Laser Plume in the Aesthetic Clinic: Protecting the Operator
Courses teach you to protect the patient’s eyes. They rarely mention the plume that ablative lasers, electrosurgery and laser hair removal produce, which you breathe treatment after treatment for a whole career.
The hazard is real and measurable, the long-term data are incomplete, and the most effective controls cost little. Here is what is known and what to do about it.
What the evidence shows
A review of surgical smoke in operating-room staff found no firm evidence of higher cancer rates than in the general population, but concluded that the smoke is hazardous and that no safe level of exposure is known [2]. There are no comparable studies of aesthetic laser operators. The popular claim that a day of plume equals smoking a certain number of cigarettes has never been tested; the review notes only that such comparisons have been made [2].
What the plume contains
The study most relevant to aesthetic clinics looked at laser hair removal. In the laboratory, lasering hair in sealed chambers released hundreds of chemical compounds, among them known and suspected carcinogens. During real treatments, the researchers measured ultrafine particles in the room, with and without a smoke evacuator running [1]. They concluded that this plume should be treated as a biohazard that calls for smoke evacuation, good ventilation and respiratory protection, especially for staff with long exposure [1].
When tissue infected with human papillomavirus is ablated, the plume can also carry the virus. A systematic review concluded that laser surgeons are at risk of inhaling it [3]. A meta-analysis found warts of the upper airway more often in CO2 laser users than in controls, and found that simple safety measures greatly reduced contamination [4]. A case report describes a laser surgeon with laryngeal papillomatosis carrying HPV types 6 and 11, the same types found in the anogenital warts the surgeon had treated with a laser [5].
The short-term effects are better established. A systematic review of operating teams describes symptoms such as headache and irritation of the eyes and throat in exposed staff [6].
Which treatments produce plume
Ablative resurfacing produces the most and needs extraction every time. Electrosurgery, radiofrequency cautery and plasma devices produce visible plume close to the operator’s face. Laser hair removal produces a plume that grows with the amount of hair left on the skin. Tattoo removal gives off no smoke, but the breakdown of pigment still releases particles.
Injectables and cryolipolysis neither burn tissue nor singe hair, so they produce no plume. Intense pulsed light used for hair removal singes hair as a laser does, and radiofrequency microneedling coagulates tissue, so do not assume either is free of plume.
The controls that work, in order
- Make less plume. Shave the area properly before laser hair removal. Where a non-ablative treatment gives the result, it produces no plume at all.
- Capture it at the source. Hold the evacuator nozzle close to where the plume forms, because extraction captures far less a short distance away. Even close capture does not remove everything [1].
- Ventilate the room. General ventilation dilutes what extraction misses, but it does not replace extraction.
- Organise the room. Close the door, keep out anyone who does not need to be there, and stand out of the plume rather than over it.
- Protect your airway last. An ordinary procedure mask does not filter ultrafine particles; a fitted respirator does. One review warns that no mask can replace local extraction [6].
What to do this week
List which of your treatments produce plume. Check how many hours your extraction filter has been used and plan its replacement; a particle filter does not remove odours and gases, which need an activated carbon stage. Keep a short log of filter changes and of any headaches or irritation among staff. If you employ others, assessing and controlling this exposure is usually the employer’s duty under national occupational safety law.
The patient lies directly under the plume with no protection at all. Extraction at the source is the one measure that protects you both, and it belongs in any course on lasers and energy-based devices, alongside the settings.
Read next
- CO2 laser training: what a first course should cover
- Energy-Based Devices: What to Understand Before You Buy One