Operators who use refrigerated air or cryogen spray cooling rather than contact cooling during laser hair removal procedures could be breathing in potentially dangerous carcinogens and toxins found in plume released during treatment, according to a recent Cutera-funded study.
Dr. RossThe study’s lead author, dermatologist E. Victor Ross, M.D., says the finding, itself, wasn’t that surprising. Rather, it was the significance of the finding that got his attention.
Submicron nanoparticles released during laser hair removal have been shown to contain chemical compounds, including carcinogens and environmental toxins. To protect themselves from burning hair plume, laser operators should use smoke evacuators, respiratory protection and good ventilation, according to the paper.
This study examined the plume effect of using contact cooling, or sapphire skin cooling, during laser hair removal with Cutera’s excel HR device compared to cryogen skin cooling with GentleMax (Candela). The researchers didn’t use a smoke evacuator.
They applied a layer of clear aloe vera gel to the treatment area and set the sapphire window temperature to 4 degrees Celsius before using the laser. The researchers set the cryogen for 40 milliseconds (ms) of application, followed by a 20-ms delay before treating with the Candela laser.
They found post treatment perifollicular edema occurred with both devices. But as long as providers using the contact cooling device maintained contact and used aloe vera gel, no detectable plume escaped during treatment. That was in stark contrast to 72-fold increase in plume levels from baseline with the cryogen cooling device. The odor was also noticeably less with contact cooling, according to the study.
Real-Life Application
“Certainly, in real life, if you use a smoke evacuator with refrigerated air or cryogen sprayed cooling that will minimize the plume to some degree. But even when you use a smoke evacuator with spray cooling or air — particularly, because it’s hard to get it as close to the skin surface as you’d like — there’s always more of a smell of plume than with contact cooling,” says Dr. Ross, director of laser and cosmetic dermatology at Scripps Clinic Carmel Valley, San Diego, Calif.
Essentially, providers that have the option to use contact cooling, should use it, particularly if they are working alone and unable to have an assistant hold a smoke evacuator very near the application site, according to Dr. Ross.
One concern with contact cooling is that it typically does not enjoy as high a cooling protection factor as cryogen spray cooling. So, while contact cooling may suppress plume better than cryogen spray, the fluence might need to be reduced a bit with contact cooling versus cryogen spray cooling to ensure epidermal protection, he says.
If cryogen spray cooling is the only option, providers should make sure to place the smoke evacuator as closely as possible to the treatment site to get the most benefit, he says. Smoke evacuators do help. Researchers have found that when using hair removal devices, such as the GentleMax, particulates increased eight-fold when a smoke evacuator was used continuously, compared to 30-fold when evacuators were used intermittently.
Regardless of the cooling method used, hair removal laser operators should wear masks, in addition to using the evacuators, according to Dr. Ross.
The study is not yet published in a peer review journal but is the subject of a Cutera white paper.
