Fractional CO2 Laser with Platelet-rich Plasma

Compare To Other Treatments

The charts below show the chances of developing various side effects from fractional CO2 laser resurfacing with PRP.1-7 While studies suggest that the addition of PRP to fractional CO2 laser can reduce the severity and occurrence of side effects, combined treatment normally still causes redness, swelling, pain, and hyperpigmentation. The chart below summarizes data from 7 clinical studies.

For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Redness (erythema)up to 100%
SHORT TERM Swelling (edema)up to 100%
SHORT TERM Skin darkening (post-inflammatory hyperpigmentation)up to 100%
SHORT TERM Painup to 100%
SHORT TERM Crusting / Scalingup to 15%

Possible/Rare Side Effects

SHORT TERM Acne flare-upup to 6%
SHORT TERM Skin infectionup to 3%
SHORT TERM Oozing from woundsincidence not known

Studies:

Seven studies have looked at the side effects of treatment with fractional CO2 laser with PRP.

  • Study 1:

    • Authors: Min et al.1
    • Total # of patients: 25
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: Average: 31.9
    • Laser type: CO2 fractional laser
    • Laser settings: 12 mm spot size, 0.9 W, 1 ms pulse duration
    • PRP: Isolated plasma was applied after laser treatment as intradermal injection
    • Duration of treatment and follow-up: 2 treatments, follow-up for 2 months
    • Side effects:
      • Erythema (redness): 100%
      • Edema (swelling): 100%
      • Temporary hyperpigmentation (skin darkening): 100%
      • Oozing: incidence not reported
  • Study 2:

    • Authors: Galal et al.2
    • Total # of patients: 30
    • # of female patients: 21
    • # of male patients: 9
    • Age of patients: 20-42
    • Laser type: CO2 fractional laser
    • Laser settings: SmartXide DOT Fractionated CO2 Laser with smart stack scanning method with a power of 15 W, spacing of 800 mµ, a 600 sµ dwell time, and stack2
    • PRP: Isolated plasma was applied after laser treatment as intradermal injection with nappage technique (application of multiple superficial injections only 2mm deep at a 45-degree angle). Excess drops were rubbed gently on the skin. Cold compresses were applied after injection to decrease edema and pain
    • Duration of treatment and follow-up: 3 treatments, follow-up for 3 months
    • Side effects:
      • Erythema (redness): 100%
      • Edema (swelling): 100%
      • Mild post-inflammatory hyperpigmentation (skin darkening): 45.5%
  • Study 3:

    • Authors: Arsiwala et al.3
    • Total # of patients: 33
    • # of female patients: 12
    • # of male patients: 21
    • Age of patients: 22-35
    • Laser type: CO2 fractional laser
    • Laser settings: Fractional CO2 laser system with a wavelength of 10,600nm; pulse energy of 50–100 mJ; spot density of 50–100 spots cm2 in the static mode; 1–2 passes were delivered using a 120-density tip with beam size of 120 µm and peak power of 30 W
    • PRP: Isolated plasma was applied topically (massaged into the treated area)
    • Duration of treatment and follow-up: 3 treatments, follow-up at 2-3 days and 4 weeks after each session
    • Side effects:
      • Erythema (redness): 66.67%
      • Post-inflammatory hyperpigmentation (skin darkening): 30.3%
      • Edema (swelling): 24.24%
      • Pain: 9%
      • Acne flare-up: 6%
      • Secondary infection: 3%
  • Study 4:

    • Authors: Godara et al.4
    • Total # of patients: 30
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: 18-60
    • Laser type: CO2 fractional laser
    • Laser settings: Pulse energy 25 mJ; spot density 144/cm2; pulse interval 0.5 mm, and pulse duration 0.1 milliseconds
    • PRP: Intradermal injections at 1cm intervals of 0.1 ml PRP
    • Duration of treatment and follow-up: 4 treatments, follow-up at 2-3 days and 4 weeks after each session
    • Side effects:
      • Erythema (redness): 100%
      • Pain: 100%
  • Study 5:

    • Authors: Gawdat et al.5
    • Total # of patients: 30
    • # of female patients: 18
    • # of male patients: 12
    • Age of patients: 19-35
    • Laser type: CO2 fractional laser
    • Laser settings: power, 15 W; dwell time, 600 ls; spacing, 700 lm; smart stack, level 2
    • PRP: One group received injections administered under sterile conditions, with 0.2 mL of autologous PRP at 10 different sites approximately 1.5 cm apart. In the other group, 2 mL of PRP was applied topically
    • Duration of treatment and follow-up: 3 treatments, follow-up at 3 months
    • Side effects:
      • Erythema (redness): incidence not reported
      • Edema (swelling): incidence not reported
      • Mild crusting: incidence not reported
      • Transient acneiform (acne-like) lesions: incidence not reported
      • Pain: incidence not reported
  • Study 6:

    • Authors: Makki et al.6
    • Total # of patients: 20
    • # of female patients: 11
    • # of male patients: 9
    • Age of patients: 18-40
    • Laser type: CO2 fractional laser
    • Laser settings: 10,600 nm (Quanta System DNA Laser Technology, Italy) for the whole scar; 2 passes of 30 mJ fluence; a dwell time 750 ms; total density 100 spots/cm2
    • PRP: Intradermal injection
    • Duration of treatment and follow-up: 3 treatments, follow-up at 1 month
    • Side effects:
      • Edema (swelling): 20%
      • Erythema (redness): 15%
      • Crusting: 15%
      • Post-inflammatory hyperpigmentation (skin darkening): 5%
  • Study 7:

