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State of the Art

Die Guidlines unserer Licht -und Laserabteilung entsprechen denjenigen der American Academy of Dermatology (AAD). Dadurch ist gewaehrleistet, dass die Behandlungen nach dem neusesten Stand des Wissens durchgeführt werden. Derzeit liegt die deutsche Uebersetzung leider noch nicht vor. Für einzelne Fragepunkte wollen Sie bitte die untenstehenden Hyperlinks anklicken. Literatur findet sich am Schluss de Dokumentes reichlich. Für weitere Informationen bezüglich Laser siehe auch Laserskinresurfacing.

Guidelines of Care for Laser Surgery (following the Guidlines of the AAD)

Task Force: Jeffrey S. Dover, M.D., Chairman, Kenneth A. Arndt, M.D., Scott M. Dinehart, M.D., Richard E. Fitzpatrick, M.D., Ernesto Gonzalez, M.D.

1. Introduction

The American Academy of Dermatology's Committee on Guidelines of Care is developing guidelines of care for our profession. The development of guidelines will promote the continued delivery of quality care and assist those outside our profession in understanding the complexities and scope of care provided by dermatologists. For the benefit of members of the American Academy of Dermatology who practice outside the jurisdiction of the United States, the listed devices may include indications that are not currently approved by the U.S. Food and Drug Administration for the particular type of laser.

2. Definition

Lasers (Light Amplification by the Stimulated Emission of Radiation) are sources of high-intensity, monochromatic light that can be advantageously employed in the treatment of a variety of dermatologic diseases depending on the wavelength, the pulse characteristics, and the true irradiance of the laser being used and the nature of the clinical condition being treated. in addition, high intensity incoherent and multi-chromatic pulsed light may be used with the same principles of selective targeting by proper choice of wavelength spectrum, pulse characterization, and fluence.

3. Rationale

3.1.    Scope

Laser surgery is a rapidly changing field in which new types of lasers, as well as the conditions amenable to treatment, are continually being introduced. The conditions listed below have been treated using the particular laser or group of lasers by different physicians with varying results. This guideline reflects the best information available at the time the report was prepared.

3.1.1. Visible light lasers emitting continuous wave radiation and recognized by the skin

Lasers in this group include the continuous wave and quasi-continuous wave visible light lasers, which are the argon laser (488-514 nm); the continuous wave dye laser, usually tuned between 585-600 nm; the copper vapor laser (511-578 nm); the continuous wave potassium titanyl phosphate (KTP) lasers (532 nm); and the krypton laser (521, 530 and 568 nm). All these lasers produce continuous or shuttered visible laser light, in general, laser wavelengths from 532 to 595 nin are used predominantly in the treatment of vascular disorders, while wavelengths from 488 to as high as 532 are used in the treatment of benign pigmented disorders. With all these continuous and quasi-continuous devices the ability to confine spatially thermal damage is difficult. Thus, unlike treatment with the pulsed dye and pulsed KTP laser, the final outcome is highly dependent on the skill of the laser operator. Computer-driven mechanical scanning devices have been developed to ensure more uniformity of treatment and to help contain the thermal injury spatially, thus reducing the risk of using these continuous and quasi-continuous lasers.     Argon laser and continuous wave  argon-pumped dye laser

The argon laser produces visible light at 6 wavelengths between 488 and 514 nm. in the continuous wave argonpumped tunable dye laser an argon laser is coupled to a dye cavity to produce visible laser light of differing wavelengths depending on the type of dye placed in the laser cavity. The dyes that are used absorb strongly in various portions of the physical spectrum to produce colored light. By choosing the appropriate dye, it is possible to produce a desired wavelength or color of laser light. Dye lasers employed for the treatment of cutaneous vascular disorders use rhodamine dye having a peak emission at or near 577 nm, Fine tuning can be achieved by using a prism to increase or decrease the emitted wavelength by up to 20 nm. Copper vapor lasers

Copper vapor lasers produce either yellow light at 578 nm or green light at 511 nm by heating elemental copper or copper salts in the optical cavity. The energy is released as a chain of lowenergy short 20-40 ns pulses at a frequency of 10-15 kHz. This chain can be electronically shuttered to produce bursts of pulses of 0.075-0.3 seconds in duration. Krypton laser

The krypton laser is a gas-medium laser that emits either yellow light at a wavelength of 568 nm to treat vascular lesions, or green light at wavelengths of 521 and 530 nm to treat pigmented lesions. Conditions amenable to continuous and quasi-continuous wave laser treatment.

Vascular lesions
  • Angiokeratomas
  • Angiolymphoid hyperplasia
  • Superficial (capillary) hemangiomas
  • Cherry angiomas
  • Blue rubber bleb nevi
  • Essential telangiectasia
  • Red nose caused by telangiectasia seen in the post traumatic red nose syndrome
  • Facial and truncal telangiectases of a variety of causes including
  • rosacca, solar- induced chronic dermatitis, radiation dermatitis, CREST syndrome, and Osler-Weber-Rendu syndrome
  • Spider angiomas
  • Lymphangiomas
  • Kaposi's sarcoma
  • Port-wine stains (particularly those which are deeply colored, cobblestoned and nodular in surface texture when the non-specific thermal effects are desired)
  • Pyogenic granulomas
  • Yenouslakes
  • Other
Benign pigmented disorders
  • Cafe-au-1ait macules
  • Lentigines
  • Early, relatively flat, seborrheic keratoses
  • Other
Miscellaneous conditions
  • Adenoma sebaceum 
  • Fibrous papule of the nose
  • Glomus tumors
  • Granuloma faciale
  • Other

