Complications of laser resurfacing - Methods of prevention and management

BACKGROUND. Modern skin resurfacing began with wire brush surgery. The short-pulse carbon dioxide (CO2) lasers provide an alternative approach for facial rejuvenation. However, the potential for the same complications exist. OBJECTIVES. To review the more common complications, the reasons for their development, and their possible avoidance. METHODS. After pre-op evaluation and skin conditioning, a protocol for resurfacing was followed with standardized settings on the Ultrapulse CO2 laser. On the glabrous skin 300 mJ of energy and 60 W of power were used. On the eyelid skin the settings were reduced to 250 mJ and 50 W. After three passes with the Computer Pattern Generator (CPG), a semi-occlusive dressing was applied for the first 5 days after surgery. Then, a bland petrolatum ointment was applied for an additional 5 days. Finally, a moisturizer with sunscreen or a bleaching cream was used. RESULTS. It was possible at these energy fluences to avoid excessive collagen denaturation and to facilitate wound healing with occlusive dressing. However, complications still occurred. Examples of these are presented in detail. CONCLUSION. Complications can be minimized with patient education, using optimal laser settings, applying occlusive dressings, and recognizing pending problems early. (C) 1997 by the American Society for Dermatologic Surgery, Inc.