Laser resurfacing complication

A 43 year-old woman had full facial laser resurfacing for treatment of multiple actinic keratoses and aging skin. Healing was uneventful on most of the areas treated except the forehead, where a progressive nonhealing wound developed. After seeking numerous consultations around the Southeast, the patient came to our facility, 6 months after the initial laser treatment, with exuberant granulation tissue of the forehead and temples and a painful wound. Many topical treatments had been previously tried. Debridement and split-thickness skin grafting were done using general anesthesia. Pathologic analysis revealed hyperplastic granulation tissue and epidermal appendages. The wound healed with an improved aesthetic result. This case illustrates that seemingly impossible laser complications can be handled by a basic approach to wound healing.