Risks from Ablative CO2 Laser Resurfacing?

One of the biggest advantages of the new, more sophisticated CO2 lasers is the significant decrease in side effects when compared to older lasers and older techniques. CO2 resurfacing has been around for a long time, but initially the lasers or much more limited with respect to the control that you had over them, and the treatment area was continuous without any islands of normal skin left in between to expedite healing.The most publicized side effect of CO2 resurfacing was hypopigmentation, which did tend to happen in a continuous fashion, not being broken up, and giving the entire treated area a lighter appearance. This was sometimes desirable, but often left A line of delineation between treated and untreated areas.New her CO2 lasers are significantly more sophisticated and allow your laser surgeon to carefully choose parameters and control them very closely. This allows your treatment to be tailored exactly to your needs, maximizing your benefits and minimizing your side effects. This is where all laser surgeons are not created equal.In addition to increased control, most of the new CO2 lasers have the capacity to fractionate your treatment. What that means is instead of treating the entire surface of the skin, small zones of skin are ablated, leaving normal islands of skin and between intact. This allows you to heal quickly and significantly decreases the side effects while still providing the overall capacity for your desired results to be obtained.In addition to hypopigmentation, scarring was always a theoretical risk, as well as prolonged redness. Even with fractionated lasers this redness can last 2 to 4 weeks in a normal situation, but when persisting longer is considered to be prolonged redness.CO2 resurfacing can get beautiful, dramatic results at a very reasonable price. As I said though, not all laser surgeons are created equal. To guarantee you're receiving the highest level of care, seek out a dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Ablative resurfacing is an intense treatment that does have certain risks linked to the procedure. Both hypopigmentation and hyperpigmentation are two of those risks, particularly when treating certain skin tones. However, when this device is used by a very experienced, board-certified dermatologist with expertise in this procedure, the risks are greatly reduced. My advice is to make sure the doctor you choose has the qualifications and experience necessary to ensure a safe and successful treatment.

Thank you for your question. It is common to have hyperpigmentation or even hypopigmentation after an ablative laser. I always recommend to pretreat with a lightening cream such as hydroquinone 2 weeks prior to the procedure to reduce the risk of hypo/hyper pigmentation.

Thanks for the great question.  With nonfractional deep ablative resurfacing (i.e. fully ablative laser) there is a risk of hypopigmentation.  However this was more common with the first generation CO2 fully ablative lasers.  Newer CO2 lasers are more precise and are lower risk.  Furthermore, with fractional ablative resurfacing hypopigmentation is much less common and if it does occur it is usually only temporary.  This is the beauty of fractional technology because islands of normal skin are preserved between the ablated tissue. This allows quicker recovery and collagen remodelling with less risks.    The Lumenis Ultrapulse TotalFX laser achieves excellent results with this technology.
Hope that this helps.  A consultation with a board certified dermatologist with training in laser and cosmetic surgery is recommended.

Skin darkening (hyper-pigmentation) of the skin can occur in the treated area and will eventually fade within a few months This reaction is more common in patients with olive or dark skin tones.  The risks of this complication are minimal but can occur.

So this is a very thoughtful question. There are many possible complications of laser but we will focus on hyper and hypopigmentation here.
You are exactly right that skin tone plays a big role. You are also correct that the laser settings will affect the outcome. So this is why as experienced laser surgeons, we adjust the settings to fit each specific patient and each patients goals. We can increase the effectiveness or decrease the downtime etc also with the laser settings. Many of use use different settings in certain areas. For instance around the lips we are often more aggressive because there are often deep vertical wrinkles there.
The pigmentation changes are in the treated area. Depending on the settings it can be the whole face or spotted fashion. People with more color in their skin are at higher risks of hyper (darker) pigmentation. You are correct that lightening of white skin typically looks nice.
Essentially get a few consults with some laser surgeons and discuss your goals. I encourage people to get these laser treatments in the winter (less sun =  lighter skin tones for all).
Hope this helps,
Best of luck,
DrC

The newest advancements in CO2 laser treatment of the skin is Fractionated CO2 Lasers which do not result in abnormal loss of skin pigmentation (hypopigmentation) and has a faster healing time.

Fractional CO2 Laser resurfacing produces wonderful and dramatic results. The Fractional CO2 Laser can be performed in an more aggressive ablative mode for acne scars, lines and wrinkles and for more aggressive skin tightening, or it can be used in a microablative mode for complexion, quality, pores, and sundamage with pigmentations. Different areas of the face are treated with varying levels as well. Much, of course, will depend on the pigmentation skin types. Using more aggressive ablative mode on darker pigmented skin can cause hypopigmentation and ever hyperpigmentation. When fractional CO2 laser is performed properly on the right candidates, hypopigmentation is rare. For more aggressive ablative procedures it is recommended to prepare the skin for at least a couple weeks with hydroquinone ( a skin lightener which stabilizes the pigment producing cells ) and a retin A type product, which sheds the outer dermis of dry and dead skin cells, increases the production of new skin cells and collagen. And to further answer your question, complications can arise when being too aggressive, especially on darker pigmented skin, or when patients are on certain medications. Permanent lightening is hypopigmentation and not desirable. What's desireable is resurfacing the skin to create tighter, smoother, clearer, healthy and glowing looking younger skin. A post laser skin regimen, preferably simple, is important to keep the new quality of the skin looking great. 

The issue with hypopigmentation was particularly related to the traditional, fully ablative resurfacing machines, like the Coherent ultra pulse.  Despite our attempts to "feather" the edge of the treatment zone, we'd see a step off in color between the treated area (lighter) and the untreated area (tanned / darker) in the occasional patient.Fortunately, this is dramatically better with the use of fractional resurfacing.  Unless you increase the treatment densities and energies to levels approaching the old ablative machines, you really don't see that problem much anymore.

Hello and thank you for your question. We use The Lumenis system for Active and Deep FX. I personally feel that pretreatment is essential in preventing pigment changes post procedure. The new Laser systems are much more sophisticated than older units that caused more skin damage. I recommend that during the consultation process you ask about pretreatment prior to CO2 Laser procedures. We utilize the ZO skin preparations. Best of luck to you.