Ablative Fractional Lasers

Compare To Other Treatments

The charts below show the chances of developing various side effects from ablative fractional laser treatment.1-5 For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Painup to
100%
SHORT TERM Redness (erythema)up to
100%
SHORT TERM Swelling (edema)up to
100%
SHORT TERM Oozing from woundsup to
100%
SHORT TERM Skin lightening  (hypopigmentation)up to 10%

Studies:

Three studies have looked at the side effects of ablative fractional laser treatment on raised scars.

  • Study 1:

    • Authors: Choi et al.1
    • Total # of patients: 23
    • # of female patients: 17
    • # of male patients: 6
    • Age of patients: 8-57
    • Laser type: Ablative fractional laser Er:YAG (2.5-3.0 J/P, 10-20 passes) or ablative fractional CO2 laser (40-60 mJ, a density of 150 spots/cm2, 3-5 passes)
    • Duration of treatment and follow-up:  Er:YAG fractional laser: 2 to 7 treatments, CO2 fractional laser: 1 to 9 treatments, follow-up for up to 10 months
    • Side effects:
      • Mild-moderate pain: (percentage not reported)
      • Redness (erythema): (percentage not reported)
      • Swelling (edema): (percentage not reported)
  • Study 2:

    • Authors: Tawfic et al.2
    • Total # of patients: 30
    • # of female patients: 22
    • # of male patients: 8
    • Age of patients: 18-49
    • Laser type: Ablative fractional CO2 laser (power: 20 W, dwell time: 1000 µs, spacing: 800 µm, and stack of 5) or ablative fractional Nd:YAG laser (fluence of 40 J/cm2, pulse duration of 0.3 m/s, and spot size of 5 mm in a focused mode for 3 passes), or the combination of both lasers with a 30 minutes pause in between
    • Duration of treatment and follow-up: 4 treatments, follow-up for 1 month
    • Side effects:
      • Pain: 100%
      • Redness (erythema): 100%
      • Swelling (edema): 100%
      • Oozing from wounds: 100%
      • Skin lightening (hypopigmentation): 10%
  • Study 2:

    • Authors: Manuskiatti et al.3
    • Total # of patients: 24
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: 24-45
    • Laser type: Ablative fractional Er:YAG laser (fluence: 28 J/cm2, pulse width: 300 µs, density: 5%)
    • Duration of treatment and follow-up: 4 treatments, follow-up for 3 months
    • Side effects:
      • No side effects reported.

Study 1: In a study published in 2013 in the Journal of Dermatological Treatment, Choi and colleagues treated 23 patients with raised scars with ablative fractional Er:YAG or CO2 laser. Patients treated with Er:YAG laser received up to 7 treatments in 3 to 4 weeks intervals, while CO2 laser was applied up to 9 times at 4 to 8 weeks intervals. While the safety of both lasers was good, patients treated with the CO2 laser had more satisfying results than patients treated with Er:YAG laser. Both groups experienced side effects such as mild to moderate pain, redness, or swelling which resolved in 4 to 10 days. However, the exact number of patients who developed these adverse effects was not reported.1

Study 2: In a study published in 2020 in Lasers in Surgery and Medicine, Tawfic and colleagues treated 30 patients with hypertrophic scars and keloids with 2 different types of ablative fractional lasers, CO2 and Nd:YAG (a different type of laser), or their combination. All patients received 4 laser sessions in 3 to 6 weeks intervals and were followed for 1 month after the last session. While all patients experienced side effects, such as pain, swelling, redness, and oozing from wounds, their severity differed among groups. The tables below show the difference in reported side effects among groups.2

Ablative fractional CO2 laser

Mild-to-moderate pain66.7% 
Severe pain33.3%
Oozing from wounds after laser session:100%

Ablative fractional Nd:YAG laser

Mild-to-moderate pain100%

Combination of ablative fractional CO2 laser and Nd:YAG laser

Mild-to-moderate pain66.7%
Severe pain33.3%
Oozing from wounds after laser session100%
Skin lightening10%

Study 3: In a study published in 2021 in the journal Acta Dermato Venereologica, Manuskiatti and colleagues treated 24 patients with raised scars with ablative fractional laser. All patients received 4 treatment sessions in 2-week intervals and were followed up for an additional 3 months. The authors reported that patients did not experience any side effects at any of the follow-up visits.3

Systematic reviews: Two recent systematic reviews summarized published clinical data about the use of ablative fractional lasers for the treatment of hypertrophic and keloid scars. All reported side effects were tolerable and resolved quickly. Most commonly, patients experience pain, itching, and skin lightening (hypopigmentation).4,5

References
  1. Choi JE, Oh GN, Kim JY, Seo SH, Ahn HH, Kye YC. Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers. J Dermatolog Treat. 25(4), 299-03 (2014).
  2. Tawfic SO, El-Tawdy A, Shalaby S, Foad A, Shaker O, Sayed SS, Metwally D. Evaluation of Fractional CO2 Versus Long Pulsed Nd:YAG Lasers in Treatment of Hypertrophic Scars and Keloids: A Randomized Clinical Trial. Lasers Surg Med. 52(10), 959-65 (2020).
  3. Manuskiatti W, Kaewkes A, Yan C, Ng JN, Glahn JZ, Wanitphakdeedecha R. Hypertrophic Scar Outcomes in Fractional Laser Monotherapy Versus Fractional Laser-Assisted Topical Corticosteroid Delivery: A Randomized Clinical Trial. Acta Derm Venereol. 101(3), adv00416 (2021).
  4. Oosterhoff TCH, Beekman VK, van der List JP, Niessen FB. Laser treatment of specific scar characteristics in hypertrophic scars and keloid: A systematic review. J Plast Reconstr Aesthet Surg. 74(1), 48-64 (2021).
  5. Choi KJ, Williams EA, Pham CH, Collier ZJ, Dang J, Yenikomshian HA, Gillenwater TJ. Fractional CO2 laser treatment for burn scar improvement: A systematic review and meta-analysis. Burns. 47(2), 259-69.

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