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Lee KWA, Chan LKW, Lee AWK, Lee CH, Wan J, Yi KH. Ocular Complication in Facial Aesthetic Laser and Light Treatments: A Comprehensive Review. Diagnostics (Basel) 2024; 14:2006. [PMID: 39335685 PMCID: PMC11431483 DOI: 10.3390/diagnostics14182006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The increasing popularity of laser- and light-based esthetic treatments for facial rejuvenation has raised concerns regarding ocular safety. Although these procedures are generally considered safe and effective, there is a growing body of evidence highlighting the potential for ocular complications. This review aims to systematically analyze the types and mechanisms of ocular injuries associated with such treatments, as well as to evaluate preventive measures and management strategies. METHODS A comprehensive literature search was conducted using databases including MEDLINE, PubMed and Ovid for relevant studies published on clinical trials, diagnosis and treatment. Some papers were further reviewed using a double-blinding approach, varying sample sizes, control usage, randomization usage and objective endpoint measurements. All studies were classified according to the Oxford Centre for evidence-based medicine evidence hierarchy. RESULT Our review identified several types of ocular complications associated with facial laser or light treatments, including but not limited to conjunctival burns, corneal damage, retinal phototoxicity, and transient vision disturbances. The incidence of these complications varies significantly depending on the type of laser or light source employed, treatment parameters, and the anatomical proximity of the eyes to the treatment area. Factors such as inadequate protective measures, patient movement during the procedure, and the operator's experience were found to contribute to the risk of ocular injury. Strategies such as the use of appropriate eye protection, careful patient positioning, and thorough pre-treatment assessments were highlighted as essential preventive measures. CONCLUSION Ocular complications, though rare, represent a significant risk in facial esthetic laser and light treatments. This review underscores the importance of awareness among practitioners regarding the potential ocular hazards and the implementation of robust safety protocols. Future research is needed to establish standardized guidelines to minimize risks and enhance patient safety in esthetic dermatological practices. Continued education and improved protective strategies will be essential in safeguarding ocular health as the field of esthetic treatments continues to evolve. This comprehensive review serves as an essential resource for practitioners, informing them of ocular risks, management options, and the need for vigilance to mitigate complications in clinical practice.
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Affiliation(s)
| | | | | | | | - Jovian Wan
- Asia Pacific Aesthetic Academy, Hong Kong
| | - Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
- Maylin Clinic (Apgujeong), Seoul 06005, Republic of Korea
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Kaya Erdogan H, Sahin Tekin M, Agaoglu E, Sanal Bas S, Acer E, Saracoglu ZN, Bilgin M. Emergency complications during dermatological, surgical, or cosmetic procedures: A cross-sectional study among dermatologists. J Cosmet Dermatol 2024. [PMID: 39032133 DOI: 10.1111/jocd.16479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/28/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Medical emergency complications may occur during dermatological, surgical, and cosmetic procedures. AIMS This study aimed to investigate the frequency of dermatologists who experienced emergency complications as well as their level of knowledge regarding emergencies and basic life support. METHODS The cross-sectional descriptive study was conducted online among 240 dermatologists to whom a questionnaire was sent via email and a closed social media group. The survey instrument asked about emergency complications during dermatological, surgical, or cosmetic procedures and the dermatologists' level of knowledge regarding emergencies and basic life support. RESULTS Among the dermatologists, 53% reported emergency complications during dermatological and surgical procedures and 43.2% during cosmetic procedures. The most common complications were vasovagal syncope, hypotension/bleeding, and seizures. Emergency complications were more common among specialists, those with more than 15 years of professional experience, those working in their private clinics, and those performing an average of 10-50 dermatological/surgical procedures per week and fewer than 10 cosmetic procedures per week (p < 0.05). The knowledge level of dermatologists was highest among residents, dermatologists with 0-4 years of professional experience, those working in university hospitals, and those who had both theoretical and practical training in basic life support. CONCLUSIONS This study shows a relatively high frequency of dermatologists who experienced emergency complications during dermatological, surgical, or cosmetic procedures. Although these complications seem to be common; most of them are mild, self-limiting, and not life-threatening. Nevertheless, dermatologists should be competent and prepared to intervene in medical emergencies in daily practice.
