title: Clinical Outcomes and Complications Associated with Fractional Lasers: A Review of 730 Patients.
abstract: BACKGROUND
  Fractional lasers were introduced to provide increased safety, while maintaining high efficacy and patient satisfaction. Patients with virtually all Fitzpatrick skin types could be safely treated using a wide spectrum of wavelengths and a broad array of skin conditions, and aging could be addressed. Although safety studies have been reported for ablative CO2and erbium lasers, surprisingly few data are available on adverse events and complications associated with fractional lasers.
  
  
  OBJECTIVE
  We report the frequency of adverse events, skin improvement and complications in a broad range of skin types using a standardized protocol that can be safely tailored to the patient's presenting complaints by varying the laser wavelength and number of treatments.
  
  
  METHODS
  The medical records of 730 patients (>90% females, age ranged from 50.5. to 59.9 years.) who had been treated at FACES+ Aesthetic Facility were reviewed. Patients were followed from 1 to 10 months and were reviewed to determine the frequency of complications, as well as their frequency, type, cause, treatment and resolution thereof. Patients were categorized by Fitzpatrick skin type (I-IV) to determine whether skin type was related to the frequency of complications. Improvement in skin condition (wrinkles, nasolabial folds and pigment) was rated by a technician before and after treatment using a Likert scale, 0-5, with 0 being no change and 5 being the most improvement.
  
  
  RESULTS
  Seven hundred thirty patients underwent procedures using fractional lasers in our center. Procedures were carried out with 3 different laser wavelengths, depending on the condition(s) treated (wrinkling vs. pigmentation issues, etc.) and the patients' desired length of downtime. The fractional Fraxel 1927-nm laser was used in 224 patients [Fitzpatrick skin type I (2.2%), II (38.4%), III (46.0%), IV (12.5%)]; the fractional Fraxel 1550-nm laser was used in 334 [type I (4.5%), II (31.9%), III (50.0%), IV (13.3%)], and the fractional Fraxel CO2laser was used in 172 [type 1 (4.7%), II (49.7%), III (41.5%), IV (4.1%)]. The Fraxel CO2laser showed greater improvement in wrinkles and naso-labial fold (p < 0.001). The greatest improvement in pigmentation was seen with the Fraxel 1927-nm laser (p < 0.001). Adverse events and complications occurred in 31 of 730 patients (4.2%). There was no significant difference in the rate of complications among the three treatments (p = 0.26). Complications were generally minor, and all resolved completely with treatment. Complications occurred in 4.0% of patients having the fractional Fraxel 1927-nm laser, 3.3% of patients having the fractional Fraxel 1550 nm and 6.4% of patients having the fractional Fraxel CO2laser. Complications included 5 herpes simplex virus breakouts, 13 acne eruptions, 1 abrasion, 1 bacterial infection, 9 dermatitis, 1 drug eruption, 4 prolonged erythema, 1 hyperpigmentation, 1 increased swelling and 1 telangiectasia. There was no significant relationship between Fitzpatrick skin type and incidence of complications (p = 0.37).
  
  
  CONCLUSIONS
  Fractional lasers in general have reduced complication rates, while maintaining high degrees of patient satisfaction. Since their inception in early 2004, our clinic has utilized fractional lasers to treat patients from a variety of ethnic backgrounds and diverse skin types with an overall complication rate of 4.2%, all of which resolved. Comprehensive care of patients with facial aging is not limited to surgery alone and should include these types of strategies to appropriately and safely address photo-damage and photo-aging.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: FACES+ Plastic Surgery, Dermatology, Skin and Laser Center, La Jolla, CA, USA. scohen@facesplus.com.|Division of Plastic Surgery, University of California, San Diego, San Diego, CA, USA. scohen@facesplus.com.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cohen
authors.affiliation: FACES+ Plastic Surgery, Dermatology, Skin and Laser Center, La Jolla, CA, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Goodacre
authors.affiliation: FACES+ Plastic Surgery, Dermatology, Skin and Laser Center, La Jolla, CA, USA.|Division of Plastic Surgery, University of California, San Diego, San Diego, CA, USA.
authors.forename: Soobin
authors.initials: S
authors.lastname: Lim
authors.affiliation: FACES+ Plastic Surgery, Dermatology, Skin and Laser Center, La Jolla, CA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Johnston
authors.affiliation: FACES+ Plastic Surgery, Dermatology, Skin and Laser Center, La Jolla, CA, USA.
authors.forename: Cory
authors.initials: C
authors.lastname: Henssler
authors.affiliation: FACES+ Plastic Surgery, Dermatology, Skin and Laser Center, La Jolla, CA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Jeffers
authors.affiliation: FACES+ Plastic Surgery, Dermatology, Skin and Laser Center, La Jolla, CA, USA.|Division of Plastic Surgery, University of California, San Diego, San Diego, CA, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Saad
authors.affiliation: FACES+ Plastic Surgery, Dermatology, Skin and Laser Center, La Jolla, CA, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Leong
mesh_terms: D003357:Cosmetic Techniques; D016208:Databases, Factual; D004487:Edema / Q000209:etiology / Q000503:physiopathology; D004890:Erythema / Q000209:etiology / Q000503:physiopathology; D004954:Esthetics; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000175:diagnosis / Q000532:radiotherapy; D054020:Lasers, Gas; D053844:Lasers, Solid-State; D028022:Low-Level Light Therapy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D015595:Skin Aging; D016896:Treatment Outcome
keywords: Complications; Fractional lasers; Outcomes