Dr. David Goldberg discusses avoiding and addressing aesthetic treatment complications to minimize legal risk.
David Goldberg, MD, JD, is Director of Skin Laser & Surgery Specialists of New York and New Jersey, and Clinical Professor of Dermatology at Mount Sinai School of Medicine and Rutger’s New Jersey Medical School.
“There are more IPLS on the planet in the United States than any other energy based device and often used by more untrained individuals than any other device,” said David Goldberg, MD, JD, who discussed the legal implications associated with aesthetic interventions this year at South Beach Symposium Part II.
“And whether it’s lasers or IPLs, in the end, complications generally occur because there’s too much heat being delivered.”
Complications are related to fluency, wavelength, color of light, and cooling, said Dr. Goldberg.
“The key is to make sure to lessen the amount of energy being delivered… over a longer period of time.”
Pigment, water, and hemoglobin all absorb light. Delivering too much energy over a short period of time without enough cooling creates opportunities for complications.
“Whether it’s using an intense pulse light or any of the lasers we use, the issues are going to be the same: too much energy, too short a zap, not enough cooling, what wavelength. Those are the things people have to think about in order to lessen the complication rate.”
Still other ancillary issues can also cause complications:
1. Avoid the risk of a scarring complication by taking a patient history for cold sores.
If you don’t pretreat with an antiviral, both laser treatments and injections can lead to scarring where they might not otherwise, said Dr. Goldberg.
“So standard of care… when you’re treating around the mouth, is to ask them a family history of cold sores and to make sure to treat them for that.”
2. Do not laser eyebrow hair.
Laser hair removal of the eyebrows presents a potential complication that has rendered the service ill advisable, said Dr. Goldberg.
“There used to be a lot of people who did eyebrow sculpting with laser hair removal to lessen the density of eyebrows. That’s become a no-no now because some of that light—even if you use eye shields—is going to be absorbed by the pigment in the iris of the eye and you can cause long-term problems with that as well.”
3. Avoid ultrasound device complications that can result from operator error. `
“If you don’t have the [ultrasound] hand piece connected to the skin appropriately—if the energy, again, is not being delivered appropriately—you can get bumps from denatured collagen.”
Bumps tend to disappear with time, he said.
“By and large, although a complication can occur from anything—and it has to be in your consent form warning people about it—most complications are related to technique. And so it’s just being conservative. Learning basic techniques will really lessen the incidence of complications. And a complication doesn’t mean that you are negligent. Things do happen, but they generally go away if you’re not a cowboy.”
