Complications of Cutaneous Laser Surgery. A Review

Abstract

Continuous wave (CW) lasers, the first medical lasers to be used, continue to be effective, but are extremely operator dependent and can potentially result in significant risks, including scarring. In 1983, the theory of selective photothermolysis was introduced, which enabled physician-scientists to design lasers that were highly selective and safer to operate. These newer lasers are capable of affecting a specific target tissue without a high risk of scarring and pigmentary changes. They accomplish this task by producing a wavelength and pulse duration that is best absorbed by a specific target. However, not all modern lasers employ this theory and, therefore, may operate in either a CW, quasi-CW, pulsed, or Q-switched mode. CW lasers are least selective and tend to produce unwanted tissue damage and scarring through heat dissipation. Quasi-CW lasers attempt to limit unwanted thermal damage by producing a series of brief laser pulses or by the chopping of a CW beam; however, they still have a relatively high risk of causing nonspecific tissue damage and thermal injury. The pulsed and Q-switched systems adhere most closely to the principles of selective photothermolysis and result in the most selective destruction with the lowest risk of scarring and unwanted thermal diffusion. Of course, any laser system can potentially result in scarring and tissue damage; therefore, adequate operator education and skill are essential when utilizing medical lasers.

A clinical comparison and long‐term follow‐up of topical 5‐fluorouracil versus laser resurfacing in the treatment of widespread actinic keratoses

“…Quaedvlieg et al [40] mention delayed wound healing on atrophic bald scalp after laser resurfacing, with depigmentation and teleangiectasia as long-term complications. The other adverse effects in our study were comparable to the rates mentioned in literature [36][37][38]. Overall, patients treated with laser resurfacing were satisfied with the clinical results and did not consider the long-term side effects as cosmetically annoying.…”

“…This is common after laser resurfacing [36][37][38] as well as after 5-FU [16]. Edema and wound infections were seen significantly more in the LA-group.…”

“…These longterm side effects after laser resurfacing have been described before. Persistent erythema is one of the mild long-term side effects, prolonged hypopigmentation is classified as a moderate complication [36][37][38]. Our high rate of persistent erythema could be due to the fact that in many cases the scalp was treated, an area more susceptible to adverse effects.…”

Laser Erbium: YAG no tratamento de nevos melanocíticos

“…12,15,16 Apesar do excelente resultado estético a curto prazo e da ótima cicatrização observada, devido à persistência de células névicas em sete das nove lesões tratadas, o laser Er:YAG, neste trabalho, mostrou-se ineficaz quanto à destruição dessas lesões.…”

Complications of laser dermatologic surgery

“…Complications associated with CO 2 resurfacing have been well described [13][14][15][16][17][18][19]. The use of aggressive techniques, including use of high energy densities, multiple passes, and overlapping spots or scans can increase the risk of hypertrophic scarring and infections (Cases 13 and 16).…”