CO₂ laser safety considerations in facial skin resurfacing

Carbon dioxide lasers have been used increasingly in the field of aesthetic plastic surgery, specifically for facial resurfacing procedures. As many plastic surgeons are now venturing into the arena of laser surgery for the first time, it is paramount to understand basic laser safety principles to protect our patients, the operating room personnel, and the laser surgeon. This article reviews basic laser principles and practices and delineates the safety requirements needed to perform laser resurfacing using the CO₂ laser system. We subjected several common objects present in the operative field during resurfacing procedures to multiple passes of both the Coherent 5000 C laser and the Laser Industries (Sharplan) model 150XJ laser Silktouch to assess flammability and margins of safety. We tested endotracheal tubes, wet and dry towels, wet and dry gauze sponges, cottonoids, eye protectors, and ophthalmic ointments. Neither flame nor burn was incited in the moistened preparations. The dry objects tested produced flame. The plastic corneal protectors began to melt by the third pass and produced significant heat. Lastly, both the Lacrilube and Bacitracin ophthalmic ointments began to vaporize after three laser passes. On the basis of our findings in this study, we recommend guidelines for prudent and safe CO₂ laster usage in facial skin resurfacing.