3.1.2. Visible light pulsed vascular lasers Flashlamp-pumped pulsed dye laser

The flashlamp-pumped pulsed dye laser produces short (450-1500 microseconds) pulses of yellow light at a wavelength of 585, 590, 595, or 600 nm. The characteristics of these laser systems induce selective thermal damage spatially confined to cutaneous vessels, making them most effective in the treatment of port wine stains and benign cutaneous ectasias. The shorter pulse duration and the shorter wavelength pulse dye laser may be more effective for smaller, more superficial vessels, while the newer longer pulse duration 0 .5 msec), longer wavelength (595) pulsed dye laser may be more effective for deeper, larger vessels, and for leg veins. Pulsed KTP laser

A group of pulsed KTP (532 nm) and Nd:YAG (1064 nm) lasers has been developed with pulse durations in the 1 to 100 msec range, which induce spatially confined thermal injury to cutaneous vessels. They are effective in the treatment of benign vascular ectasias and some port wine stains. Visible light, pulsed non-laser sources

By using wavelength filters, a broad band of light from either 515 nm, 550 nm, 570 nm or 590 nm to approximately 1000 nm is produced with a high intensity flashlamp. Depending on the filter chosen, treatment spectra are 515-1000, 550-1000, etc. The pulse width may be adjusted from 1 to 10 msec and the interval between pulses, as well as the fluence, may be selected. Because of the mix of wavelengths used, a more non-specific response may be seen with competing tissue chromophores. However, the longer pulse widths and longer wavelengths may be useful in treating larger vessels. Conditions amenable to pulsed lasers and pulsed light sources

Vascular lesions
  • Angiokeratomas
  • Angiolymphoid hyperplasia
  • Superficial (capillary) hemangiomas
  • Cherry angiomas
  • Blue rubber bleb nevi
  • Essential telangiectasia
  • Telangiectatic superficial leg veins
  • Red nose caused by telangiectasia seen in the post traumatic red nose syndrome
  • Facial and truncal telangiectases of a variety of causes including rosacca, solar- induced chronic dermatitis, radiation dermatitis, CREST syndrome, and Osler-Weber-Rendu syndrome
  • Spider angiomas
  • Lymphangiomas
  • Port wine stains (large nodular mature port wine stains usually require repeated treatments)
  • Yenouslakes
  • Other
Miscellaneous conditions
  • Warts
  • Hypertrophic scars
  • Striae distensae
  • Other

3.1.3. Short-pulsed pigment lasers

A group of short-pulsed lasers is effective for treatment of a variety of benign pigmented disorders. All have pulse durations less than 1 p sec, the thermal relaxation time of 1 pm diameter melanosornes. Their effect is through combined photo-acoustic and photo-thermal effects. Q-switched ruby laser

The Q-switched ruby laser produces very short pulses (25 ns) of high-intensity red light at a wavelength of 694 mn. Because red light penetrates through the dermis, the Q- switched ruby laser is effective for the treatment of both epidermal and dermal benign pigmented disorders, as well as blue, black, and green tattoos. b. Q-switched and millisecond pulsed Nd:YAG laser

The Q-switched neodymium yttrium aluminum garnet (Nd:YAG) laser produces 5 -10 nsec high-intensity pulses at 1064 mn in the near infrared spectrum. The laser can be frequency doubled by means of a KTP doubling crystal to produce green light at 532 nm. 1064 nm light penetrates several mm into the depths of the dermis, therefore, even deep dermal pigmented disorders, including black and blue tattoos can be treated. The 532 nm light penetrates only into the upper dermis and is not effective for deep melanocytic processes, but is well suited for treatment of superficial pigmented lesions, such as, lentigines, and red, orange, and purple tattoos.  Q-switched alexandrite laser

The Q-switched alexandrite laser produces either 50 or 100 nsec high- intensity pulses at 755 nm in the red portion of the spectrum. Like the Q- switched ruby laser, alexandrite laser light is effective for treatment of epidermal and dermal pigmented processes and black, blue, and green tattoos. Pulsed dye laser (510 nm)

This pulsed dye laser produces short pulses (300 nsec) of green (510 nm) light and is used for the treatment of epidermal pigmented disrders and red, orange, and purple tattoos. The wavelength is not long enough to penetrate sufficiently to affect deeper dermally pigmented disorders, such as nevus of Ota. Conditions amenable to treatment with the short pulsed lasers

Benign pigmented lesions (epidermal)
  • Lentigines
  • Cafe-au-lait macules
  • Ephelides
  • Epidermal melasma
  • Nevus spilus
  • Becker's nevus
  • Lower labial macule
  • Peutz jeghers spots
  • Other
Benign pigmented lesions (dermal)
  • Dermal melasma may lighten with treatment, but almost invariably recurs with sun exposure
  • Nevus of Ota
  • Nevus of Ito
  • Blue nevi (flat)
  • Mongolian spot
  • Post-inflammatory hyperpigmentation
  • Hyperpigmented scars
  • Other
  • Amateur
  • Professional
  • Traumatic
Miscellaneous conditions  

