title: Complications of fractional CO2 laser resurfacing: four cases.
abstract: OBJECTIVE
  Fractional ablative laser therapy is a new modality which will likely be widely used due to its efficacy and limited side-effect profile. It is critical to recognize, characterize, and report complications in order to acknowledge the limits of therapeutic efficacy and to improve the safety of these devices.
  
  
  METHODS
  The photographs, treatment parameters, and clinical files of four female patients aged 54-67 who had scarring or ectropion after fractional CO(2) laser resurfacing on the face or neck were carefully reviewed to search for any possible linking factors.
  
  
  RESULTS
  Patient 1 developed erosions and swelling of the right lower eyelid 2 days postoperatively, which developed into scarring and an ectropion. Patient 2 developed linear erosions and beefy red swelling on the right side of the neck which developed into a tender, band-like scar over 1-month. Patient 3 developed stinging and yellow exudate in multiple areas of the neck 3 days postoperatively. Cultures grew methicillin-resistant Staphylococcus aureus. Despite appropriate treatment, she developed multiple areas of irregular texture and linear streaking which developed into scars. Patient 4 developed an asymptomatic patchy, soft eschar with yellowish change on the left side of the neck. Azithromycin was started, however at 2-week follow-up she had fibrotic streaking which developed into horizontal scars and a vertical platysmal band. The treatment and final outcome of each patient are described.
  
  
  CONCLUSIONS
  Scarring after fractional CO(2) laser therapy may be due to overly aggressive treatments in sensitive areas (including excessive energy, density, or both), lack of technical finesse, associated infection, or idiopathic. Care should be taken when treating sensitive areas such as the eyelids, upper neck, and especially the lower neck and chest by using lower energy and density. Postoperative infections may lead to scarring and may be prevented by careful taking of history, vigilant postoperative monitoring and/or prophylactic antibiotics.
authors.affiliation: Department of Dermatology, Northwestern University, Chicago, Illinois 60611, USA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Fife
authors.forename: Richard E
authors.initials: RE
authors.lastname: Fitzpatrick
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Zachary
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002921:Cicatrix / Q000209:etiology*; D062109:Dermatologic Surgical Procedures; D004483:Ectropion / Q000209:etiology*; D005143:Eyelids; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D054020:Lasers, Gas / Q000009:adverse effects*; D008875:Middle Aged; D009333:Neck; D015361:Rhytidoplasty / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000209:etiology