Risks from Ablative CO2 Laser Resurfacing?
- Asked by Samili_love in Sunshine, USA
- 4 years ago
After having done some research, it seems that one of the largest risks/complications of ablative CO2 Laser resurfacing is permanent hypopigmentation. Are certain skin types more prone to this, or is this a complication that is mostly related to aggressiveness of treatment?
Also, does the hypopigmentation extend uniformly to the entire treated area (i.e., in the case of full face treatment, the whole face takes on a mask-like appearance), or does it usually manifest itself in a more spotted manner across the treatment site? I would think permanent lightening would be desirable for somebody with severe sun damage.
Hypopigmentation is rare but can occur
Probably the most publicized side effect of heavy CO2 resurfacing is hypopigmentation. This occurred more frequently years ago when CO2 lasers first came out. The lasers back then were slower and hotter making all types of side effects more common.
Today, CO2 lasers are faster, better controlled through computer scanners and are very safe. With more aggressive treatments, however, there are small chances of delayed healing, or theoretically hypopigmentation.
More common issues to be considered are prolonged redness lasting anywhere from weeks to months. In patients with more natural pigment, there is also the risk of increased or hyperpigmentation after treatment. Avoiding sun exposure and the use of bleaching creams can help decrease this risk.
Something else to consider, today there are now Fractionated CO2 lasers. These lasers, such as the Total FX by Lumenis, are delivered in a pixelated manner using a computer scanner. The laser still penetrates deeply and creates some nice skin tightening, but is not as aggressive as the fully ablative CO2 laser. Healing is shortened and the safety profile is better. For many patients, this is a better option and definitely something to look into.
Hope that this helps
CO2 and hypopigmentation
With the traditional fully ablative CO2 lasers, there was a risk of hypopigmentation or waxy white discoloration to the skin. The hypopigmentation risk is significantly less with the fractional co2 laser. The fractional CO2 drills tiny column in the skin, thus treating only a certain portion of the skin as opposed to the fully ablative one. Overall, its a lot safer with less risk of side effects. Dr. Behnam, Santa Monica
Decreased pigmentation following CO2 laser resurfacing
I am in Florida where people don't like to wear a lot of makeup due to the heat. One of the nice advantages of newer fractional CO2 laser resurfacing techniques is that I really don't see any pigment change (other than desired removal of solar lentigos (brown spots)). There is no need to cover up the interface between where the laser was used and where it was not with the fractional CO2 laser because there is no persistent alteration of baseline skin pigmentation.
Use of completely ablative CO2 laser resurfacing can result in some lightening of pigmentation although the best lasers have high energies applied for very short dwell times - this yielded much less of a problem than the early lasers had. I used the Coherent Ultrapulse laser and had very nice results with a minimal effect on pigmentation.
At this time I use fractional CO2 laser almost exclusively as it retains most of the fully ablative CO2 laser power with a shorter recovery time and less effect on pigmentation (the concern you describe).
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.