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I developed orange peel skin after CO2 laser. There is one go-to thread on this subject but there's no real resolution there, just a new poor soul commenting every once in a while trying to get an answer. I don't yet have one either but I have visited quite a few doctors for help and want to share what I have so far and call out for anyone else who has experienced this or knows about it to comment as well since this still afflicts me.
Early in the year, I went to a dermatologist who recommended a full face CO2 laser for my atrophic acne scars. He assured me he has tons of experience with lasers and that it's the only thing that would give me real, permanent results (I had already had vampire facials, RF microneedling, and spot subcision with only neutral and negative results). His office has "laser" in the name and he boasted having hundreds of lasers to target specific problems with. He said my skin texture will improve, which seemed hard to believe because my skin texture was already nice; even the scarred areas on my cheeks and temples weren't proper scars since they had nice superficial texture”they were just tethered and there was fat loss below (which RF microneedling seemingly worsened, but that is another story). I assumed he meant texture in a broad sense in that overall my face would have fewer indents. I know I didn't ask enough questions but he was always so busy and I had already had several other minor treatments with him that went just fine. I was also under the impression I should trust him to do what's best for me. His bio described his philosophy as performing subtle and precise treatments to enhance natural beauty. He assured me risks were minimal compared to previous generations of lasers but he advised there is downtime and I'll be red for a few months. Fine, I thought, I am privileged to work from home and the world is in a global crisis and I'm in my own crisis; there's no better time.
He performed two lasers on me:
- 1 pass with the Ultrapulse CO2 ActiveFX that was more superficial with 100% coverage (non-fractionated)
- 1 pass with the Ultrapulse CO2 DeepFX that was deeper and only 10-25% coverage (fractional)
I was insanely swollen after but I refused the steroid shot because of a previous reaction to steroids. He assured me that it doesn't make a difference in the ultimate results. He instructed me not to wipe away scabbing but instead to put on occlusive ointment always and do vinegar soaks. The scabbing finally came off after a couple weeks (it took 3 weeks on my beard area). I thought that was a bit long and worried about risks that might have for healing but he said everything is fine. I then started to use a growth serum called TNS Recovery Complex and about 6 weeks after I started my retinoid again, all under his instruction.
After the scabs peeled, I did notice a slight orange peel texture:
It was shinier and rougher than my skin was before, but things were still raw and my doctor said all looks fine for this stage of healing.
I also noticed a couple months in that scrunching my skin showed lines everywhere:
My doctor didn't say it was anything to be worried about.
A few months in and I was still bright red, which seemed abnormal since he said it would last just a few months. So he said we should do a vbeam. He said one should be enough. It wasn't, so I ended up doing about 6 and I still think I am a bit red.
As months went on, the texture only got worse. The bumpy parts only got more pronounced.
Before:
After:
Before:
After:
Before:
After:
In the photo below you can see the blue parts are where the laser didn't go/where the doctor feathered it:
Here's the same photo without the blue:
Here is a demarcation on my forehead:
And without the line:
Here is a close-up of the texture under overhead lighting:
I have been to many dermatologists and plastic surgeons regarding this. The original one who performed the laser said he has heard of this before but has never seen it. He said my fibroblasts over-proliferated and it should even out with time or we can do microneedling later. Most say it's not scarring. Some gaslight me and say this looks better than before. Others have said wait at least a year (I'm 11 months out now). One gave me a steroid cream for 2 weeks that seemed to reduce how much the bumps come out but he said I can't use the cream beyond 3 weeks because it can cause atrophy or dependence. I have done two microneedling sessions with one dermatologist but I haven't noticed too much progress. I did one light erbium with the same doctor and I actually did see improvement in the biggest bumps from that but he didn't go quite deep enough to get it all.
My thoughts about it all so far are any sufficiently powerful fractionated laser will visibly produce collagen where it hits and everywhere else between will be the same as before. I think this is what produces the differential between the raised bumpy parts and the normal parts. When I got the laser, I was under the misunderstanding that it would be fully ablative and more even. Now knowing the strong laser was pretty sparse, this seems fully expected and the only reason I can think of that my doctor didn't know this would happen is that the older clientele that more typically get this laser don't have as high of a collagen production response as a younger person like me or that I just have an abnormally high collagen production response or that it was heightened by using a retinoid and the human growth factors in TNS Recovery Complex.