3.1.4. Long pulsed long wavelength lasers

A group of longer pulsed, non-Q-switched, relatively long wavelength lasers has recently been developed in an effort to damage larger cutaneous targets selectively. Long pulsed ruby laser

Long pulsed ruby lasers produce up to 6 J/cm' in 0.3 to 3.0 msec pulses at 694 nm. Long pulsed alexandrite laser

Long pulsed alexandrite lasers produce over 20 J/cm' and pulse durations of 320 msec 755 nm lamp pumped pulsed light sources

This device emits up  to 60 J/cm2 over a broad band in 2 to 20 msec pulsed at wavelength above 590, 615, 645, or 690 nm to an upper limit of approximately 1000 nm. Conditions amenable to treatment with long pulsed long wavelength lasers

Miscellaneous conditions
  • Excessive facial or body hair
  • Veins (0.4 to 1.5 mm diameter)
  • Other

3.1.5. Ablative and cutting lasers Continuous wave carbon dioxide (CO2) laser Characteristics: The CO 2 laser produces invisible, mid-infrared light at a wavelength of 10600 nm. it can be used in the continuous mode of operation (focused or incisional) for making relatively bloodless incisions, or defocused (vaporizational) for ablating a variety of superficial cutaneous disorders. Incisional surgery with the C02 laser may be valuable in patients requiring anticoagulation therapy or cardiac monitoring, and patients with cardiac pacemakers. It may also be valuable in patients undergoing scalp surgery, and in reducing bruising and post-operative swelling. Conditions amenable to continuous wave CO2 laser treatments in the vaporization or defocused mode

Miscellaneous conditions
  • Actinic cheilitis and actinic keratoses
  • Appendageal tumors
  • Adenoma sebaceum
  • Angiokeratomas
  • Angiolymphoid hyperplasia
  • Balanitis xerotica obliterans Basal cell carcinomas (superficial type)
  • Bowenoid papulosis
  • Cherry angiomas
  • Condyloma acuminatum
  • Cylindromas
  • Deep fungal infections (primary inoculation)
  • Digital mucous cysts
  • Epidermal nevi
  • Eruptive vellus hair cysts
  • Granuloma faciale
  • Hailey-Hailey disease
  • Lichen myxedcmatosus
  • Lichen sclerosus et atrophicus
  • Lymphangioma circumscriptum
  • Neurofibromas
  • Nodular arnyloidosis
  • Pearly penile papules
  • Port-wine stains (adult, nodular type)
  • Pyogenic granulomas
  • Rhinophyma
  • Sebaceous hyperplasia
  • Steatocystorna multiplex
  • Syringomas
  • Trichoepitheliomas
  • Trichilemmomas
  • Warts (refractory, periungual, plantar types)
  • Xanthelasma
  • 0ther Pulsed and scanned CO2 laser Characteristics : Most conventional continuous wave CO 2 lasers can be superpulsed, a pulsing technique where the laser produces a train of relatively high power short duration pulses. Although superpulsed CO 2 laser light can theoretically vaporize or cut tissue leaving a smaller residual zone of thermal damage than with continuous wave CO 2 lasers, in practice, this is only achieved using a spot size of 0.8 mm or smaller. Recently developed pulsed CO 2 lasers produce short pulses (< 1 msec) at high power ( > 5 J/cm') that can remove thin layers of skin (30-50 pm) in a single pass with little sub-adjacent thermal damage (50-100 pm). Short-pulsed C0 2 lasers and some scanned CO 2 lasers are effective for resurfacing photoaged and scarred skin. The precision of these laser systems is due to the selective absorption of this wavelength of light by intracellular and extracellular water combined with the appropriate fluence to vaporize tissue and/or the appropriate pulse width to confine residual thermal damage. Conditions that may be amenable to treatment with pulsed and some scanned CO 2 lasers

Miscellaneous conditions
  • Photoaged skin with dyspigmentation and fine, or occasionally coarse, rhytids
  • Acne scars
  • Slightly raised hypertrophic scars
  • Actinic keratoses
  • Actinic cheilitis
  • Rhinophyma
  • Small appendageal tumors,such as syringomas
  • Epidermal nevi
  • Cosmetic surgical procedures, e.g., blepharoplasty, rhytidectomy, and hair transplantation
  • Other Erbium: Yttrium Aluminum Garnet (Er:YAG) lasers Characteristics: Er:YAG lasers produce short pulses (< 1 msec), at high powers (> 2.5 J/ cm'), at a wavelength of 2.94 Micron which, like pulsed CO 2 lasers, can remove very thin layers of skin (25 micron) in a single pass with even less thermal damage (5 micron) because of highly selective absorption by intracellular and extracellular water. Conditions that may be amenable to treatment with the Er:YAG laser

Miscellaneous conditions
  • Photoaged skin with fine rhytids
  • Acne scars
  • Actinic cheilitis and actinic keratoses
  • Small appendageal tumors
  • Other

3.2. Issue

3.2.1. Physician qualifications General

The physician should have

  1. Completed residency training in an appropriate specialty such as dermatology, which provides training in cutaneous surgery
  2. General knowledge of basic laser physics, laser-tissue interaction, and laser safety
  3. Knowledge of the special safety requirements and elements of the laser, and the prevention and management of potential complications for the specific type of laser to be used
  4. Knowledge of cutaneous anatomy and basic factors regarding cutaneous wound healing. Specific

