Laser Hair Removal Complications

Status: draft compiled 2026-04-20.

Laser hair removal's complication profile is narrow and well-characterised but includes a small number of severe failure modes that merit independent chapters. This summary is a navigational index; the individual chapters cover mechanism, prevention, management, and the 2024-2026 literature updates.

• burns-pih.md — acute burns, post-inflammatory hyperpigmentation (PIH), hypopigmentation, erythema, scarring.
• paradoxical-hypertrichosis.md — paradoxical induction of terminal hair growth in the treated field, with 2024-2026 incidence data and the recent male-specific 33% signal.
• ocular-injury.md — iritis, iris atrophy, uveitis, synechiae, cataract, retinal haemorrhage; orbital-rim rule; intraocular shields.
• hsv-reactivation.md — HSV flare after perioral or genital laser; valacyclovir prophylaxis.

Common to all: the single best predictor of complication rate is wavelength-Fitzpatrick matching. A correctly-matched wavelength at appropriate fluence with adequate cooling produces complications rare enough to be near-zero in aggregate practice; a mismatched wavelength, excessive fluence, or inadequate cooling compounds the risk of every individual complication category. See ../wavelengths/ for wavelength selection and ../protocol/fluence-pulse-selection.md for parameter selection.

The other common thread is that non-physician operators account for a disproportionate share of the litigation. The 2012-2020 review cited in dermatology practice found 75% of laser-surgery lawsuits involved non-physician operators; laser hair removal was the most litigated procedure (64% of cases). State regulation of who may operate a hair-removal laser varies widely; in some states unlicensed technicians can legally operate, in others a physician or physician-supervised nurse is required. Patients selecting a clinic on complication risk alone should prefer physician-operated or physician-supervised clinics over unregulated med-spa operations. Confidence: C2.