Complications of Carbon Dioxide Laser Resurfacing. An Evaluation of 500 Patients

Background: 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.

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

Methods: 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.

Results: 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.

Conclusions: 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.