Unfavorable Outcome |

Treatment of Complications of Laser Skin Resurfacing

Tina S. Alster, MD; Jason R. Lupton, MD
Arch Facial Plast Surg. 2000;2(4):279-284. doi:.
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During the past decade, cutaneous laser resurfacing has evolved into a primary treatment modality for photoinduced facial rhytides, lentigines, facial dyschromias, and atrophic scars.1-11 Major advances in laser technology during the past 15 years have made possible the ability to perform safe and reliable laser resurfacing of facial skin. In fact, cutaneous laser resurfacing has become so popular in North America that more than 150,000 procedures were performed in 1999 alone. Fortunately, most adverse reactions associated with laser resurfacing are mild and, when recognized early, are easily treated. Serious complications may result after laser resurfacing, however, and may be due to various factors, including surgeon inexperience, inappropriate or inadequate postoperative wound management, and individual patient characteristics (skin phototype, UV light exposure, and postoperative compliance). For these reasons, laser surgeons must be aware of all potential adverse effects associated with cutaneous laser resurfacing, so that when one does occur, appropriate interventions can be promptly initiated to prevent further cutaneous damage.

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Figure 3.

Increased pain, discharge, and crusting are indicative of bacterial infection. Bacterial cultures should be obtained from a wound swab, and the patient given appropriate oral antibiotics.

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Figure 2.

Grouped vesicles on an erythematous base are the distinguishing hallmarks of a herpes simplex virus (HSV) infection. If an HSV outbreak occurs before reepithelialization has been completed, erosions (rather than intact vesicles) may be evident. Appropriate oral antiviral treatment should be initiated, with aggressive wound care.

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Figure 1.

Increased redness with development of pruritic and erythematous papules on the resurfaced facial and adjacent (untreated) neck skin appeared 5 days after laser treatment because of the application of neomycin sulfate–containing topical antibiotics. Cessation of the offending agent, followed by the use of topical corticosteroids and cool compresses, usually provides rapid resolution of the problem.

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Figure 7.

Ectropion formation may be seen in patients with infraorbital laxity or in those who have undergone prior lower blepharoplasty, particularly when aggressive periocular laser resurfacing has been performed. Surgical correction may be necessary.

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Figure 6.

Hypertrophic scars are preceded by focal areas of intense erythema and induration that never resolve. Pulsed-dye laser irradiation has been shown to improve these hypertrophic burn scars.

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Figure 5.

The development of hypopigmentation is often delayed for several months after laser resurfacing. Skin typically appears pale relative to the adjacent untreated skin, rather than truly hypopigmented.

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Figure 4.

Hyperpigmented square laser scan patterns are evident approximately 1 month postoperatively in a patient with skin phototype III. Topical application of various mild peeling and skin bleaching agents and avoidance of sun exposure can help speed resolution.

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