Complications are not "normal" but do happen. Patients need to be informed about them so they are not surprised if they experience one (or more). They include:
- Infection. I favor the open technique for laser resurfacing because this allows the face to be washed frequently and reduces the likelihood of bacterial colonization, which could give rise to infection. Some patients do not cleanse adequately after laser resurfacing. They are tentative and worry that maybe they will scrub too hard and it can be painful during the first few days. Close follow-up is important to be sure that patients are cleaning properly. We typically see our patients a day or two after laser resurfacing to make sure that the patient is cleansing the face properly. We often prescribe antibiotics and Valtrex® to help prevent bacterial or viral infection. If the patient focuses on cleansing and takes antibiotics, the likelihood of infection is very small. The face has an excellent blood supply and will resist infection unless colonization is allowed to develop. If an infection does develop, it will likely respond to frequent cleansing and antibiotics as well.
- Hyperpigmentation. Laser resurfacing can cause the pigment cells in the deep layer of the skin (melanocytes) to produce extra melanin which causes darkening of the skin. Hyperpigmentation is more common in patients with naturally darker skin types and is also much more likely to occur in the presence of ultraviolet light. Because the pigment cells are sensitized to UV light, it is very important to protect the skin from ultraviolet light after laser resurfacing. Sources of UV light include natural sun exposure and tanning beds. Our patients are regularly reminded after surgery to protect their skin and regard the sun as "the enemy." For several months after laser resurfacing, and at all times when the skin is still red, patients must protect their skin from UV light. Typically, I recommend at least six months of caution and use of sunblock after laser resurfacing.
The most important treatment for hyperpigmentation is avoidance of ultraviolet exposure. If it occurs, a bleaching lotion (hydroquinone 4%) may be prescribed to reduce the output of melanin by the pigment cells. But, no amount of bleaching cream can overcome the effects of the sun if the skin is unprotected. The bleaching cream is applied in the evening to the darker areas, avoiding the lighter skin. The significance of ultraviolet exposure is one reason laser resurfacing is popular in the winter months.
For patients with darker skin types, I recommend laser treatment be avoided during the summer months.
M.C. (Age 48) - Assembler
Description: CO2 laser resurfacing of lower lids, upper and lower blepharoplasties.
Comments: This Hispanic patient developed hyperpigmentation after laser resurfacing of the lower eyelids and surrounding skin. The CO2 laser was used to obtain maximum treatment of her conspicuous dark circles. After she started using sunblock scrupulously and applying a bleaching cream (hydroquinone, 4 %), the hyperpigmentation resolved. While treatable, this complication is better avoided.
- Milia (Whiteheads) can develop after laser resurfacing. This may be related to the use of petroleum-based ointments such as Vaseline® to lubricate the skin after laser resurfacing. The openings of the sweat glands can be blocked and sebum (protein fluid) gets backed up in the glands. Once the skin is healed, this ointment may be discontinued and a moisturizer can be used instead, preferably one that is not too greasy. For patients prone to whiteheads, "noncomedogenic" moisturizers are best. Whiteheads may be disrupted by vigorous scrubbing. It is not unusual for me to pluck these whiteheads at the time of follow-up appointments during the few months after laser resurfacing.
- Hypopigmentation (lightening of the skin) is occurs when laser resurfacing interferes with the function of the pigment cells in the deep layers of the skin. As a result, less melanin is produced which causes lightening of the skin. Patients with brown spots or unwanted darkening of the skin may find hypopigmentation advantageous and actually a benefit rather than a complication. It can also be helpful in the treatment of dark circles (See Patient Photographs). However, hypopigmentation can also be a problem because of the demarcation of treated and untreated skin which can be obvious and unattractive, particularly along the jawline, which is why we are cautious about using the CO2 laser in this area.