  1. The physician should have laser surgery training in residency, or 
  2. Attendance at an appropriate laser course that includes instruction in basic laser physics, laser safety, didactic lectures on clinical applications of lasers, hands-on experience, or equivalent hands-on experience conducted under the supervision of an appropriately trained and experienced laser surgeon

4. Diagnostic Criteria

4.1.  Clinical

Medical History
  • Duration
  • Location
  • Changes that have occurred over time
  • Cosmetic concerns
  • Family history
  • Concurrent medical problems
  • Current medications
  • History of isotretinoin usage
  • Previous dermabrasion
  • Previous cutaneous radiation
  • Allergies
  • History of abnormal scarring, especially keloids
  • Skin type (facultative and acquired pigmentation)
Physical examination
  • Description of the lesion
  • Extent
  • Location

4.2.  Diagnostic tests

  • If the clinical appearance of the condition or lesion is insufficient to ensure an accurate diagnosis, then a biopsy should be performed, especially with pigmented lesions.
  • In some conditions, the performance of a small representative test area may be necessary in order to accurately determine the proper laser parameters to use and tissue response in the treatment of larger areas.

5.   Recommendations

5.1. Treatments

5.1.1. Medical

Not applicable

5.1.2. Surgical Preoperative

  • Patient selection is very important and care must be taken to explain the procedure and to ensure that the patient has a complete understanding of the nature of the problem, the treatment options that are available, the risks and benefits of the various forms of treatment, the associated complications, and the potential for scarring and/or pigment changes.
  • Pre- and post- treatment photographs may be useful in ensuring reasonable expectations Anesthesia (See Guidelines of care for local and regional anesthesia in cutaneous surgery)
The choice of no anesthesia, topical anesthesia, local anesthesia, local anesthesia in combination with sedation, cry-anesthesia, regional nerve blocks, intravenous sedation, or general anesthesia is determined by the physician. Treatment techniques

The treatment techniques may vary depending on the physician's personal experience and judgment. However, the lowest power density or energy fluence that is consistent with a good clinical result is strongly encouraged except when using the CO 2 laser for cutting or ablation. By choosing the most appropriate wavelength and pulse characteristics that limit unwanted thermal damage, therapeutic outcome can be optimized. Achieving optimal results is more difficult and requires a higher level of experience and expertise with continuous and quasi continuous wave lasers than with pulsed lasers. Postoperative findings

The frequency of complications is related to the type of laser that is used and the condition that is treated.

  • Irregular pigmentation
  • Pain
  • Persistent erythema
  • Recurrence
  • Bleeding
  • Failure to show satisfactory improvement
  • infection
  • Scarring or textural changes Other

Follow-up examinations are highly encouraged and are strongly recommended. In many cases, especially tattoos, port wine stains, some pigmented lesions, such as cafe-au-lait macules, several treatments may be required in order to achieve the best results and the greatest degree of improvement. For some pigmented lesions, like cafe-aulait macules and Becker's nevi, repigmentation may occur following treatment and the patient should be given additional information about this situation at a follow-up visit.

5.2. Surgical setting

Laser surgical treatments may be performed in a physician's office, an ambulatory surgical center, or in a hospital. The American Academy of Dermatology has recommended guidelines for office surgical facilities to help assure the provision of quality office surgical care. (See Guidelines of carefor office surgical facilities, Parts 1 and 2.) In addition to the recommendations set forth in those guidelines, the Academy recommends the following for laser surgery facilities. These guidelines do not supersede any existing local, state, or federal regulations.

5.2.1. Facility

  1. The entrance way to the laser facility has a laser device safety sign posted in plain view on the door when the laser is in use.
  2. Protective measures are taken to prevent stray laser irradiation from leaving the room or from reflecting.
  3. The room is adequately ventilated with a smoke evacuator.
  4. Smoking is not allowed in the surgical suite.

5.2.2. Equipment

Laser Laser equipment is appropriately signposted.
Laser Maintenance
  • Each laser system is maintained by trained personnel who are skilled in assuring proper laser output, beam alignment, and lenses employed in each procedure.
  • Up to date preventive maintenance logs are kept.
  • Safety maintenance includes
    • intact electrical cables
    • Functioning shutters and safety interlocks
    • Warning light indicators
Eye protection
  • Appropriate safety goggles of sufficient optical density specified for the wavelength of each laser in the facility are available.
  • Patients and personnel are protected by appropriate eye protection.
  • Goggles are labeled with the wave length protection provided.
  • The use of masks that filter particles as small as 0.1 pm in diameter are available.
Vacuum Devices
  • Vacuum devices with sufficient power and with the ability to filter to 0.1 pm are used for all procedures in which a plume is produced.
  • Silastic tubing is changed after each individual patient treatment.
  • Filters are replaced according to the manufacturer's recommendation.
Dyes Dye and filter changes are performed when the room is empty.

Gloves and an adequate ventilating mask are worn by all person~ nel handling the dyes because of their potential toxicity.

Dye spills are reported to the environmental service representative in the building and to the laser company.

other For CO 2 laser surgery, nonreflective or ebonized instruments are used.

Nonflammable surgical drapes are used.

Oxygen sources, such as nasal prongs and tubes should be removed from the patient prior to surgery.

5.2.3. Staff
Appropriate nursing and technical staff have documentation of laser training and safety training.

5.2.4. Procedure manuals

A periodic review program is in effect and includes review of

  • Adequacy of safety protocols for the laser, vacuum, and power meters
  • Procedure manuals for laser use and safety that are available in the facility.

