Deep treated spot after CO2 laser and wedding in two weeks! Is it supposed to look like this after CO2 laser? (Photos)

Hi, I went to a clinic due to a sun spot on my cheek (doctor said it was a lentigo) and doctor suggested the CO2 laser treatment. They told me the recovery time is around one week so i went for it. Now it is 24 days later, my wound still looks red and the worst part is it looks deep. I have been taking care of the wound carefully without any complication after the procedure. Since the spot is so deep, will it leave scar in the future and how long should I went to see the result? Thank you!

Doctor Answers 1

Your solar lentigo should have healed within the expected time, and it's important to address it to prevent a skin depression

Thank you for your question. I understand that about 24 days earlier, you had a solar lentigo treated with CO2 laser. You’re concerned that after this time, the wound still looks red and quite deep. You’d like to know what to expect in this situation, particularly since you will be attending a wedding soon.

To first give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I’ve been using the CO2 laser since the original CO2 lasers came out in the mid-90s, so I can certainly give you guidance on this issue. Keep in mind however that the absence of a physical examination, as well as knowledge about the particulars of your treatment, will limit the kind of advice I can give.

A solar lentigo is a well-defined brown spot that occupies the dermal-epidermal junction of the skin. It’s essentially a concentration of pigment cells that cause this brown discoloration, which is associated with sun exposure. Solar lentigos can be treated with superficial peels, or chemical peels such as TCA peels or trichloroacetic acid chemical peels. Thermal energy devices that convert light energy into heat energy can be used as well, such as intense pulsed light treatment (IPL); as well as erbium and CO2 lasers.

Looking at this particular defect in your skin, I would express some concern. You stated in your question your recovery was anticipated to last for about a week. Now that it’s been 24 days, I am concerned that the epidermis or the epithelial part of the healing is not closing in, judging from the level and the depth that appears in the photo. This means that there could be significant depth to this wound, which concerns the healing of the dermis.

This is where the importance of understanding and choosing the right modality for a procedure like this comes in. Modalities like pulsed light treatment focus on the actual pigment or the melanin, while ablative procedures take off the top layer of skin, after which newer and smoother skin is generated. With CO2 lasers, you get a relatively deep penetration of heat.

With regard to your case, the effect of the heat of the CO2 laser on reepithelialization or repair is one factor, and the aftercare that was performed on your skin is another factor. Based on your photos alone, I’m concerned you will be left with a slight depression on your skin after it has eventually healed. This is certainly one of the complications of laser treatment during the healing process. Other problems can include formation of crust, inflammation, and infection, among others. The level of energy of the CO2 laser and the depth at which it is applied can also be a factor; however we don’t spontaneously need to think the cause is due to the laser itself.

As a specialist who has done similar work like this for many years, my ultimate concern about your case is whether or not you will be able to heal properly without getting an indentation. In my experience, the epithelium would have healed well enough at this point that there would be no depression left behind. Your doctor may have done multiple passes over the area because they felt that the level of pigment is much deeper. It’s difficult for me to give a more concrete diagnosis since I wasn’t there for the treatment, and have no knowledge of the parameters of your situation. As such, communication with your doctor is crucial. Meet with them and talk to them to try and get an understanding of what happened and how the situation can be improved.

I hope that was helpful and I wish you the best of luck!

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