Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 Treatments

Graber, Emmy; Tanzi, Elizabeth L.; Alster, Tina S.

doi:10.1111/j.1524-4725.2007.34062.x

Cited by 194 publications

(226 citation statements)

References 12 publications

(21 reference statements)

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“…10 However, unprecedented treatment depths (up to 4 mm with current devices) combined with tissue sparing adjacent to ablative columns probably facilitates rapid reepithelialization and provides ample viable cells to drive a vigorous remodeling response while maintaining excellent safety margins. [11][12][13][14][15] Gains in ROM observed in the immediate postoperative period probably derive from photomechanical fenestration of stiff scar tissue. Long-term, persistent gains in function and improvements in scar characteristics probably result from gradual diffuse dermal remodeling and a relative normalization of dysfunctional scar tissue.…”

Section: Discussionmentioning

confidence: 99%

Ablative Fractional Laser Resurfacing Helps Treat Restrictive Pediatric Scar Contractures

et al. 2014

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Conventional management of debilitating pediatric scar contractures, including hand therapy and surgery, may often be beset by delayed treatment, suboptimal results, and additional surgical morbidity. Ablative fractional laser resurfacing is an emerging adjunctive procedural option for scar contractures because of its promising efficacy and safety profile. However, its use to improve function has not been studied in the pediatric population. Herein we report 2 pediatric patients with recalcitrant scar contractures, causing persistent functional deficits, treated with an ablative fractional laser protocol. Both patients experienced rapid and cumulative subjective and objective improvements in range of motion and function as measured by an independent occupational therapist without reported complications. We highlight ablative fractional laser resurfacing as a novel and promising tool in the management of function-limiting scar contractures in children and propose that the technique be incorporated into existing scar treatment paradigms, guided by future research.

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Section: Discussionmentioning

confidence: 99%

Ablative Fractional Laser Resurfacing Helps Treat Restrictive Pediatric Scar Contractures

et al. 2014

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“…Side effects did not vary depending on underlying condition or skin type, except for PIH, which occurred with an increased frequency in patients with darker skin types. 73 Similar to AFLs, lower densities and fewer treatment passes have been associated with a lower risk for hyperpigmentation at the expense of more treatment sessions, 43 whereas higher densities result in more side effects without improved results. 40 Pre-and posttreatment with hydroquinone 4% may help decrease the incidence of PIH, even in darker patients.…”

Section: Safety and Adverse Eventsmentioning

confidence: 99%

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

2017

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I n recent decades, there has been a revolution in energy-based treatment options for skin scarring, rejuvenation, and tightening. One of the most promising developments has been the introduction of fractional photothermolysis, developed by Anderson and Manstein in 2004. Fractionated systems deliver laser energy in a grid-like pattern, creating microscopic columns of ablative and/or coagulative damage termed microthermal zones (MTZs), which stimulate collagen remodeling.1 The incorporation of fractional photothermolysis into energy-based devices has allowed less destruction to surrounding tissue, leading to desired results with the minimization of unwanted side effects, leading to both ablative and nonablative laser devices becoming desirable treatment options for cutaneous scarring and rejuvenation. Given their impressive results, newer fractional laser treatment options, including picosecond lasers, quality-switched (QS) lasers, and combined ablative and nonablative lasers, are being investigated for the treatment of these common skin conditions.The following review addresses the current and emerging topics on fractional laser treatment of skin scarring and rejuvenation based on the device type, including ablative, nonablative, QS, picosecond, and hybrid fractional lasers (HFLs). Additionally, newer energy-based fractional devices, such as radiofrequency (RF) with and without microneedling and the use of fractionated technology for drug delivery, are discussed in the context of these common skin conditions. Fractionated lasersTreatment options for cutaneous scars and skin rejuvenation have evolved significantly since the rise in popularity of ablative lasers in the 1990s. Newer treatment options, including ablative fractional lasers (AFL) and nonablative fractional lasers (NAFL), have garnered favor, given the milder side effect profile in comparison with traditional fully ablative lasers. Ablative fractional lasersAcne scarring AFLs were developed in an attempt to achieve the efficacy of traditional ablative lasers with the milder side effect profile of fractional technology. Although a single treatment produces less dramatic, albeit noticeable, results than traditional fully ablative lasers can, multiple treatments result in greater clinical improvement.2 Currently, there are 3 types of AFLs available for scar treatment: the 10600-nm carbon dioxide (CO2), the 2940-nm erbium:yttrium aluminum garnet (Er:YAG), and the 2740-nm yttrium scandium gallium garnet (YSGG) lasers. AFL is associated with the increased risk of both protracted erythema and postinflammatory hyperpigmentation (PIH) in darker skin types, which has led many clinicians to prefer a longer series of NAFL treatments over AFL treatments to achieve similar results with a lower risk of side effects.Multiple studies support the efficacy of the fractional CO2 laser in acne scars. The overwhelming majority of these studies investigate the utility of these lasers in atrophic facial scars. While NAFLs typically require multiple sessions to achieve modest ...