6. Supporting evidence
See bibliography (Appendix)

7. Disclaimer

Adherence to these guidelines will not ensure successful treatment in every situation. Further, these guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. For the benefit of members of the American Academy of Dermatology who practice outside the jurisdiction of the United States, the listed devices may include indications that are not currently approved by the U.S. Food and Drug Administration for the particular type of laser.



  • Achauer BM, Vander KAM VM, Berns MW. Lasers in plastic surgery and derniatology. New York: Thieme Publishers, 1992.

  • Alster TS. Manual of cutaneous laser technique. Philadelphia: Lippincott-Raven Publishers, 1997.

  • Alster T, Apfelberg DB (eds). Cosmetic laser surgery. New York: John Wiley & Sons, Inc., 1995.

  • Arndt K, Dover JS, Olbricht SO. Lasers in cutaneous and aesthetic surgery. Philadelphia: Lippincott-Raven Publishers, 1997.

  • Arndt KA, Noe JM, Northam DB, et al. Laser therapy. Basic concepts and nomenclature. J Am Acad Dermatol 1981;5:649-54.

  • DoverJS, Arndt KA, Geronemus RG, et al. illustrated cutaneous laser surgery. A practitioner's guide. Norwalk, Connecticut: Appleton & Lange, 1990.

  • Goldman M, Fitzpatrick R. Cutaneous laser surgery. The art and science of selective photothermolysis. St. Louis: Mosby, 1993.

  • Goyal S, DovcrJS, Arndt KA. Lasers. J Am Acad Dermatol 1995;32: 262-72.

  • Hruza GJ, Geronernus RG, Dover JS, et al. Lasers in dermatology- 1993 (editorial). Arch Dermatol 1993; 129:1026-35.

  • Spicer M, Goldberg DJ. Laser in dermatology. JAAD 1996;34:1- 25.

  • Tan OT. Management and treatment of benign cutaneous vascular lesions. Philadelphia: Lea & Febiger, 1992. Dermatologic Clinics, 1997;15:3:355-548.

  • Baggish MS, Poiesz BJ, Joret D, et al. Presence of human immunodeficiency virus DNA in laser smoke. Lasers Surg Med 1991;11:197-203.

  • Fretzin S, Beeson WH, Hanke CW Ignition potential of the 585 nm pulsed-dye laser. Review of the literature and safety recommendations. Dermatol Surg 1996;22:699702.

  • Garden JM, O'Banion MK, Shelnitz LS, et al. Papillomavirus in the vapor of carbon dioxide laser-treated verrucae. JAMA 1988;259:1199-1202.

  • Nezhat C, Winer WK, Nezhat F, et al. Smoke from laser surgery: is there a health hazard? Laser Surg Med 1987;7:376-82.

  • Sawchuk WS, Weber PJ, Lowy DR, et al. Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol 1989;21:41-9.
  • Alster TS. Comparison of the "superpulsed" and "ultrapulsed" lasers in the treatment of periorbital rhytides. Cosmetic Derm 1995;8:30-34.

  • Alster TS, Garg S. Treatment of facial rhytides with a high energy pulsed carbon dioxide laser. Plast Reconstr Surg 1996;98:791-4.

  • Bernstein L, Kauvar A, Grossman M, Gcronemus R. The shortand long-term side effects of carbon dioxide laser resurfacing. Dermatol Surg 1997;23:519-25.

  • Cotton J, Hood AF, Gonin R, et at. Histologic evaluation of preauricular and postauricular human skin after high-energy, short pulse carbon dioxide laser. Arch Dermatol 1996;132:425-8.

  • David LM, Goodman G. Blepharoplasty for the laser dermatologic surgeon. Clin Dermatol 1995;13:49-53.

  • Fairhurst MV, Roenigk RK, Brodland DG. Carbon dioxide laser surgery for skin disease. Mayo Clin Proc 1992;67:49-58.

  • Fitzpatrick RE, Tope WD, Goldman MP, et al. Pulsed carbon dioxide laser, trichloroacctic acid, Baker-Gordon phenol, and dermabrasion: a comparative clinical and histologic study of cutaneous resurfacing in a porcine model. Arch Dermatol 1996;132:469-71.

  • Fitzpatrick RE, Goldman MP, Satur NM, et a]. Pulsed carbon dioxide laser resurfacing of photo-aged facial skin. Arch Dermatol 1996;132:395-402.

  • Green HA, Burd E, Nishioka NS, et al. Mid-dermal wound healing. A comparison between dermatomal excision and pulsed carbon dioxide laser ablation. Arch Dermatol 1992;128:639- 45.

  • Green HA, Burd EE, Nishioka NS, et al. Skin graft take and healing following 193-nm excimer, continuous-wave

  • carbon dioxide (CO.), pulsed CO 21 or pulsed holmium:YAG laser ablation of the graft bed. Arch Dermatol 1993; 129:97988.

  • Ho C, Nguyen Q, Lowe NJ, et al. Laser resurfacing in pigmented skin. Dermatol Surg 1995;21:1035-7.

  • Hruza GJ, Dover JS. Laser skin resurfacing [editorial; comment]. Arch Dermatol 1996, 132:451-5.

  • Kaufmann R, Hartmann A, Hibst R. Cutting and skin ablative properties of pulse mid-infrared laser surgery. J Dermatol Surg Oncol 1994;20:112-8.

