Medesthetics

APR 2018

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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© GETTY IMAGES UP IN SMOKE 44 APRIL 2018 | MedEsthetics The U.S. Occupational Safety and Health Administration (OSHA) notes that, to date, there have been no reports of transmission of communicable disease from laser or cautery plumes. With relatively little known about the potential harm of short- and long-term exposure to laser plume particulate, OSHA currently has no regulatory re- quirements. But several professional associations, including the American Society for Lasers in Medicine and Surgery (ASLMS), have developed guidelines to protect practitio- ners and patients. Following are the latest recommenda- tions to help practices develop their own laser plume safety protocols. CAUSE FOR CONCERN Harmful and potentially harmful compounds found in plumes, particularly those emitted by ablative—or tissue- vaporizing—devices include blood particles, viral particles, including HPV and HIV, as well as particles of viable bacte- ria, such as staphylococcus and neisseria. "Other harmful compounds found in plume include: aromatic hydrocarbons, such as benzene, which is a car- cinogen; toluene, which can cause liver damage; acrolein, a toxic irritant; hydrogen and cyanide; and inorganic gases such as carbon monoxide," says Owens. "Researchers have also found nanoparticles smaller than fi ve microns, which can lead to lung damage." Even nonablative lasers pose risks. Gary S. Chuang, MD, et al, surprised the aesthetics community when they identifi ed 377 chemical compounds in laser hair removal plume—13 of which are known or suspected carcinogens and more than 20 of which are known environmental toxins—in a study published in December 2016 in JAMA Dermatology. "Most research has been on cauterizing devices, but laser hair removal is not a vaporizing procedure," says Owens. "So now we are looking at procedures that don't necessarily produce vaporization of tissue." Laser tattoo removal also creates potentially harmful plume, according to a study awaiting publication by Michael Murphy, BSc, MSc. When utilizing a Q-switched Nd:YAG laser for tattoo removal, high optical laser irradiances created fragmentation and minuscule splatter. By holding a glass slide onto the skin, Murphy demonstrated that the high velocities generated during the photoacoustic process resulted in ejection of some tattoo ink particles into the air. "When he lifted the glass slides up, there was an impres- sion of the tattoo ink," says Owens. "Some of Murphy's preliminary studies also showed gram negative bacteria on these slides." So how can you prevent these harmful compounds from entering the respiratory tracts of providers and patients? Two of the most effective tools in reducing the risk of air- borne particles and nanoparticles are a good smoke evacu- ator system and physical barriers that trap ejected materials. CLEARING THE AIR While performing laser hair removal, Dr. Chuang recom- mends using a smoke evacuator that has both charcoal and particulate fi lters and positioning it as close to the treatment site as possible. Providers should also wear an N95 particulate-fi ltering respirator and run HEPA fi lters in the treatment room. "These fi lters circulate the air and fi lter out particulates that were not picked up by smoke evacua- tors," says Dr. Chuang. The 2017 ASLMS Laser and Energy Device Plume Position Statement recommends using high-fl ow volume (25 to 50 cubic feet per minute) smoke evacuators and changing the fi lters per manufacturer instructions. "Plume evacuators have a pre-fi lter that collects large smoke par- ticulate and fl uid, and a secondary fi lter called an ultra-low penetration air (ULPA) fi lter, which captures particulate and microorganisms down to 0.12 micron," Owens says. "A third section, the charcoal fi lter, absorbs toxins and or- ganic gases. By holding the suction wand or tubing as close as possible to the source of emission—at one inch, you collect 90 percent; at two inches, 50 percent—you'll get a higher collection." Researchers discovered that tattoo ink particles are among the compounds emitted into the air during laser tattoo removal.

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