Clinical studies on laser skin resurfacing are still insufficient to make any serious conclusions about the long-term consequences of this procedure, and even more so about possible complications after it. And if the immediate consequences of this procedure have been studied in sufficient detail, then the situation is completely different with more distant complications.
This is mainly due to the fact that patients slip away from medical supervision immediately after they leave the clinic. However, careful selection of patients for the laser skin resurfacing procedure and their monitoring in the postoperative period are necessary, this will help to avoid most of the possible complications.
Along with the desired effect of thermal tissue damage (reduction of denatured collagen fibers, smoothing of the skin), there are also side effects. Delayed re-epithelialization, prolonged erythema, dyspigmentation – the main problems that the doctor and patient face when using this technology. They are temporary. Along with this, more serious complications are possible, such as hyper- and atrophic scars, as well as hyperpigmentation of the skin.
One of the first serious studies of the risks associated with laser resurfacing can be considered a large-scale study by Nanni and Alster in 1998, which included 500 patients. Resurfacing was performed with a CO2 laser on various areas of the face (a total of 1589 areas). The most common complication of the postoperative period was erythema, which lasted an average of 4.5 months after the procedure. Hyperpigmentation was observed in 37% of patients. Acne outbreaks and dermatitis were observed in 10-15% of patients, activation of herpes – at 7.4%. Other complications such as scarring and hyperpigmentation were found in less than 1% of patients.
The most common types of complications after laser resurfacing:
- erythema,
- pigmentation disorders,
- scarring,
- infectious complications.
Erythema after laser skin resurfacing
Residual erythema after skin resurfacing with CO2 laser persists for 3-4 months. After resurfacing with an erbium laser, erythema is less pronounced and in most cases almost completely disappears two weeks after the operation. Histological studies suggest that the redness is due to both an inflammatory response and insufficient maturity of the new epithelium. Some inconvenience to patients can be caused by the presence of a demarcation line, which becomes especially noticeable when resurfacing on limited areas of the skin. However, the demarcation line – the phenomenon is temporary, unlike scarring, the risk of which increases with extensive resurfacing.
Pigmentation disorder after laser resurfacing
There are two types of pigmentation disorders after laser resurfacing – hyperpigmentation, which is usually observed in patients with dark skin, and hypopigmentation. Hypopigmentation is an unfavorable sign, since its appearance indicates local death of melanocytes.
Possibility of scarring after laser skin resurfacing
The most serious complication is scarring (hypo- and hyperatrophic). The risk of their appearance increases with increasing radiation energy, increasing pulse duration and the number of passes. The risk of scarring is higher with CO2 laser resurfacing due to the difficulty in controlling the depth of the damage.
Accession of infection after laser skin resurfacing
With laser resurfacing, as with any method of removing the epidermis, a dormant infection that lurks in the thickness of the skin may awaken. According to Fitzpatrick et al., the incidence of infectious complications after laser resurfacing is about 5%, with Pseudomonas aeruginosa (41%) most often encountered, followed by Staphylococcus aureus (35%), Staphylococcus epidermidis (35%), Candida spp ( 24%). It should be noted that about half of the patients found mixed infection. Provocative tests (alcohol, spicy food, low-energy laser irradiation) help to assess the number and activity of potentially dangerous microorganisms in the skin. With timely treatment, infectious complications are quite well eliminated, however, cases of infections are described, leading to prolonged inflammation and scarring. Therefore, before laser resurfacing, it is recommended to carry out prophylactic antibiotic therapy and antiviral treatment (famciclovir).
Thus, laser skin resurfacing gives a relatively low percentage of complications, which can be further reduced by optimizing the parameters of the laser system, more careful selection of patients, as well as improving the methods of managing patients in the postoperative period.
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