  • Lanzafame R , Naim JO, Rogers DW, et al. Comparison of continuous-wave, chop-wave, and super pulse laser wounds. Lasers Surg Med 1988;8:119-24.
  • Lowe NJ, Lask G, Griffin ME, et al. Skin resurfacing with the Ultrapulse carbon dioxide laser. Observations on 100 patients. Dermatol Surg 1995;21:1025-9.

  • Sriprachya-Anunt S, Fitzpatrick R, Goldman M, Smith S. Infections complicating pulsed carbon dioxide I a s e r resurfacing for photoaged facial skin. Dermatol Surg 1997;23:527-36.

  • Teikemeier G, Goldberg D. Skin resurfacing with the Erbium:YAG laser. Dermatol Surg 1997;23:685-687.

  • Unger VT. Laser hair transplantation 111. Computerassisted laser transplanting. Dermatol Surg 1995;21:104755.

  • Unger VT. Laser hair transplantation: is it really state of the art? Lasers in Surgery and Medicine 1996;19:236238.

  • Waldorf HA, Kauvar AN, Geronemus RG. Skin resurfacing of fine to deep rhytides using a char-free carbon dioxide laser in 47 patients. Dermatol Surg 1995;21:940-6.

  • Weinstein C. Ultrapulse carbon dioxide laser removal of periocular wrinkles in association with laser blepharoplasty. j Clin Laser Med Surg 1994;12:205-9.

Continuous-wave Lasers
  • Arndt KA. Argon laser therapy of small cutaneous vascular lesions. Arch Dermatol 1982;118:220-4.

  • Neumann RA, Knobler RM, Leonhartsberger H, et al. Comparative histochemistry of port-wine stains after copper vapor laser (578 nm) and argon laser treatment. j Invest Dermatol 1992;99:160-7.

  • Neumann RA, Leonhartsberger H, BAohler-Sommeregger K, et al. Results and tissue healing after copper-vapor laser (at 578 nm) treatment of port wine stains and facial telangiectasias. Br j Dermatol 1993; 128:306-12.

  • Noe JM, Barsky SH, Geer DE, et al. Port wine stains and the response to argon laser therapy: successful treatment and the predictive role of color, age and biopsy. Plast Reconstr Surg 1980;65:130-6.

  • Scheibner A, Wheeland RG. Argon-pumped tunable dye laser therapy for facial port-wine stain hemangiomas in adults-a new technique using small spot size and minimal power. j Dermatol Surg Oncol 1989;15:277-82.

Pulsed Dye Lasers
  • Ashinoff R, Geronemus RG. Capillary hemangiomas and treatment with the flash lamp-pumped pulsed dye laser. Arch Dermatol 1991;127:202-5.

  • Garden JM, Bakus AD, Paller AS. Treatment of cutaneous hemangiornas by the flashlamp-pumped pulsed dye laser: prospective analysis. j Pediatr 1992;120:550-60.

  • Geronemus R. Treatment of spider telangiectases in children using the flashlamp-pumped pulsed dye laser. Pediatr Dermatol 1991;8:61-3.

  • Gonzalez E, Ganga RW, Momtaz KT. Treatment of telangiectases and other benigh vascular lesions with the 577 nm pulsed dye laser. j Am Acad Dermato11992;27:2206.

  • Landthaler M, Hohenleutner U, el-Raheem TA. Laser therapy of childhood hemangiomas. Br j Dermatol 1995;133:275-81.

  • Lanigan SW. Patient-reported morbidity following flashlamp-pumped pulse tunable dye laser treatment of port wine stains, Brj Dermatol 1995;133:423-5.
  • Morelli JG, Tan OT, Yohn jj, et al. Treatment of ulcerated hemangiomas infancy. Arch Pediatr Adolesc Med 1994; 148:1104-5.

  • Renfro L, Geronemus RG. Anatomical differences of portwine stains in response to treatment with the pulsed dye laser. Arch Dermatol 1993;129:182-8.

  • Reyes BA, Geronemus R. Treatment of port-wine stains during childhood with the flashlamp-pumped pulsed dye laser. j Am Acad Dermatol 1990;23:1142-8.

  • Tan OT, Morrison P, Kurban AK. 585 nm for the treatment of port-wine stains. Plast Reconstr Surg 1990;86:11127.

  • Tan OT, Sherwood K, Gilchrest BA. Treatment of children with port-wine stains using the flashtamp-pulsed tunable dye laser. N Eng] j Med 1989;320:416-21.

  • Waner M, Dinehart SM, Wilson MB, et al. A comparison of copper vapor and flashlamp pumped dye lasers in the treatment of facial telangiectasia. J Dermatol Surg Oncol 1993; 19:992-8.

Robotized Scanning Devices
  • Dover JS, Geronemus R, Stern RS, et al. Dye laser treatment of port-wine stains: comparison of the continuouswave dye laser with a robotized scanning device and the pulsed dye laser. j Am Acad Dermatol 1995;32:237-40.

  • Rotteleur G, Mordon S, Buys B, et al. Robotized scanning laser handpiece for the treatment of port wine stains and other angiodysplasias. Lasers Surg Med 1988;8:283-7.

Other Considerations
  • Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet 1995;345:1198-2000.

  • Geronernus RG, Ashinoff R. The medical necessity of evaluation and treatment of port-wine-stains. J Dermatol Surg Oncol 1991;17:76-9.

