Complications of fractional ablative carbon dioxide laser in various aesthetic procedures: a retrospective study

Abstract

<p class="abstract"><strong>Background:</strong> Though fractionated CO<sub>2</sub> laser technology resurface patients with a lower rate of complications than non-fractionated ablative laser treatment, adverse effects can still occur even with the best technology.</p><p class="abstract"><strong>Methods:</strong> In this retrospective study we evaluated 65 patients for early and delayed complications after laser treatment with Sellas Cis-Fl™ fractional CO<sub>2</sub> laser system of wavelength 106400 nm for various aesthetic indications over the period of 12 months from October 2017 to September 2018<strong>. </strong>Follow up was done for the period of 2 months after the last session to determine the nature and frequency of various complications. Patient’s subjective assessment of the complications was recorded in the form of patient subjective score (PSS) which ranged from 1 to 10.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the current study, the most common aesthetic indication for fractional CO<sub>2</sub> laser was post acne scarring (38.4%). The most common early side effects reported were erythema (95.38%) and burning sensation (92.30%) after the procedure. Post procedural dryness and edema was seen in 72.3% and 69.23% patients. Among the delayed complications most frequently observed was persistent erythema (46.15%) followed by post inflammatory hyperpigmentation (44.61%).</p><p><strong>Conclusions:</strong> Though fractional CO<sub>2</sub> laser is relatively a safe procedure, undesirable sequelae may still occur as a result of inappropriate selection of laser parameter, injudicious patient selection, inadequate preoperative counselling and suboptimal postoperative care. Dermatologist should keep the possibility of all the side effects that can occur after fractional CO<sub>2</sub> laser and must take appropriate precautions during the procedure to avoid them.</p>

Complications seen with the use of lasers for cosmetic applications

“…As per Metelitsa, 13 the occurrence of posttreatment HSV is 2% to 7% for full ablative procedures, but only 0.3% to 2% for fractional lasers. In a study by Kaur, 15 3.07% of cases developed secondary HSV. According to a report by Metelitsa, HSV has been reported in up to 2% of cases after fractional CO 2 laser resurfacing.…”

“…A study by Kaur 15 found only 6% of patients to exhibit posttreatment hypopigmentation while other reports noted up to 20%. The mandible is highly susceptible to hypopigmentation and scarring, and thus, should only be treated with a single pass 15 . Notably, a report by Chen found the CO 2 and Er:YAG lasers to be comparable in side effects 23 …”

“…Patients with Fitzpatrick skin types III and higher are at increased risk for dyspigmentation after laser treatment. Lower fluencies demonstrate less PIH in people of color according to a study by Steyadi 15 . These skin tones have fewer adverse reactions with a longer wavelength laser such as the Nd:YAG 12 .…”

“…In Alshami's 19 study using an Nd:YAG 1064‐nm beam on 296 patients with skin types III and IV, 6.7% developed PIH. In Kaur's 15 study of 65 patients, 84.61% of whom had Fitzpatrick skin types IV and V, 44.61% had PIH after undergoing fractionated CO 2 laser treatment 15 . In a study consisting of 534 subjects undergoing CO 2 resurfacing ablation, hyperpigmentation occurrence increased with darker skin types.…”

“…Full‐face resurfacing can decrease this risk of this causing a splotchy hypopigmented face, but the hypopigmentation often fades with time regardless 11 . A study by Kaur 15 found only 6% of patients to exhibit posttreatment hypopigmentation while other reports noted up to 20%. The mandible is highly susceptible to hypopigmentation and scarring, and thus, should only be treated with a single pass 15 .…”