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Side Effect Profile of CO₂ Laser Resurfacing

This retrospective study evaluated the incidence of side effects over 4 to 23 months of follow-up (mean, 8.2 months) in 104 women who underwent CO₂ laser resurfacing for facial photoaging or acne scarring.

Patients were treated either with the Ultrapulse CO₂ laser or the scanned continuous wave SilkTouch laser. Just under half had full-face laser resurfacing. Pretreatment included application of 4% hydroquinone solution and 0.025% retinoic acid cream, and oral dicloxacillin (250 mg four times per day) and acyclovir (400 mg three times per day) taken one day preoperatively and continuing for one week after surgery. Postoperative care included frequent soaking with cold water compresses and application of Aquaphor Healing Ointment, but no occlusive dressings were applied.

Erythema developed in 100% of patients, and lasted an average of 3.5 months. A burning discomfort after surgery was noted by 100% of patients, but only 2.8% had pain. Over 90% developed pruritus, and 80% had either milia or acneiform pustules. Hyperpigmentation occurred in only 2.8% of patients and its average duration was 1.5 months. Hypopigmentation occurred in 16.3% and in most instances was delayed, appearing after the erythema subsided. Five percent developed highly sensitive skin. Transient hypertrophic scarring occurred in 2.8%, and was reversed with intralesional corticosteroid injections and pulsed dye laser therapy.

Comment: This study is the first to describe the outcome of CO₂ laser resurfacing in patients followed for more than six months. Unlike previous studies, there were no infections, which likely can be attributed to perioperative use of antivirals and antibiotics in all patients and to fastidious wound care. Hyperpigmentation has previously been reported to occur in up to 36% of patients. The low incidence in this study may be attributed to pretreatment in all patients with hydroquinone solution and retinoic acid cream. Hypopigmentation, which received little mention in previous studies, appears to be a delayed phenomenon. It takes on a special importance because of its permanence. Finally, the low incidence of scarring is encouraging, and may be attributable to the safety margins used with this device, but is more likely due to the surgical technique of the experienced authors.

— JS Dover

Published in Journal Watch Dermatology September 1, 1997

Citation(s):

Bernstein LJ et al. The short- and long-term side effects of carbon dioxide laser resurfacing. Dermatol Surg 1997 23 519-525.

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