Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing

Abstract

Background Ablative fractional carbon dioxide (CO2) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO2 resurfacing. To date, scarring with fractional CO2 lasers has not been reported. Objective Five patients treated with the same fractional CO2 laser technology for photodamage of the neck were referred to our practices 1–3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 μm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO2 ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 μm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS). Results Histopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month. Conclusion As with traditional ablative CO2 laser resurfacing, HS is a potential complication of ablative fractional CO2 laser resurfacing, particularly on the neck. With early diagnosis and appropriate treatment HS of neck skin may be reversible. We urge caution when treating the neck with this device and close attention to wound care in the post-operative period.

Ablative fractional lasers (CO2 and Er:YAG): A randomized controlled double‐blind split‐face trial of the treatment of peri‐orbital rhytides

“…Serious side effects have been reported [26,27] and the manifest risk of scarring demands great caution when ablative fractional resurfacing is applied to delicate regions such as the peri-orbital area or the neck [28].…”

Hand Rejuvenation by Ablative Fraction CO2 Laser

“…Since then, AFCL has been used for resurfacing of the face with significant results and acceptable safety profile (13)(14)(15)(16)(17), but caution has been considered for non-facial areas such as neck, chest and hands due to the possibility of delayed wound healing and abnormal scarring (18,19). Therefore, the efficacy and safety of AFCL in hand resurfacing has been studied less frequently until 2011, when Stebbins and Hanke (11) reported AFCL resurfacing as a highly tolerable, safe, and efficient modality in hand resurfacing.…”

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

“…Postlaceration scars treated with AFL at 4 weeks after repair showed improvement on all elements of the VSS in 1 study involving 15 facial lacerations. 20 While scars with contracture are a rare but known side effect of AFLs, most notably after treatment of the neck, 21 these laser devices may also be employed in the treatment of scar contractures related to burn and trauma. It is important to use settings with lower energies when treating areas of the face because they are at greater risk for scarring.…”

“…2,3 Unwanted side effects include hypo-or hyperpigmentation, acneiform eruption, herpes reactivation, scarring, and persistent ulceration. 3,21 Higher fluences have been associated with higher procedural pain scores. 39,40 Small case series reporting scarring located on the neck or ectropion, preceded by infection or nonhealing ulcers, have been described.…”