Many of the doctors say the sheen is an unavoidable part of lasers. They say many people like it because it makes them glow. Maybe I'd feel the same if it didn't exaggerate the abnormal texture I have developed.
From here, I am talking to one doctor about getting a very light fully ablative erbium, which he said he's used to solve this in other patients. I was thinking we want to prevent depositing any energy, so this may be risky. I'm wondering if dermabrasion might be a safer and more effective route. I haven't found any doctors who do it though. Someone else I have been talking to had a similar response after the same laser and they have been doing microneedling and they said it's partly solved it. Maybe I just need to do more microneedling or deeper microneedling (the doctor did 1mm for me because he said he only needs to treat the surface).
Here is one piece of data for my theory behind fractionated lasers causing this. On page 5 of this paper, I noticed this case where the unscarred part of the nose was also lasered. I circled it below:
I agree that the laser greatly improved the scarred area but the unscarred area looks worse. It has raised lines of skin between the pores and looks kind of shriveled. I didn't personally get my nose lasered, but I did have the rest of the face. The issue is most prevalent on my cheeks, chin, and jawline.
1 hour ago, laserorange said:Here is one piece of data for my theory behind fractionated lasers causing this. On page 5 of this paper, I noticed this case where the unscarred part of the nose was also lasered. I circled it below:
I agree that the laser greatly improved the scarred area but the unscarred area looks worse. It has raised lines of skin between the pores and looks kind of shriveled. I didn't personally get my nose lasered, but I did have the rest of the face. The issue is most prevalent on my cheeks, chin, and jawline.
With any medical procedure there are always risks, and maybe you can be that unlucky person to get those risks. I strongly believe fractional laser give more texture issues atleast erbium laser. Full ablative mode you don™t need co2 laser you can just go for erbium. Much safer. Co2 might be good fractional but don™t have experience with. Here is a response on realself
https://www.realself.com/question/people-worse-skin-after-laser-threatment
Now coming to your solution, I believe you can™t take a chance with full ablative mode with these. I would say a full face phenol chemobrasion with dr rullan might be a good bet. It does removes other pigment issues since it goes till dermis. So probably this is something to consider. Just email him and mention your issues along with pics. The way he does is day 1 he does bad scars with cross then he put acid on rest of the face in a uniform way. Then the next day he will use a toungue depressor or even sometimes he would use wet earbud. Because the top layer is melted so it get removed easily. Then he agains sees those scars and do cross and outs acid directly on the peel skin. And then he puts green powder on the top.
Hello, this actually happened to me without laser from aggressive use of tretinoin. Have you been using retinoid the past 11 months? Does your skin have a burning sensation or just have the sheen appearance and texture? I think you're onto something with your researched theory on the laser. I don't think retinoid caused it but it could make it worse with continued use.
17 hours ago, getsmart121 said:With any medical procedure there are always risks, and maybe you can be that unlucky person to get those risks. I strongly believe fractional laser give more texture issues atleast erbium laser. Full ablative mode you dont need co2 laser you can just go for erbium. Much safer. Co2 might be good fractional but dont have experience with. Here is a response on realself
https://www.realself.com/question/people-worse-skin-after-laser-threatment
Now coming to your solution, I believe you cant take a chance with full ablative mode with these. I would say a full face phenol chemobrasionwith dr rullan might be a good bet. It does removes other pigment issues since it goes till dermis. So probably this is something to consider. Just email him and mention your issues along with pics. The way he does is day 1 he does bad scars with cross then he put acid on rest of the face in a uniform way. Then the next day he will use a toungue depressor or even sometimes he would use wet earbud. Because the top layer is melted so it get removed easily. Then he agains sees those scars and do cross and outs acid directly on the peel skin. And then he puts green powder on the top.
Sorry Im a little confused by some of the things you wrote. You say the fully ablative erbium is safe but then say it might be risky and recommend the phenol peel that goes deeper?
I really appreciate you sharing the realself post. That does seem in line with my thoughts.
