LAST WEEK, I PICKED UP a respected laser journal and saw two well-written articles detailing nine cases of significant complications — any of which, in a given situation, could trigger the volatile combination of a litigious patient and a welcoming plaintiff attorney.

With the advent of fractional laser resurfacing and the related hype by both industry and clinicians, most seasoned laser practitioners have been waiting for the first wave of complication reports. I believe that these articles represent only the tip of the iceberg and there are scores of unreported complications from fractional laser resurfacing. I am aware of numerous cases in litigation and have more and more colleagues commenting on this increase.

LASER ALLURE So why is anyone surprised? As with all new technologies, manufacturers, media, surgeons and patients are excited at the possibility of "more results with less downtime." We have seen this hype many times with many different devices and techniques including barbed threads, "miracle" facelifts, nonsurgical skin tightening devices and yes, lasers. Especially lasers! There is something appealing about laser technology as it truly represents "space age physics," which most baby boomers had ingrained in their lives from Sputnik to the moon walk. It is technology in its purest form. Patients are fascinated with laser treatments as are physicians. The manufacturers and the media fully realize this laser preoccupation and it is always newsworthy. Again, the root of the problem.

RECOVERY VS. RESULTS Lasers remain a big part of my practice and clinical interests and I own a number of them — including a fractional system. Not that the experiences of a single practitioner dictate communal experience, but I have basically failed to see the huge differences in decreased downtime and increased results with fractional lasers, and I have written about this numerous times. To encapsulate my experience in a single phrase: expectations exceed results!

I am not saying there is no value in fractional laser resurfacing, and it may be the future of laser treatment, but "we ain't there yet." I continue to see case presentation of results that herald a three to four day recovery, but in small print state that there were four treatment sessions. Not much of an advantage to a single aggressive CO₂ laser treatment in my book. We are creating a culture based on hype where patients and novice practitioners think that it is a sin for a patient to reverse decades of aging with a two-week recovery and some extended erythema. They think that patients won't accept such treatment plans in this day and age and that they can circumvent the drawbacks of recovery with new technology. Not true. When it is explained to a patient that they can in fact have "the real gold standard" for rhytid and scar effacement and dyschromia ablation — but it will require a longer recovery, the tradeoff is not an obstacle.

DR. DUBIOUS Finally, why should we be surprised that these "conservative" lasers can cause complications? A laser is a laser is a laser. Concentrated light energy, regardless of the platform, has the ability to destroy tissue to depths that cannot re-epithelialize. Most of us have all said the laser prayer: "God, get me through this and I will never do that again!" None of us are beyond complications and it goes with the territory. However, we all must embrace cutting-edge technology with some skepticism and remember the hard-learned lessons of days past. New technology will happen, new doors will be opened and someday, the thought of burning someone's skin off to improve their appearance will sound irrational. Until then, we all need to put some brakes on the landslide of hype concerning "miracle" lasers. Time will tell, but at what expense? We have been there before; we should not go there again. Embrace technology, believe half of what you hear, don't forget where we have been, and if something sounds too good to be true, it probably is.

Joseph Niamtu, D.M.D., is a fellow of the American Academy of Cosmetic Surgery and the American Society for Lasers in Medicine and Surgery and board certified by the American Board of Oral and Maxillofacial Surgery. Dr. Niamtu, who specializes exclusively in cosmetic facial surgery, is in private practice in Richmond, Virginia.