A method of treating a patient with a therapeutic laser pulse includes applying a cooling mechanism to a first skin area, cooling a target skin area within the first the skin area from a first surface temperature to a second temperature through application of the cooling mechanism prior to application of the therapeutic laser pulse, initiating application of the therapeutic laser pulse at a first timepoint, while continuing to apply the cooling mechanism, determining a surface temperature of the target skin area a plurality of times during application of the therapeutic laser pulse at a refresh rate of 25 Hz to 400 Hz, and terminating the application of the therapeutic laser pulse at a second timepoint, based on the surface temperature determinations. Each of the plurality of surface temperature determinations occurs during a single therapeutic laser pulse duration from the first time point to the second timepoint.