JAN-FEB 2016

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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LESS IS MORE 24 JANUARY/FEBRUARY 2016 | Med Esthetics is the best because it can be used on a wider range of skin types. An alexandrite can't safely treat darker skin and, while a 1064nm laser is safest for dark skin, it is more painful and may not produce the best results for patients with lighter skin." In addition to better cooling, larger spot sizes and new microwave-based devices, Sienna Labs is developing a silver nanoparticle topical preparation that Dr. Goldman calls "the single most exciting new technology out there. It penetrates into the hair follicle and can be tuned to be activated by energy from almost any laser," he says. "The silver nanoparticles safely and effectively heat and destroy the hair follicle no matter what color the hair or skin may be. It is in pivotal trials right now and my expectation is that it will be generally available in 2016 or 2017." Sienna Labs refers to its patented technology as Targeted Plasmonic Therapy (TPT) and in press releases explains that TPT is being investigated for acne treatments as well as hair removal indications. TREAT WITH CARE AND SKILL A retrospective study by Paloma Tejero, et al ("Adverse Effects of Laser Hair Removal," Journal of Surgery, March 2015), reviewed 300,000 medical laser hair removal sessions conducted between June 1998 and April 2014 in an effort to assess the incidence of signifi cant adverse events. They concluded that "laser hair removal is still a safe and effective method, but it is not risk-free, and it requires signifi cant training and regular maintenance of safety protocols." Our panel agrees and adds some cautions. "Laser hair reduction, as with many cosmetic laser procedures that have been around for some time, is much safer now than it was when originally performed," says Dr. Brauer. "However, one cannot completely eliminate the possibility of scarring or changes in pigmentation and, therefore, correct selection of the patient, device and parameters as well as proper training are essential in minimizing those risks." Dr. Ross attributes this improved safety largely to "a better understanding of the need to use longer pulsed technologies and longer wavelength technologies overall for darker skin types, particularly the use of the Nd:YAG laser for patients with skin types V and VI." Unfortunately that doesn't mean the danger of burns has disappeared. "I'm called on to serve as an expert witness far too often by attorneys for patients who are burned and suffer scarring from hair removal procedures," says Dr. Seiler. "While the use of an approved hair removal laser in the right hands should never result in a burn, improperly used it can actually remove skin. These are complications that many do not realize can really occur. We have performed more than 9,000 laser procedures in our practice and about one-fi fth of those were for permanent hair reduction. We treat a wide range of patients and due to proper use of devices, practitioner training and experience, we have never had a burn." The risk of injury is not the only problem that concerns Dr. Seiler. "Treatment with the wrong kind of device or undertreatment that does not kill the hair follicle may mean the patient continues to have hair growth, but the hair is weaker and loses pigment," he explains. "The patient does not achieve permanent hair reduction and often is no longer a candidate for effective laser hair reduction. I hate seeing people waste money on ineffective or risky treatments and am passionate about advocating for stricter laws governing all medical procedures in my state and all other states." While all laser hair removal procedures are still done by physicians in Dr. Brauer's practice, many physicians now delegate most or all of these procedures to physician extenders. State laws vary wildly on who can perform laser hair removal and under what kind of supervision. In its advice to those seeking hair removal procedures, WebMD uses the term "technician" rather than doctor to describe the person performing the procedure. Yet the literature is clear that lack of experience is a major contributor to signifi cant adverse events and poor outcomes. "I did all of my own laser hair removal procedures for more than eight years before fi nally training an esthetician," says Dr. Seiler. "And I'm still heavily involved in the process." Dr. Goldman's experience is similar. "For many years I did my own hair reduction procedures but now I delegate them to my physician assistant, Leysin Fletcher, PA-C, who is also our laser safety offi cer in charge of managing our 45 laser and energy-based devices," he notes. "She is extremely well trained and the physicians in our practice still see every patient before treatments begin. A physician is always on site when procedures are being done." Linda W. Lewis is the contributing editor of MedEsthetics. Setting clear expectations for the number of sessions required and the potential for hair regrowth is necessary to maintain patient trust. © GETTY IMAGES

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