  • Goldman MP, Fitzpatrick RE. Laser treatment of scars. Dermatol Surg 1995;21:685-7.
  • Kauvar AN, McDaniel DH, Geronemus RG. Pulsed dye laser treatment of warts. Arch Fam Med 1995;4:103540.

  • Rabinowitz L, Esterly N, eds. Anesthesia and/or sedation for pulsed dye laser therapy. Special symposium. Pediatr Dermatol 1992;9:132-53.

  • Anderson RR, Margolis Rj, Watanabe S, et al. Selective photothermolysis of cutaneous pigmentation by Qswitched Nd:YAG laser pulses at 1064, 532, and 355 nm. j Invest Dermatol 1989;93:28-32.

  • Dover JS, Margolis Rj, Polla LL, et al. Pigmented guinea pig skin irradiated with Q-switched ruby laser pulses. Morphologic and histologic findings. Arch Dermatol 1989;125:43-9.

  • Taylor CR, Anderson RR, Gange RW, et al. Light and electron microscopic analysis of tattoos treated by Qswitched ruby laser. j invest Dermatol 1991;97:131-6.

Benign Pigmented Lesions
  • DePadova-Elder SM, Milgraum SS. Q-switched ruby laser treatment of labial lentigines in Peutz-jeghers syndrome. J Dermatol Surg Oncol 1994;20:830-2.

  • Fitzpatrick RE, Goldman MP, Ruiz-Esparzaj. Laser treatment of benign pigmented epidermal lesions using a 300 nsecond pulse and 510 urn wavelength. J Dermatol Surg Oncol 1993; 19:341-7.

  • Geronemus RG. Q-switched ruby laser therapy of nevus of Ota. Arch Dermatol 1992;128:1618-22.

  • Goldberg Dj. Benign pigmented lesions of the skin. Treatment with the Q-switched ruby laser. J Dermatol Surg Oncol 1993;19:376-9.

  • Tan OT, Morelli JG, Kurban AK. Pulsed dye laser treatment of benign cutaneous pigmented lesions. Lasers Surg Med 1992;12:538- 42.

  • Lowe NJ, Wieder JM, Sawcer D, et al. Nevus of Ota: treatment with high energy fluences of the Q-switched ruby laser. J Am Acad Dermatol 1993;29:997-1001.

  • Lowe NJ, Wieder JM, Shorr N, et al. Infraorbital pigmented skin. Preliminary observations of laser therapy. Dermatol Surg 1995;21:767-70.

  • Milgraum SS, Cohen ME, Auletta Mj. Treatment of blue nevi with the Q-switched ruby laser. j Am Acad Dermatol 1995;32:307-10.

  • Setsuko U, Imayama S. Normal-mode ruby laser for treating congenital nevi. Arch Dermatol 1997;133:355-59.

  • Watanabe S, Takahashi H. Treatment of nevus of Ota with the Q-switched ruby laser. N Engl j Med 1994;331:1745-50.

  • Alster TS. Q-switched alexandrite laser treatment (755 nm) of professional and amateur tattoos. J Am Acad Dermatol 1995;33:69- 73.

  • Anderson RR, Geronemus R, Kilmer SL, et al. Cosmetic tattoo ink darkening. A complication of Q-switched and pulsed-laser treatment. Arch Dermatol 1993;129:1010-4.

  • Fitzpatrick RE, Goldman MP, Ruiz-Esparza J. Use of the alexandrite laser (755 nm, 100 nsec) for tattoo pigment removal in animal model. J Am Acad Dermatol 1993;28:74550.

  • Kilmer SL, Lee MS, Grevelink JM, et al. The Q-switched Nd:YAG laser effectively treats tattoos. A controlled, doseresponse study. Arch Dermatol 1993;129:971-8.

  • Reid WH, Miller ID, Murphy Mj, et al. Q-switched ruby laser treatment of tattoos; a 9-year experience. Br J Plast Surg 1990;43:663-9.

  • Stafford Tj, Lisek R, Tan OT. Role of the Alexandrite laser for removal of tattoos. Lasers Surg Med 1995;17:32-8.

  • Taylor CR, Gange RW, Dover JS, et al. Treatment of tattoos by Q-switched ruby laser. A dose-response study. Arch Dermatol 1990;126:893-9.
Hair Removal
  • Grossman M, Dierickx C, Farinelli W, Flotte T, Anderson R. Damage to hair follicles by normal-mode ruby laser pulses. J Am Acad Dermatol 1996;35:889-94.

  • Wheeland R. Laser-assisted hair removal. Dermatol Clin 1997; 15:469-77.

  • Goldberg D, Littler C, Wheeland R. Topical suspension-assisted Q-switched Nd:YAG laser hair removal. Dermatol Surg 1997;23:741-5.

  • Abramson AL, DiLorenzo TP, Steinberg BM. Is papillornavirus detectable in the plume of laser-treated laryngeal papilloma? Arch Otolaryngol Head Neck Surg 1990; 116:604-7.

  • ANSI Z136.3 Safe Use of Lasers in Health Care Facilities. American National Standards Institute, New York, 1996.

  • American Society for Laser Medicine and Surgery. Standards of practice for the safe use of lasers in medicine and surgery. Wausau, WI.

  • Baggish MS, Poiesz Bj, joret D, et al. Presence of human immunodeficiency virus DNA in laser smoke. Lasers Surg Med 1991;11:197-203.

