FRACTIONAL ABLATIVE LASER RESURFACING ERBIUM:YAG & CO2 SCITON PRO-FRACTIONAL

Although the majority of patients do not experience complications, you should be aware of all of them in order to make an informed decision. Some are more expected side effects as part of the natural healing and recovery process such as swelling, redness, feeling of heat, bruising and peeling skin. It is imperative you follow the strict aftercare routine prescribed to you – this is the key determinant of your recovery.

• Swelling & Heat Sensation – This is to be expected and is variable from significant to mild but usually settles in 48 hrs to 5 days.
• Bruising – Bruises and rarely large bruises called haematomas may form in and around areas that have been injected for anaesthetic purposes. This can also rarely occur over areas of deeper resurfacing. 
• Infection – Although infection following laser skin treatment is unusual, bacterial, fungal, viral and parasitic infections can occur. Herpes simplex virus infections around the mouth or other areas of the face can occur following a laser treatment. This applies to both individuals with a past history of Herpes simplex virus infections and individuals with no known history of Herpes simplex virus infections in the mouth area. Specific medications may be prescribed and taken both prior to and following the laser treatment procedure in order to suppress an infection from this virus. Should any type of skin infection occur, additional treatment including antibiotics may be necessary. 
• Scarring – Although normal healing after the procedure is expected, abnormal scars may occur both in the skin and deeper tissues. In rare cases, hypertrophic or keloid scars may result. Scars may be unattractive and of different color than the surrounding skin.
• Burns – Laser energy can produce burns. Adjacent structures including the eyes may be injured or permanently damaged by the laser beam. Burns are rare yet represent the effect of heat produced within the tissues by laser energy. Additional treatment may be necessary to treat laser burns
• Redness – Laser treatments may potentially change the natural color of your skin. Skin redness can last several weeks to 6 months+ following laser skin treatment. 
• Post Inflammatory Hyper/Hypopigmentation (PIH) There is the possibility of irregular colour variations within the skin including areas that are both lighter and darker (hypopigmentation and hyperpigmentation). A line of demarcation between normal skin and skin treated with lasers can occur. Rarely, colour changes can develop much later after treatment as a delayed side-effect. PIH is more common on darker skin types. Thankfully it usually spontaneously improves. Improvement can be speeded up by the addition of topical treatment. Duration usually depends on the severity of the inflammation that created it in the first place. Complete resolution can take anything from a few weeks to 6 months depending on severity. Rarely it could be permanent. Sun exposure is the most common aggravating factor and this is why strict sun avoidance is important in the first few weeks following treatment. If the aftercare instructions are strictly adhered to one is much more likely to avoid this type of complication.
• Pseudo-hypopigmentation – Hypopigmentation is the medical term for lightening of the skin. After fully ablative laser resurfacing it is normal for the skin to be slightly lighter. This is due to the way that the organised collagen in the new skin reflects more light. This gives an impression of a slightly lighter colour. This effect is called pseudo-hypopigmentation. True hypopigmentation is lack of melanin production due to damage caused to melanin producing cells by thermal injury from the laser. This is rare with fully ablative erbium yag resurfacing as the new skin is repopulated with new melanin producing cells from the deeper adnexal structures which are a reasonable distance away from the treated surface of the skin. If true hypopigmentation occurs, it can take many months to recover and can indeed be permanent.
• Scleral show/ Ectropion – Resurfacing around the eyes can cause a skin tightening effect which rarely can cause excessive skin tightening that can cause the eyelid to retract down leading to excessive scleral show or eversion of the eyelid margins and an inability to completely close the eye. Mild cases may improve with non-surgical management but more severe cases may require corrective oculoplastic surgery.
• Cysts, milia and/or acne eruption – Due to the need of using heavier, skin protecting products constantly for the initial recovery period, it is not uncommon to develop temporary clogged pores which can develop in to cysts or milia or sometimes an acne-like eruption due to the heaviness of the product ingredients. This will be reviewed and will eventually subside. It is more common in those prone to acne. 
• Dry, tight, irritated and/or itchy skin – As the new skin heals, it is normal to feel dry, tight or develop sensitive, sensitized or itchy skin. This will be monitored in the daily virtual ward round and is greatly reduced by following the aftercare instructions and ensuring the skin is kept moist and covered with the given creams, sprays and/or balms during the recovery period
• Loss of Hair In Treated Area – Although this laser does not target hair, in certain instances of deeper resurfacing, the hair follicles may be damaged and the hair may not grow back in these areas
• Skin Tissue Pathology – Laser energy directed at skin lesions may potentially vaporize the lesion. Laboratory examination of the tissue specimen may not be possible.
• Visible Skin Patterns – Laser treatment procedures may produce visible patterns within the skin. The occurrence of this is not predictable.
