Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients

Cutaneous laser resurfacing with high-energy, pulsed and scanned carbon dioxide (CO2) lasers has become popularized for the treatment of a variety of cutaneous indications, but potential complications and side effects remain a large concern. Despite the recent boom in cutaneous laser resurfacing procedures, there remains a relative paucity of written information documenting laser complication rates.

The purpose of this study was to identify and report the complications that occurred after cutaneous CO2 laser resurfacing within a large patient population.

A retrospective analysis and chart review was performed in 500 consecutive patients who underwent cutaneous laser resurfacing of 1589 facial regions with the UltraPulse CO2 laser by a single operator. Side effects and complications relating to infection, postoperative healing, pigmentary changes, and scarring were tabulated.

The most common complication observed was postoperative erythema, which occurred in all patients, lasting an average of 4.5 months. Hyperpigmentation was seen in 37% of patients with a higher rate in darker skin phototypes. Acne flares, milia formation, and dermatitis occurred in 10-15% of patients. Postoperative infection with herpes simplex virus (HSV) was observed in 7.4% regardless of prior HSV history. Hypopigmentation, scarring, and other local or disseminated infections occurred in < 1% of this study population.

Cutaneous CO2 laser resurfacing is a relatively safe procedure with a low complication profile. Proper laser treatment protocol and postoperative management is important in reducing side effects and complications.