6 hours ago, Kay24 said:Hello, this actually happened to me without laser from aggressive use of retinoid. Have you been using retinoid the past 11 months? Does your skin have a burning sensation or just have the sheen appearance and texture? I think you're onto something with your researched theory on the laser. I don't think retinoid caused it but it could make it worse with continued use.
I used my retinoid Tazoracstarting about 6 weeks after the co2 laser for about 4 months. It was a little strong when I first restarted it and made me peel but moisturizing before helped that so I did that.I stopped it when another doctor suggested it might have contributed to this. I had been using retinoids for about 7 years before that and never had this issue so I agree it didnt cause this by itself, but combined with the stimulation from the laser, I am led to believe it amplified the orange peel effect.
I'm not healed all the way but my skin did look just like that. There are older threads on here discussing the issue with retinoid damage and they seem similar. I felt like my skin was inflamed. My skin was also a deep purple color and it burned constantly. It still does 10 months out but it's healing, very very slowly.
I can't say for sure if it's the same problem because the co2 might be more complicated. I only have one picture of the before/recent in daylight. I'll pm you tomorrow. If it is the same problem then it does heal but it takes forever. Are you only 6 months out on stopping the Tazorac? I had to dial my topicals down. I absolutely do not touch harsh active ingredients. Just a gentle cleanser once daily and a sunscreen.
8 hours ago, laserorange said:Sorry Im a little confused by some of the things you wrote. You say the fully ablative erbium is safe but then say it might be risky and recommend the phenol peel that goes deeper?
I really appreciate you sharing the realself post. That does seem in line with my thoughts.
I used my retinoid Tazoracstarting about 6 weeks after the co2 laser for about 4 months. It was a little strong when I first restarted it and made me peel but moisturizing before helped that so I did that.I stopped it when another doctor suggested it might have contributed to this. I had been using retinoids for about 7 years before that and never had this issue so I agree it didnt cause this by itself, but combined with the stimulation from the laser, I am led to believe it amplified the orange peel effect.
Both co2 and erbium laser comes with 2setting, full mode and fractional. Full mode covers all skin tissue whereas fractional covers only portion of tissue and leave healthy skin in between. Erbium in fractional mode is not good. as it evaporates columns in skin, sure this might help boxcars but can give you texture issues like dotted appearance. Since you have orange texture i thought your best bet would maybe try erbium in full ablative mode or phenol peel covering the same treatment area.
I'm not healed all the way but my skin did look just like that. There are older threads on here discussing the issue with retinoid damage and they seem similar. I felt like my skin was inflamed. My skin was also a deep purple color and it burned constantly. It still does 10 months out but it's healing, very very slowly.
I can't say for sure if it's the same problem because the co2 might be more complicated. I only have one picture of the before/recent in daylight. I'll pm you tomorrow. If it is the same problem then it does heal but it takes forever. Are you only 6 months out on stopping the Tazorac? I had to dial my topicals down. I absolutely do not touch harsh active ingredients. Just a gentle cleanser once daily and a sunscreen.
Hi !
I just wanted to ask you if your "deep purple/red color" subsided?. I believe im am in the same boat that you were in or might still be?, i got erbium YAG and RF microneedling. and I used .1 tret and azelaic acid 20% after the treatments for about 6-7 months. I noticed that my skin was always oily and felt warm and irritated. I also would get random rosacea flare-ups during the day. and at night I could feel my skin getting warmer and I could feel my heartbeat through it. I think the tretinoin didn't let my skin fully heal after these treatments and now my skin barrier is just fried out to the MAX. I have not used anything on my skin for the last month and it's getting better, however, I still have a long road ahead to fully heal my skin.
@orangelaser162gmail-com
I had co2 laser in 2022 and ended up with the orange peel texture, sepcifically, on my cheeks, chin, and jawline. My previous scarring looks worse than it did prior to getting laser too. I developed deep wrinkles on my forehead one month after laser and didnt have any wrinkles beforehand. I trusted my dermatologist as he had 30 years of experience, has written papers regarding lasers, etc. Now, my skin looks like your photos. I found this thread through a Google search trying to find someone who was successful in fixing the damage caused by lasers. I literally paid someone 5k to make my skin look worse. Do you happen have any updates? I'm desperate for answers. Thanks