Avoiding Laser Treatment Complications in Cosmetic Dermatology

The causes of complications associated with different laser procedures are classified.

The potential complications of laser treatment in cosmetic practice was described in study data published in Dermatologic Therapies. The article also described and outlined methods to avoid adverse outcomes.

Investigators provided a classification system for the most common causes of complications in laser therapy. They identified 6 causes: errors in patient selection; errors in treatment tactics; wrong choice of device or technology; neglect of treatment protocol; inadequate post-procedural care; and patient-specific response. All causes are considered preventable, aside from patient-specific response.

Errors in patient selection can occur when contraindications are not considered, the indication for laser therapy is misdiagnosed, and/or risk factors are not properly assessed. The investigators suggested that patients should be carefully evaluated before laser therapy; those with precancerous lesions may be at increased risk for cancer progression after exposure to lasers. Certain pre-existing conditions may also mean a patient is not an appropriate candidate for laser treatment.

The second primary cause for adverse laser outcomes—errors in treatment tactics—refers to the application of incorrect treatment or poor understanding of test procedures. To avoid errors in treatment tactics, investigators suggested consulting clinical guidelines to select the appropriate treatment. Testing the treatment on a small area may also allow for risk forecasting.

The third and fourth etiologies of laser complications—wrong choice of treatment and neglect of protocol—can be avoided on the practitioner level. Dermatologists should use only certified devices and carefully consult safety guidelines before treatment, the study authors wrote. Laser wavelength and mode of radiation should be selected with care. Devices should be frequently checked for functionality and tested before use on a patient. To ensure that treatment protocols are properly followed, only practitioners with specialization in medical laser science should be permitted to administer treatment. The study authors also recommend that facilities employ a designated laser safety officer to enforce compliance with safety rules.   

The fifth cause of laser complications, noted by the researchers, is inadequate post-procedural care, which may either be a result of poor instructions or low patient compliance. To ensure compliance, practitioners should provide clear written instructions on post-procedure care, it was suggested. Follow-up appointments are also recommended.

The final cause of laser complications—patient-level response—is difficult to prevent, the study authors wrote. Some patients may have unexpected reactions to laser treatment, even with careful adherence to screening procedures and safety protocol. A detailed medical history review may allow for certain risk factors to be identified.

“[C]linicians should be able to understand that complications after laser exposure are variable and they can occur even among experienced physicians,” investigators wrote. “[However], their probability depends on the level of literacy and practical experience of the physician…The preventive approach must be comprehensive and carried out at every stage of treatment.”


Kalashnikova NG, Jafferany M, Lotti T. Management and prevention of laser complications in aesthetic medicine: an analysis of the etiological factors [published online October 8, 2020]. Dermatol Ther. doi: 10.1111/dth.14373