  • Bean AK, Ceilley RL Reducing fire risks of the flashlamp pumped 585-nm pulse dye laser [letter]. j Dermatol Surg Oncol 1994;20:224.

  • Beck WC. Lighting the surgical suite. Contemp Surg 1978; 12:9- 13.

  • Beergbrant IM, Samuelsson L, Olofsson S, jonassen F, Ricksten A. Polymerease chain reaction for monitoring human papillomavirus contamination of medical person~ nel during treatment of genital warts with CO 2 laser electrocoagulation. Acta Derm Venereol (Stockh) 1994;74:3935.

  • Byrne PO. Carbon dioxide laser irradiation of bacterial targets in vitro. J Hosp Infection 1987;9:265-73.

  • Drake LA, Ceilley RI, Cornelison RL, et al. Guidelines of care for office surgical facilities. Part I. J Amer Acad Dermatol 1992;26:763-5.

  • Drake LA, Ceilley RI, Cornelison RL, et al. Guidelines of care for office surgical facilities. Part IL Self-Assessment checklist. J Amer Acad Dermatol 1995;33:265-70.
  • Drake LA, Dinehart SM, Goltz RW, et al. Guidelines of care for local and regional anesthesia in cutaneous surgery. J Amer Acad Dermatol 1995;33:504-9.

  • Elliott RA. The design and management of an aesthetic surgeon's office and surgery suite. In: Regnault P, Daniel R, eds. Aesthetic Plastic surgery: principles and techniques. Boston: Little Brown 1984:46-73

  • Ferenczy A, Bergeron C, Richart RM. Human papillomavirus DNA in CO 2 laser-generated plume of smoke and its consequences to the surgeon. Obstet Gynecol 1990;75:114-8

  • Fretzin S, Beeson WH, Hanke CW. Ignition potential of the 585 nm pulsed-dye laser. Review of the literature and safety recommendations. Dermatol Surg 1996;22:699702.

  • Garden JM, O'Banion MK, Shelnitz LS, et al. Papillornavirus in the vapor of carbon dioxide laser-treated verrucae. JAMA 1988;259:1199-1202

  • Gilbert DA, Adamson JE. Procedure manuals in office surgery. Clin Plast Surg 1983-110:269-72.

  • Gloster HM jr, Roenigk RK. Risk of acquiring human papillomavirus from the plume produced by the carbon dioxide laser in the treatment of warts. J Am Acad Dermatol 1995;32:436- 41.

  • Gray F, Mittleman H. implementation and management of a laser program. In: Apfleberg DB, ed. Evaluation and installation of surgical laser systems. Springer-Verlag 1986;54-68.

  • Holmes JA. A summary of safety considerations for the medical and surgical practitioner. IN: Apfleberg DB, ed. Evaluation and installation of surgical laser systems. Springer-Verlag 1986:69- 95.

  • Johnson GK, Robinson WS. Human immunodeficiency virus-1 (HIV-1) in the vapors of surgical power instruments. J Med Viral 1991;33:47-50.

  • Kashima HK, Kessis T, Mounts P, et al. Polymerase chain reaction identification of human papillomavirus DNA in C02 laser plume from recurrent respiratory papillomatosis. Otolaryngol Head Neck Surg 1991;104:191-5.

  • Laser Institute of America: Laser safety guide 1992, Orlando, Florida.

  • Lobraico RV, et al. A retrospective study on the hazards of the carbon dioxide laser plume. J Laser Applications Fall, 1988: 6-8.

  • Mackety Cj. Administrative responsibilities of laser surgery: Nursing and administrator roles. IN: Apfelberg DB, ed. Evaluation and installation of surgical laser systems. Spring-Verlag 1986:34-53.

  • Nezhat C, Winer WK, Nezhat F, et al. Smoke from laser surgery: is there a health hazard? Laser Surg Med 1987;7:376-82.

  • Olbricht SO, Stem RS, Tang SV, et al, Complications of cutaneous laser surgery. Arch Derm4tol 1987;123:345-9.

  • OSHA Instructional Publication, Guidelines for laser safety and hazard assessment 1992;8-1.7.

  • Rabinowitz L, Esterly N, eds. Anesthesia and/or sedation for pulsed dye laser therapy. Special symposium. Pediatr Dermatol 1992;9:132-53.

  • Recommended practices: Laser safety in practice setting. AORN J 1990.

  • Rockwell Jr. R. James. Laser accidents. reviewing thirty years on incidents: what are the cncerns - old and new? J Laser Applications 1994;6:203-211.

  • Sawchuck WS, Felton FP. Infectious potential of aerosolized particles. Arch Dermatol 1989;125:1689-92.

  • Sawchuk WS, Weber Pj, Lowy DR, et al. Infectious papillornavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol 1989;21:41-9.

  • Sebben JE. Sterile technique and the prevention of wound infection in office surgery-part 1. J Dermatol Surg Oncol 1988;14:1364-71.

  • Sebben JE. Sterile technique and the prevention of wound infection in office surgery-part 11. J Dermatol Surg Oncol 1989; 15:38-48.

  • SebbenjE. Sterilization and care of surgical instruments and supplies. J Am Acad Dermatol 1984;11:381-92.

  • Smith JP, Moss CE, Bryant Cj, et a]. Evaluation of a smoke evacuator used for laser surgery. Lasers Surg Med 1989;9:276





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