• Patient Failure to Follow Through – Patient follow through following a laser skin treatment procedure is important. You must follow the instructions provided to you for post-treatment daily virtual ward round reviews with Dr Zoya as well as post operative instructions concerning appropriate restriction of activity, use of prescribed skincare and/or dressings, and use of sun protection need to be followed in order to avoid potential complications, increased pain, and unsatisfactory result. Your physician may recommend that you utilize a long-term skin care program to enhance healing following a laser skin treatment.
• Damaged Skin – Skin that has been previously treated with chemical peels or dermabrasion, or damaged by bums, electrolysis (hair removal treatments), or radiation therapy may heal abnormally or more slowly following treatment by lasers or other surgical techniques. The occurrence of this is not predictable. Additional treatments may be necessary.
• Distortion of Anatomic Features – Laser skin treatments can produce distortion of the appearance of the eyelids, mouth, and other visible anatomic landmarks. The occurrence of this is not predictable. Should this occur, additional treatment, including surgery, may be necessary.
• Post-resurfacing contact dermatitis – This is a form of increased sensitivity of the skin that is encountered by a proportion of individuals post laser resurfacing. In some cases it can be quite severe. Mild irritants can trigger a disproportionately large irritation of the skin (burning and itching) that then can result in prolonged redness and darkening of the skin. It is usually treated by topical steroid ointment if it occurs and eventually spontaneously settles. Triggering can be minimised by the use of mild perfume free cleansers and skin products post treatment such as the ones given in your homecare kit.
• Unsatisfactory Result – There is the possibility of an unsatisfactory result from these procedures. Laser procedures may result in unacceptable visible deformities, skin slough, loss of function, and permanent color changes in the skin. You may be disappointed with the final result from laser treatments.
• Pain – During the healing period, you may experience some discomfort, especially initially once the anaesthetic wears off. Very infrequently, chronic pain may occur after laser skin treatment procedures.
• Pores – Pores may rarely get worse with laser resurfacing
• Vision Damage or Blindness – This is extremely rare and can only occur if the laser beam hits the eye however we use intraocular shields and/or fully shielded eye protection to minimize the chance of this happening.
• Damage to Teeth – This is exceedingly rare and can only occur if the laser beam hits the tooth. We cover and protect the teeth to minimize the chance of this happening. 
• Allergic Reactions – In rare cases, local allergies to tape, preservatives used in cosmetics or topical preparations have been reported. Systemic reactions which are more serious may result from drugs used during medical procedures and prescription medicines. Allergic reactions may require additional treatment.
• Lack of Permanent Results – Laser or other treatments may not completely improve or prevent future skin disorders, lesions, or wrinkles. Additional procedures or surgery may be necessary to further tighten loose skin.
• Pigment removal – If you have any tattoos including microblading, tattooed eyebrows or lip blush, the laser may remove this as it vaporizes the skin. If this is directly in an area that is being treated, that is unavoidable however even if it isn’t, all necessary steps are taken to minimize the risk of effecting these areas but no guarantee can be made.
• Delayed Healing – It may take longer than anticipated for healing to occur after laser treatments. Slower than normal skin healing may result in thin, easily injured skin. This is different from the normal redness in skin after a laser treatment.
• Erosive pustular dermatosis – This is an extremely rare dermatological condition that can be triggered by any type of skin injury including laser. There are only a few case reports worldwide following laser sugery. It is an exceptionally rare consequence but effectively amounts to the failure of the skin to completely heal after treatment. Management would be undertaken in a specialist dermatology unit if this was to occur but the consequence of this could be permanent scarring.
• Fire – Inflammable agents, surgical drapes and tubing, hair, and clothing may be ignited by laser energy. Laser energy used in the presence of supplemental oxygen increases the potential hazard of fire. Some anesthetic gases may support combustion.
• Laser Smoke (plume) – Laser smoke is noxious to those who come in contact with it. This smoke may represent a possible bio-hazard.
• Unknown Risks – There is the possibility that additional risk factors of laser skin treatments may be discovered.
• Local Anaesthesia & Nerve Blocks – Both local anaesthetic and nerve blocks involve risk. The numbing agents can sometimes temporarily effect nerves supplying muscles which can temporarily limit the effected muscle movement. This usually subsides once the anaesthetic wears off. The adrenaline in certain blocks can make you feel jittery or experience a racing heart, restlessness or palpitations. There is the possibility of allergies, anaphylaxis, complications, injury, and even death from all forms of anaesthesia and sedation. 
• Additional Treatment or Surgery Necessary – You may have combination therapy with topical medications and/or injected medications such as Kenalog if you are having the treatment for scarring. These topical or injectable agents can cause thinning of the skin around the treated area and can incite an allergic reaction.There are many variable conditions which influence the long-term result of laser skin treatments. You may require more treatments in the future. Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with these procedures. Other complications and risks can occur but are even more uncommon. Should complications occur, procedures, surgery, or other treatments may be necessary. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty, expressed or implied, on the results that may be obtained.
•