emphasizes potential adverse incidents and safety aspects of treating cosmetic conditions, such as unwanted hair growth. Although some regulations exist, they differ from region to region and there is a specific need for international common principles and guidelines relating to the manufacture, marketing and use of intense pulsed light and laser devices, including manufacturing standards for home-use products intended, amongst others, for cosmetic hair removal and photo-rejuvenation procedures. In these guidelines, the European Society for Laser Dermatology (ESLD) provides a professional view of what ‘best practice’ may imply for manufacturers and consumers alike.
After purchasing a new device, do you read through all the instructions and safety data prior to using it? I suspect that many of us, myself included, just open the box, turn the gadget on, use it, and then look at the instructions when something goes wrong. The consequences of not mastering an alarm clock or coffee maker may not be so severe – misusing laser devices, however, may cause devastating complications. It is incumbent on manufacturers to make sure that these devices are “smart” and that instructions are explicit, clear, and somehow obligatory. (I read the instruction manual for the Tria hair removal diode laser* and it is thorough. The list of potential risks was appropriate although there was no mention of a laser plume.) For the Tria device either an online or telephone activation “that takes just minutes” is necessary before the first time it is used. I called the company — during the activation they remind the user to make certain the sensor matches the skin type. They do not discuss adverse effects. Perhaps passing on online test about how to use a device properly should be performed before the device is able to be activated would prevent untoward injury.

Dudelzak J, Goldberg DJ. Laser Safety. Curr Probl Dermatol 2011; 42: 35-9.
Chuang GS, et al. Gaseous and particulate content of laser hair removal plume. JAMA Dermatol 2016; 152: 1320-6.
Town G, et al. Guidelines on the safety of light-based home-use hair removal devices from the European Society for Laser Dermatology. J Eur Acad Dermatol Venereol 2012; 26: 799-811

*I have no financial or other relationship with Tria Beauty.

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