Complications of Carbon Dioxide Laser Resurfacing

The carbon dioxide laser has been shown to be an effective tool in the treatment of photodamaged skin since its introduction over 20 years ago. Scars, premalignant, and malignant skin lesions of the face have all been treated successfully with the carbon dioxide laser. While improvements in laser technology have facilitated the use of the carbon dioxide laser in the oral and maxillofacial surgery office, there is a paucity of literature describing the incidence of postoperative complications following laser resurfacing in the OMS literature. Previous studies have reported a relatively common occurrence of bacterial infections, viral infections, and inflammatory reactions in the early postoperative period, and scarring and facial pigment changes in the long term, as well as—rarely—iatrogenic damage during treatment.

A retrospective study of 110 patients, who underwent laser resurfacing with a carbon dioxide laser between 1999 and 2013, examined the rates of complications after treatment. Complications were separated into early (within one week) and late (one to three weeks post-procedure), and categorized by complication subtype (eg infectious, inflammatory, etc). Additionally, laser settings, Fitzpatrick skin type, immunocompromising conditions (diabetes, AIDS, etc), postoperative pain, and smoking history were all assessed.

The results of this study indicate a 3% early complication rate consisting of herpes zoster and bacterial dermatologic infections. There was an 8% late complication rate, including mostly minor dermatologic sequelae such as milia/acneiform lesions and contact dermatitis and one late HSV outbreak. All complications quickly and fully resolved with proper intervention. Despite the high rates of postoperative hypo- and hyperpigmentation found in many studies, we found a much lower incidence in ours. This is most likely due to our selection criteria for laser treatment, which includes patients only with Fitzpatrick skin types I, II and III, who are less likely to suffer these complications than patients with darker skin.

This study will help clinicians understand and anticipate complications that are most likely to follow carbon dioxide laser resurfacing, and plan to treat these adverse outcomes appropriately. Furthermore, our confirmation of low rates of serious complications should encourage more oral and maxillofacial surgeons to implement the use of laser resurfacing in their offices.

Rendon-Pellerano M, Lentini J, Eaglstein W et al. “Laser resurfacing: usual and unusual complications.” Dermatol Surg 1999; 25: 360-367.

Weinstein C, Ramirez O, Pozner J. “Postoperative care following CO₂ laser resurfacing: avoiding pitfalls.” Plast Reconstr Surg 1997; 100: 1855-1866.