Overview
The authors state that complications of fractional ablative lasers must be recognized and reported to improve device safety. They reviewed photographs, treatment settings and clinical files of four female patients with scarring or ectropion after fractional CO2 laser on the face or neck, looking for shared factors.
Findings
- 4 female patients, aged 54-67.
- Patient 1: erosions and swelling of the right lower eyelid at 2 days, which became scarring and an ectropion.
- Patient 2: linear erosions and beefy red swelling on the right neck, which became a tender, band-like scar over 1 month.
- Patient 3: stinging and yellow discharge in several neck areas at 3 days; cultures grew MRSA. Despite appropriate treatment, irregular texture and linear streaks became scars.
- Patient 4: a painless, patchy, soft eschar with yellowish change on the left neck. Azithromycin was started; at 2 weeks fibrotic streaks had formed, which became horizontal scars and a vertical platysmal band.
- Proposed causes: overly aggressive treatment in sensitive areas (excess energy, density or both), lack of technical finesse, infection, or idiopathic.
- Advice: lower energy and density on the eyelids, upper neck, and especially the lower neck and chest.
- Infection may be prevented by careful history, close monitoring after treatment and/or preventive antibiotics.
What it means for a patient
- Fractional CO2 laser can scar, in this report mostly on the neck, and can pull the lower eyelid down.
- The eyelids and neck need gentler settings. Ask how settings are adjusted for those areas.
- Report early erosions, swelling, stinging or yellow discharge; infection came before scarring in two cases.
- Limits: four cases only, no complication rate, and the causes are the authors' interpretation.
Why this paper matters
It documents scarring after a laser described as having a limited side-effect profile, and names the eyelids and neck as sensitive areas. Cited 124 times (NIH iCite, 2026-09-25).
Terms
- Fractional CO2 laser resurfacing: a laser that removes tiny columns of skin in a grid, leaving untreated skin between them.
- Ectropion: the lower eyelid turning outward away from the eye.
- Eschar: a dry crust of dead tissue on a wound.
- MRSA (methicillin-resistant Staphylococcus aureus): a skin bacterium resistant to many common antibiotics.
- Platysmal band: a vertical cord in the neck formed by the edge of the platysma muscle.