Fractional laser resurfacing diminishes unwanted changes in skin tone and texture. Fractionating the laser allows far greater chance of success with less risk compared to past nonfractionated alternatives.
Adverse effects of fractional lasers consist of treat- ment-related side effects and unusual complica- tions. Although management of complications begins with prevention, the clinician should be prepared to identify and respond to side effects and complications as they arise. Like the spectrum of adverse effects, management options are diverse.
Where available, the authors’ experiences and evidence-based literature are cited to guide other clinicians in management of the adverse effects.
References
1. Alster TS, Wanitphakdeedecha R (2009) Improvement of postfractional laser erythema with light-emitting diode photomodulation. Dermatol Surg 35:813–815
2. Alster TS, West TB (1998) Effect of topical vitamin C on postoperative carbon dioxide laser resurfacing ery- thema. Dermatol Surg 24:331–334
3. Alster TS, Tanzi EL, Lazarus M (2007) The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg 33:295–299
4. Avram MM, Tope WD, Yu T et al (2009) Hypertrophic scarring of the neck following ablative fractional car- bon dioxide laser resurfacing. Lasers Surg Med 41:185–188
5. Bernstein LJ, Kauvar AN, Grossman MC et al (1997) The short- and long-term side effects of carbon diox- ide laser resurfacing. Dermatol Surg 23:519–525 6. Chan HH, Manstein D, Yu CS et al (2007) The preva-
lence and risk factors of post-in fl ammatory hyperpig- mentation after fractional resurfacing in Asians.
Lasers Surg Med 39:381–385
7. Chapas AM, Brightman L, Sukal S et al (2008) Successful treatment of acneiform scarring with CO 2 ablative fractional resurfacing. Lasers Surg Med 40:381–386
8. Cohen SR, Henssler C, Horton K et al (2008) Clinical experience with the fraxel sr laser: 202 treatments in 59 consecutive patients. Plast Reconstr Surg 121:
297e–304e
9. Dijkema SJ, van der Lei B (2005) Long-term results of upper lips treated for rhytides with carbon dioxide laser. Plast Reconstr Surg 115:1731–1735
10. Fife DJ, Zachary CB (2009) Delayed pinpoint pur- pura after fractionated carbon dioxide treatment in a patient taking ibuprofen in the postoperative period.
Dermatol Surg 35:553
11. Fife DJ, Fitzpatrick RE, Zachary CB (2009) Complications of fractional CO 2 laser resurfacing:
four cases. Lasers Surg Med 41:179–184
12. Firoz BF, Katz TM, Goldberg LH, Geronemus RG, Polder KD, Friedman PM (2011) Herpes zoster in the distribution of the trigeminal nerve following non- ablative fractional photothermolysis of the face: report of 3 cases. Dermatol Surg 37(2):249–252
13. Fisher GH, Geronemus RG (2005) Short-term side effects of fractional photothermolysis. Dermatol Surg 31:1245–1249
14. Fisher GH, Kim KH, Bernstein LJ et al (2005) Concurrent use of a handheld forced cold air device minimizes patient discomfort during fractional photo- thermolysis. Dermatol Surg 31:1242–1243
15. Foster KW, Fincher EF, Moy RL (2008) Heat-induced
“recall” of treatment zone erythema following frac- tional resurfacing with a combination laser (1320 nm/1440 nm). Arch Dermatol 144:1398–1399 16. Foster KW, Kouba DJ, Fincher EE et al (2008) Early
improvement in rhytides and skin laxity following treatment with a combination fractional laser emitting two wavelengths sequentially. J Drugs Dermatol 7:108–111
17. Geronemus RG, Weiss E, Chapas AM, Desai S, Brightman L, Hale EK, Karen JK, Bernstein LJ (2010) Finally! A well-tolerated and effective treatment for actinic keratoses on the face. Paper presented at the
