1. Cosmetic Fractional
Laser Use
Implications for Infection Control
Gursevak Kasbia MSc. CIPHI(C)
Special Thanks to Linda Cleroux
(EOHU) and Collette Oulette (QCH)

2. Outline
Introduction
Fractional Lasers
Implications for Fractional Lasers
Complications of Fractional Laser Use
Infection Control
Summary
Questions/Answers

3. Introduction
LASER: Light Amplification by
Stimulated Emission of Radiation
Different classifications for different
functional purposes of lasers
(Class 1 and 2 are quite safe,
class 3b and 4 are more
dangerous)
Fractional Lasers are considered
Class II lasers
FRACTIONAL LASERS:
A type of laser device that can be
both ablative and non-ablative
and can emit anywhere from 1550
to 10600nm and used to treat a
Figures 1 & 2: spectrum of wavelength
for different laser based procedures

4. What is a Fractional Laser?
Fractional Lasers are typically
Non Ablative Fractional
Lasers that generate
microthermal treatment
zones (small holes 7*7 or
12*12) (MTZs)
Small columns of thermally
denatured skin of
controlled width and depth.
(i.e. 1550nm)
These small holes signal stem
cells from the dermal layer of
skin to reproduce and rise to
surface replacing the older
disintegrated ones.
Figure 3: Fractional Unit: contains arm, computerized control
system, scanner which delivers the micro-spots in a variety
of patterns and sequences (Solta Medical Inc, 2010)

5. Fractional Laser Skin Therapy
Fractional Laser technology is newer
(1998) than CO2 based lasers that
were released in the 1980's
Ablative vs. Non-Ablative
Some Ablative lasers use a higher
wavelength and require anesthesia.
Typically ablative devices are used for
different medical conditions such as for
removal of Begnin malignancies of
skin.
Non-Ablative lasers require no
anesthesia and can be medically
delegated.
Figure 1: Laser Wavelength Spectrum (BCCDC)
Figure 4: Anasthetic Cream used in procedures
(courtesy drugline.org)

6. Laser Devices used for Skin
Intense Pulse Light Sources (550-
1200nm):
1) Targets both blood vessels and
melanin
2) Aids in neo-collagenesis
Mid-Infrared Laser(1320-10600nm):
1) Targets water in epidermal and
dermal layer of skin.
2) "Rejuvinates skin"
2) Aids in neo-collagenesis
Visible Laser(400-700nm): uses a
concentrated beam of light that
targets blood vessels in the
skin.
i.e. Pulsed Dye laser and KTP
1) Used to treat pigment related
disorders such as port stains,
freckles, rosacea etc.
Figure 5: layers of skin and fractional laser impact, fractional
lasers will typicall ablate the skin in 7*7 or 9*9 formations

7. Medical Uses of Fractional Laser
Fractional Laser treatment can be
prescribed for:
1) Cosmetic use such as removal of
scars, wrinkles, dis-pigmentation
etc.
2) Medically prescribed for actinic
keratosis, scarring, wrinkles and
pigment discolouration (vitiligo)
3) Certain stages of tatoo and scar
removal (combination of ablative
Figure 6: Different medical conditions of skin including
acne, vitiligo.

8. Potential Complications
Cases of transmission of herpes and MRSA infection
have been noted (Alster et al. 2010)
Goldman et al (2011) found that 4% of procedures
produced herpes zoster outbreaks (1.07%),
contact dermatitis (4.6%) and acne eruption
(3.48%) and erythema (1.07%).
Graber et al (2008) found in a clinical study of over 960
procedures that the 1550 nm fractional laser
produced significantly less cases of infection as
opposed to CO2 lasers
Graber’s study concluded that
fractional procedures using the
1550nm wavelength seemed to
produce less skin infection.

9. Skin Dammage and Repair
Figure 7. Fife et al (2009) found
that erosion and crusting
occurred in this patient 1 week
post-operative, however the
majority of patients do recover
well in the long term and most
sever cases occur with CO2
based lasers.

10. Infection Control
Infection Control:
1. Does the clinic have a detailed
questionnaire before the
procedure (skin type etc)?
2. Is there informed consent?
3. Is there postoperative care
procedures?
4. Is there appropriate ventilation in
rooms (Laser Plume Safety)?
5. Are appropriate masks being worn
(n95)
6. Are proper consulation forms
used (not all skin types are the
same!)
7. What are steps for disinfection of
the scanner? Is it disposable?
Laser Safety
1. Has the operator had training
(Delegation)?
2. Is the operator knowledgeable of
Laser Safety?
3. Are UV/wavelength specific
eyewear available to protect both
the operator and patient?
4. Does the room have signage for
when laser is in use (remember
this is radiation)
5. Are the scanner components
cleaned? Is the scanner head
replaced (single use) or
disinfected.

11. Summary
• Lasers are used for many different types of medical
procedures in in-patient and outpatient formats
• Infection control should include a checklist of items
required including anasthetics/creams, pre/post-
operative procedures, equipment cleaning.
• Safety of the patient and the healthcare worker is
imperative (ie. Exposure to radiation, eye damage)
• While generally safe fractional lasers do pose harm if
used improperly or without proper consultation

12. References
• BCCDC: Laser Hair Removal Devices. Accessed May 23rd
2013.
http://www.health.gov.bc.ca/library/publications/year/2011/Laser-hair-removal-guidelines.pdf
• Behroozan, D. S., Goldberg, L. H., Dai, T., Geronemus, R. G., & Friedman, P. M. (2006). Fractional
photothermolysis for the treatment of surgical scars: A case report. Journal of Cosmetic and Laser Therapy,8(1),
35-38. Retrieved from www.scopus.com
• Biesman, B. S. (2009). Fractional ablative skin resurfacing: Complications. Lasers in Surgery and Medicine, 41(3),
177-178. Retrieved from www.scopus.com
• Canadian Centre for Occupational Health and Safety: Laser Safety: Accessed May 23rd
2013.
http://www.ccohs.ca/oshanswers/phys_agents/lasers.html
• Fife, D. J., Fitzpatrick, R. E., & Zachary, C. B. (2009). Complications of fractional CO 2 laser resurfacing: Four
cases. Lasers in Surgery and Medicine, 41(3), 179-184. Retrieved from www.scopus.com
• Graber, E. M., Tanzi, E. L., & Alster, T. S. (2008). Side effects and complications of fractional laser
photothermolysis: Experience with 961 treatments. Dermatologic Surgery, 34(3), 301-305. Retrieved
fromwww.scopus.com
• Choudhary, S., McLeod, M., Meshkov, L., & Nouri, K. (2011). Lasers in the treatment of acne scars. Expert
Review of Dermatology, 6(1), 45-60. Retrieved from www.scopus.com
• Gold, M. H. (2007). Fractional technology: A review and clinical approaches. Journal of Drugs in Dermatology :
JDD, 6(8), 849-852. Retrieved from www.scopus.com
• Rinaldi, F. (2008). Laser: A review. Clinics in Dermatology, 26(6), 590-601. Retrieved from www.scopus.com
• Saedi, N., Petelin, A., & Zachary, C. (2011). Fractionation: A new era in laser resurfacing. Clinics in Plastic
Surgery, 38(3), 449-461. Retrieved from www.scopus.com
• Tierney, E. P., Eisen, R. F., & Hanke, C. W. (2011). Fractionated CO 2 laser skin rejuvenation. Dermatologic
Therapy, 24(1), 41-53. Retrieved from www.scopus.com
• Images from ADAM medical images