This article is a companion to “Trends in Oculoplastic Surgery – Part VI” published earlier this month, discussing the potential complications of the procedures.
Complications can occur with ablative and non-ablative lasers, whether they are fractionated or not.
Contact dermatitis can occur in up to 65 percent of patients and can be induced by topical antibiotics, sunscreens, fragrance-containing compounds or any topical with preservatives. Milia can also occur, as well as exacerbation of acne or perioral dermatitis. Late complications include scarring and ectropion, which can be treated with steroids, massage, anti-fibrotics or other lasers, such as pulse dye laser (PDL).
Hypopigmentation can occur in 20 percent from destruction of melanocytes and can appear one to two years post-procedure. Hyperpigmentation can occur after three to four weeks in 33 percent of patients. Usually this problem is transient and responds to treatment. Treatment options for hyperpigmentation include topical retinoic acid, glycolic acid, azelaic acid, tyrosinase inhibitors, intense pulse light and sunscreen.
Herpes simplex virus infection can occur at five to 10 days post-procedure. Reactivation occurs in approximately two to 10 percent of laser treated patients, with the risk being much higher after ablative laser. Antivirals can prevent growth at the epidermal level and should be used before and after until re-epithelialization is complete.
Bacterial infection can occur at two to 10 days post-treatment. There is an increased risk when patients use occlusive dressings, such as biosynthetic materials, because these dressings prevent exudation. The necrotic tissue combined with serum caught beneath the dressing acts as a medium for growth. Also, this low oxygen environment promotes anaerobic growth. Staphylococcus and pseudomonas infections are common bugs. If using occlusive dressings, prophylactic antibiotics should be considered and the wound should be inspected and the dressing removed 24 to 48 hours post procedure.
Fungal infection, such as candida, is also a risk in patients using occlusive dressings and in those on antibiotics. Treatment should be with ketoconazole or itraconazole.
The potential complications listed above are thankfully rare, but can be devastating. It is extremely important as a provider of laser procedures to be aware of the possibilities and to know how to avoid and treat if necessary.