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Affiliation(s)
- Hilal Kaya Erdogan
- Department of Dermatology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Melisa Sahin Tekin
- Department of Internal Medicine, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Esra Agaoglu
- Department of Dermatology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Sema Sanal Bas
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Ersoy Acer
- Department of Dermatology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Zeynep Nurhan Saracoglu
- Department of Dermatology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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Seguridad en procedimientos dermatológicos: complicaciones oftalmológicas. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:804-807. [DOI: 10.1016/j.ad.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
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Aróstegui Aguilar J, Bernabeu Wittel J, Mantrana Bermejo M. [Translated article] Safety in Dermatologic Procedures: Ophthalmologic Complications. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Flegel L, Kherani F, Richer V. Review of Eye Injuries Associated With Dermatologic Laser Treatment. Dermatol Surg 2022; 48:545-550. [PMID: 35333214 DOI: 10.1097/dss.0000000000003427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The eye is susceptible to damage during dermatologic laser treatments. OBJECTIVE Discuss the anatomy of the eye related to these procedures, the principles of laser-eye interactions, and ocular injuries reported with dermatologic laser treatments. METHODS PubMed and Embase searches were conducted to identify cases of eye injuries associated with dermatologic laser treatments. RESULTS One hundred nineteen cases of eye injury associated with dermatologic laser treatments were identified. Fifty-nine cases targeted the eyelid during resurfacing and caused ectropion, while 60 cases resulted from direct injury of ocular structures. In most of the cases of the latter, improper eye protection was used (44 of 60, 73%). In nearly all these cases, it was the patient who sustained a potentially avoidable ocular injury (52 of 60, 87%). Thirty-one patients had persistent ocular symptoms at follow-up (52%). The most common procedure in this context was laser hair removal of the face (35 of 60, 58%). Most of the cases developed injuries specific for the particular laser based on its wavelength and affinity to target certain ocular chromophores (59 of 60, 98%). CONCLUSION Most of the dermatologic laser-associated eye injury cases have occurred in the context of laser resurfacing or laser hair removal and are potentially preventable.
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Affiliation(s)
- Lisa Flegel
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Femida Kherani
- Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Heights Laser, Burnaby, British Columbia, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
- Pacific Derm, Vancouver, British Columbia, Canada
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Wang A, Grushchak S, Kaul S, Lee PK, Feldman J. Toxicity of Infiltrative Lidocaine in Dermatologic Surgery: Are Current Limits Valid? Dermatol Pract Concept 2021; 11:e2021120. [PMID: 34631267 DOI: 10.5826/dpc.1104a120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/31/2022] Open
Affiliation(s)
- Allison Wang
- Division of Dermatology, Cook County Health, Chicago, IL, USA
| | | | - Subuhi Kaul
- Division of Dermatology, Cook County Health, Chicago, IL, USA
| | - Patrick K Lee
- Department of Dermatology, University of California, Irvine, California, USA
| | - Jerry Feldman
- Division of Dermatology, Cook County Health, Chicago, IL, USA
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Smith C, Srivastava D, Nijhawan RI. Optimizing Patient Safety in Dermatologic Surgery. Dermatol Clin 2019; 37:319-328. [DOI: 10.1016/j.det.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Injection technique in neurotoxins and fillers: Indications, products, and outcomes. J Am Acad Dermatol 2018; 79:423-435. [DOI: 10.1016/j.jaad.2018.01.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schwitkis AE, Pollack TL, Torbati SS. Orbital Compartment Syndrome Following Mechanical Fall. Clin Pract Cases Emerg Med 2018; 2:268-269. [PMID: 30083652 PMCID: PMC6075486 DOI: 10.5811/cpcem.2018.4.37810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Arielle E Schwitkis
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Talia L Pollack
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Sam S Torbati
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
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Shagalov DR, Taylor D, Schleichert R, Weiss J, Weiss E. Association of Central Nervous System Depression With Topical Brimonidine When Used for Hemostasis: A Serious Adverse Event. JAMA Dermatol 2017; 153:575-577. [PMID: 28403392 DOI: 10.1001/jamadermatol.2017.0247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Minor bleeding is the most common complication of dermatologic surgery. Topical brimonidine, 0.33%, gel has been reported for the use of hemostasis in dermatologic surgery. The safety profile and risk of systemic toxic effects when brimonidine is used topically for hemostasis is unknown. Objective To determine the risk of systemic toxic effects of topical brimonidine, 0.33%, gel when used for hemostasis. Design, Setting, and Participants In this case series from a private practice (Hollywood Dermatology), 2 patients presented for dermatologic procedures, complicated by persistent bleeding. Interventions Patients were treated with 10 g of brimonidine, 0.33%, gel applied under occlusion for hemostasis. Main Outcomes and Measures Mental status, cardiopulmonary function. Results Both patients experienced deterioration of mental status, respiratory depression, and somnolence. Results from cardiac testing, laboratory workup, and imaging were negative for cardiac or neurologic etiology. Both patients improved in less than 24 hours. Conclusions and Relevance Topical brimonidine, 0.33%, gel can result in systemic central nervous system toxic effects when used as a hemostatic agent. At present, it is not possible to define a quantity with which brimonidine can be used safely, nor can a safe wound size be defined. We, therefore, urge against the use of topical brimonidine as a hemostatic agent until its safety is further investigated.
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Affiliation(s)
- Devorah R Shagalov
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Drew Taylor
- Mohs Micrographic Surgery and Dermatologic Oncology Fellowship, Skin Institute of South Florida, Coral Springs3Cosmetic Dermatologic Surgery Fellowship, Hollywood Dermatology and Cosmetic Surgery, Hollywood, Florida
| | | | - Jonathan Weiss
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Eduardo Weiss
- Dermatology and Cutaneous Surgery, Florida International University, Miami7Mohs and Procedural Dermatology Fellowship, Skin Institute of South Florida, Coral Springs8Dermatology and Dermatological Surgery, Miller School of Medicine, University of Miami, Miami, Florida9Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida
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