American society for laser medicine and surgery 30th annual conference, Phoenix, 2010
18. Gewirtzman A, Meirson DH, Rabinovitz H (1999) Eruptive keratoacanthomas following carbon dioxide laser resurfacing. Dermatol Surg 25:666–668 19. Gotkin RH, Sarnoff DS, Cannarozzo G et al (2009)
Ablative skin resurfacing with a novel microablative CO 2 laser. J Drugs Dermatol 8:138–144
20. Graber EM, Tanzi EL, Alster TS (2008) Side effects and complications of fractional laser photothermoly- sis: experience with 961 treatments. Dermatol Surg 34:301–305
21. Hayes DK, Berkland ME, Stambaugh KI (1990) Dermal healing after local skin fl aps and chemical peel. Arch Otolaryngol Head Neck Surg 116:
794–797
22. Hu S, Chen MC, Lee MC et al (2009) Fractional resurfacing for the treatment of atrophic facial acne scars in Asian skin. Dermatol Surg 35:826–832 23. Hunzeker CM, Weiss ET, Geronemus RG (2009)
Fractionated CO 2 laser resurfacing: our experience with more than 2000 treatments. Aesthet Surg J 29:317–322
24. Karen JK, Hale EK, Geronemus RG (2010) A simple solution to the common problem of ecchymosis. Arch Dermatol 146:94–95
25. Kim DH, Lee SJ, Kang JM et al (2007) Cracks on the tip: an unusual complication using the fractional pho- tothermolysis system. J Eur Acad Dermatol Venereol 21:1280–1281
26. Kono T, Chan HH, Groff WF et al (2007) Prospective direct comparison study of fractional resurfacing using different fl uences and densities for skin rejuve- nation in asians. Lasers Surg Med 39:311–314 27. Mamelak AJ, Goldberg LH, Marquez D et al (2009)
Eruptive keratoacanthomas on the legs after fractional photothermolysis: report of two cases. Dermatol Surg 35:513–518
28. Manstein D, Herron GS, Sink RK et al (2004) Fractional photothermolysis: a new concept for cuta- neous remodeling using microscopic patterns of ther- mal injury. Lasers Surg Med 34:426–438
29. Marra DE, Yip D, Fincher EF et al (2006) Systemic toxicity from topically applied lidocaine in conjunc- tion with fractional photothermolysis. Arch Dermatol 142:1024–1026
30. Nanni CA, Alster TS (1998) Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 24:315–320
31. Palm MD, Butterwick KJ, Goldman MP (2010) Mycobacterium chelonae infection after fractionated carbon dioxide facial resurfacing (presenting as an atypical acneiform eruption): case report and litera- ture review. Dermatol Surg 36(9):1473–1481 32. Prado A, Andrades P, Danilla S et al (2008) Full-face
carbon dioxide laser resurfacing: a 10-year follow-up descriptive study. Plast Reconstr Surg 121:983–993 33. Rahman Z, MacFalls H, Jiang K et al (2009) Fractional
deep dermal ablation induces tissue tightening. Lasers Surg Med 41:78–86
34. Rokhsar CK, Fitzpatrick RE (2005) The treatment of melasma with fractional photothermolysis: a pilot study. Dermatol Surg 31:1645–1650
35. Rubenstein R, Roenigk HH Jr, Stegman SJ et al (1986) Atypical keloids after dermabrasion of patients taking isotretinoin. J Am Acad Dermatol 15:280–285 36. Setyadi HG, Jacobs AA, Markus RF (2008) Infectious
complications after nonablative fractional resurfacing treatment. Dermatol Surg 34:1595–1598
37. Stotland M, Chapas AM, Brightman L et al (2008) The safety and ef fi cacy of fractional photothermolysis for the correction of striae distensae. J Drugs Dermatol 7:857–861
38. Tan KL, Kurniawati C, Gold MH (2008) Low risk of postin fl ammatory hyperpigmentation in skin types 4 and 5 after treatment with fractional CO 2 laser device.