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“…Lezyonlardan sürüntü kültürü alınıp, üreme sonuçlanana kadar geniş spektrumlu, gram pozitif etkinliği yüksek sistemik antibiyoterapi tedavisi verilmelidir. Diğer kutanöz enfeksiyonlardan farklı olarak oklüziv metodlarla ve topikal antibiyotikle tedavi edilmemelidir çünkü kontakt sensitivite gelişim riski yüksektir 1,13,14 . Öyküsünde HSV enfeksiyonu olsun olmasın tüm hastalara tedaviden 2 gün önce başlanıp re-epitelizasyonunun tamamlandığı 10-14. güne kadar sistemik antiviral profilaksi önerilmektedir 15 .…”

Section: Rejuvenasyon (Yenileme) Lazer Komplikasyonlarıunclassified

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2012

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ÖzetLazerler, gün geçtikçe daha sık kullanılan ve çeşitlilikle doğru orantılı olarak komplikasyon görülme oranı da artan tedavi modaliteleridir. Ağrı, eritem, ödem, bül, enfeksiyon, pigmentasyon bozukluğu ve skar gelişimi bu komplikasyonlardan bazılarıdır. Ancak doğru hasta ve lazer seçimi, ayrıntılı anamnez ve yakın hasta takibi ile komplikasyon oranı en aza indirgenebilir. Bu derlemede lazer uygulama komplikasyonları endikasyonlara göre gruplandırılarak incelenmiş ve morbidite oranını en aza indirgemek için gerekli önlemler üzerinde durulmuştur. Sum maryLasers are the therapeutic modalities becoming more commonly used and the incidence of complications increases in direct proportion to diversity. Pain, erythema, edema, blister formation, infection, pigmentation disorder and scarring are some of these complications. However, with an appropriate patient and laser selection, detailed patient history and close patent monitoring rate of complications can be minimized. In this review, laser complications examined by indication groups and emphasized about the measures to minimize morbidity rate. Gi riflLazer teknolojileri, gerek terapötik gerek estetik amaçlarla kullanılmakta ve gün geçtikçe daha popüler hale gelmektedir. Her yeni endikasyon için yeni bir lazer geliştirilmesi sonucunda farklı lazer türlerinin sayısı çoğalmış dolayısıyla komplikasyonların sayısı ve çeşitliliği de artmıştır. Lazer uygulamalarının komplikasyonları, lazer ışınına sekonder olanlar ve olmayanlar olarak ikiye ayrılabilir. Işına sekonder olanlar, çevredeki eşyalarda yangın çıkma olasılığı, hastanın teninde meydana gelebilecek termal yanıklar ve oküler hasardır. Yangın tehlikesine karşı perde ve havlu gibi malzemeler yanıcı olmayan malzemelerden seçilmelidir. Hastaların giysileri beyaz bir örtü ile kapatılmalıdır, alkol içeren solüsyonlar da lazer ışığına maruz bırakılmamalıdır.Göz komplikasyonları ise lazer uygulaması sırasında karşılaşılabilinecek en ciddi komplikasyonlardandır. Her dalga boyunun dokulardaki etkisi farklıdır dolayısıyla meydana getirecekleri oküler hasar da farklıdır. Örneğin CO2 lazer (10.600 nm) gözde kornea tarafından emilir ve yaygın korneal hasara yol açar. Görünür dalga boyundaki lazerler (400-720 nm) kornea ve lensi geçerek retinal hasara ve hatta körlüğe yol açabilir. Oküler komplikasyonları önlemek için lazer uygulaması sırasında, uygulama odasında bulunan tüm kişilerce, göz çevresini saran ve kullanılan dalga boyundaki ışınları geçirmeyen gözlük takılmalıdır. Işına sekonder olmayan başlıca komplikasyonlar ise elektrik kazaları ve enfeksiyöz patolojilerdir. Lazer uygulaması sırasında oluşan yüksek voltajlı elektrik teması konusunda dikkatli olunmalı, özellikle CO2 lazer yanmaya daha meyilli olduğundan Sürekli Eğitim Continuing Medical Education

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Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 Treatments

Abstract: Fractional laser skin treatment is associated with a relatively low complication rate. Side effects and complications observed in this study were temporary and did not result in long-term or significantly severe sequelae (e.g., scarring).

Cited by 194 publications

References 12 publications

Ablative Fractional Laser Resurfacing Helps Treat Restrictive Pediatric Scar Contractures

Ablative Fractional Laser Resurfacing Helps Treat Restrictive Pediatric Scar Contractures

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

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