J Drugs Dermatol 7:774–777
39. Tierney EP, Kouba DJ, Hanke CW (2009) Review of fractional photothermolysis: treatment indications and ef fi cacy. Dermatol Surg 35:1445–1461
40. Vandergriff T, Nakamura K, High WA (2008) Generalized eruptive keratoacanthomas of grzybowski treated with isotretinoin. J Drugs Dermatol 7:1069–1071 41. Walgrave SE, Ortiz AE, MacFalls HT et al (2009)
Evaluation of a novel fractional resurfacing device for treatment of acne scarring. Lasers Surg Med 41:122–127
42. Wanner M, Tanzi EL, Alster TS (2007) Fractional photothermolysis: treatment of facial and nonfacial cutaneous photodamage with a 1,550-nm erbium- doped fi ber laser. Dermatol Surg 33:23–28
43. Weiss ET, Chapas A, Brightman L et al (2010) Successful treatment of atrophic postoperative and traumatic scarring with carbon dioxide ablative frac- tional resurfacing: quantitative volumetric scar improvement. Arch Dermatol 146:133–140
37 A. Tosti et al. (eds.), Management of Complications of Cosmetic Procedures,
DOI 10.1007/978-3-642-28415-1_4, © Springer-Verlag Berlin Heidelberg 2012
4
4.1 Introduction
The treatment of acquired and congenital vascular lesions is one of the most studied and performed cutaneous laser procedures; data from the litera- ture and clinical experience con fi rm the signi fi cant role of lasers in treatment of vascular lesions.
Thanks to these techniques, some lesions that could not be treated before the introduction of lasers are now easily removed by physicians, who have gradually changed their modus operandi, no more following the “wait and see” approach in front of many of such lesions. Naturally, all the bene fi ts and the advantages coming from these non-ablative vascular lasers are connected to the exact clinical diagnosis, the experience of the phy- sician, and the choice of the adequate laser, light, and parameters to be used according to the fea- tures of that single clinical case.
The vascular lesions can be classi fi ed accord- ing to the onset of their appearance, separating them in congenital and acquired lesions [ 2 ] . Congenital vascular lesions are set up by heman- giomas, constituted by endothelial cell hyper- proliferation, and true vascular malformations, with normal endothelial cell turnover and vessel wall ectasies; this last group contains capillary malformations (port-wine stain), venous malfor- mations, arterial malformations, arteriovenous malformations, and lymphatic malformations. The fi eld of the acquired vascular lesions includes forms characterized by various degrees of blood vessel ectasia as leg vein anomalies, venous lake, pyogenic granuloma, spider angiomas, cherry
Complications of Vascular Lasers
Norma Cameli , Giovanni Cannarozzo , Paolo Bonan , Nicola Bruscino , and Piero Campolmi
N. Cameli ()
Department of Dermatology San Gallicano Institute - IRCCS - Rome , via Chianesi, 53 , 00144 Rome , Italy
e-mail: cameli@ifo.it
G. Cannarozzo • P. Bonan • N. Bruscino • P. Campolmi Department of Dermatology ,
University of Florence, via della Pergola 60, 50129 Florence , Italy
Key Features Vascular lesions
•
Selective photothermolysis
•
Vascular non-ablative lasers
•
Vascular laser side effects
•
Management of vascular lasers adverse
• events
The application of new laser technologies to the treatment of different vascular lesions has radically changed the clinical outcomes.
Despite vascular lasers are generally consid- ered safe and well-tolerated, they can be associated with some risks of side effects and adverse events. We outline expected side effects and serious adverse events, how they are caused, and their preoperative, intra- operative, and postoperative management.
angiomas, and telangiectases. Nowadays, the present state of the art, considering with this term the use of the most modern vascular laser, shows as these treatments can be applied also on differ- ent lesions, which are not traditionally considered as vascular [ 8 ] , being all those forms with a vascular component which makes them amenable to be treated with many lasers: poikiloderma of civatte, molluscum contagiosum, warts, keloids, hypertrophic vascularized scars, chronic hyper- granulation tissues, and reticular erythematous mucinosis, among others.
There are good prospects for the future, as there are many lasers for vascular lesions, all characterized by speci fi c advantages and disad- vantages, very promising as regards a very favor- able risk to bene fi t ratio, but only when performed by skilled dermatologists.