    • Authors: Kar and Raj7
    • Total # of patients: 30
    • # of female patients: 10
    • # of male patients: 20
    • Age of patients: 18-34
    • Laser type: CO2 fractional laser
    • Laser settings: 30-W FIRE-XEL ablative fractional CO2 laser; area 2cm2; density 0.8mm; pulse 1540 microseconds; energy 200-250 mJ
    • PRP: Topical application immediately after the laser
    • Duration of treatment and follow-up: 3 treatments, follow-up at 6 months
    • Side effects:
      • Edema (swelling): 6.13%
      • Erythema (redness): 5.8%
      • Pain: 5.76%

Study 1: In a study published in 2018 in the Lasers in Surgery and Medicine, Min and colleagues treated 25 patients with CO2 fractional laser and PRP. Patients received 2 treatments at 4-week intervals and were followed up for 2 months. The researchers advised the patients not to use any other scar treatment during the study. Reported side effects included redness, swelling, and skin darkening.1

Study 2: In a study published in 2019 in the Journal of Cosmetic Dermatology, Galal and colleagues treated 30 patients with moderate to severe atrophic (indented) acne scars with CO2 fractional laser and PRP. Patients were given 3 treatments, which were administered at an interval of 1 month. The researchers randomly assigned patients into 2 groups, one received only fractional CO2 laser and the other one received combined fractional CO2 laser and PRP treatment. While side effects were mild and transient in both groups, researchers found that additional of PRP to fractional CO2 laser can reduce the severity of side effects.2

Study 3: In a study published in 2020 in the Journal of Cutaneous and Aesthetic Surgery, Arsiwala and colleagues treated 33 patients with mild to severe atrophic (indented) acne scars with 3 sessions of CO2 fractional laser and PRP. Patients were followed up at 2-3 days and 4 weeks after each session. All patients experienced mild side effects in the first 2-3 days after treatment. The most commonly reported side effect was redness (66.67%) followed by skin darkening (30.3%) and swelling (24.24%). Some patients also experienced pain (9%), acne flare -up (6%), and secondary infections (3%).3

Study 4: In a study published in 2020 in the Indian Dermatology Online journal, Goadara and colleagues treated 30 patients with atrophic (indented) acne scars with CO2 fractional laser and PRP. They compared the efficacy and safety of a given treatment with the efficacy and safety of fractional CO2 laser in 37 patients with the same type of scars. Patients were given 4 sessions of treatment at intervals of 4 weeks. All patients experienced significant scar improvement and mild side effects with no differences between groups.4

Study 5: In a study published in 2014 in the journal Dermatologic Surgery, Gawdat et al. treated 30 patients with atrophic (indented) acne scars with CO2 fractional laser and PRP. The patients received 3 sessions of treatment at 4-week intervals and were followed up 3 months after the last laser session. Authors reported that side effects included: erythema (redness), edema (swelling), crusting, transient acne-like lesions, and pain.5

Study 6: In a study published in 2019 in Dermatologic Therapy, Makki and colleagues treated 20 patients with atrophic (indented) acne scars with CO2 fractional laser and PRP. The patients received 3 sessions of treatment at 4-week intervals and were followed up 1 month after the last session. The majority of patients experienced swelling and redness, while only 1 patient developed post-inflammatory hyperpigmentation (skin darkening).6

Study 7: In a study published in 2017 in the Journal of Cutaneous and Aesthetic Surgery, Kar and Raj treated 30 patients with moderate-to-severe acne scars with a fractional CO2 laser and PRP. The patients were randomly assigned to receive CO2 fractional laser treatment on one side of the face and CO2 fractional laser with PRP treatment on the other side of the face. On each side, 3 treatments were administered at an interval of 1 month. The researchers followed up with the patients 6 months after the last treatment. Although both groups experienced redness, edema, and pain, symptoms were less severe in patients treated with fractional CO2 laser and PRP.7

References
  1. Min S, Yoon JY, Park SY, Moon J, Kwon HH, Suh DH. Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation. Lasers Surg Med. 50(4), 302-10 (2018).
  2. Galal O, Tawfik AA, Abdalla N, Soliman M. Fractional CO2 laser versus combined platelet-rich plasma and fractional CO2 laser in treatment of acne scars: Image analysis system evaluation. J Cosmet Dermatol. 18(6), 1665-71 (2019).
  3. Arsiwala NZ, Inamadar AC, Adya KA. A Comparative Study to Assess the Efficacy of Fractional Carbon Dioxide Laser and Combination of Fractional Carbon Dioxide Laser with Topical Autologous Platelet-rich Plasma in Post-acne Atrophic Scars. J Cutan Aesthet Surg. 13(1), 11-17 (2020).
  4. Godara S, Arora S, Dabas R, Arora G, Renganathan G, Choudhary R. A Comparative Study on the Efficacy of Fractional CO2 Laser and Fractional CO2 Laser with Autologous Platelet-Rich Plasma in Scars. Indian Dermatol Online J. 11(6), 930-6 (2020).
  5. Gawdat HI, Hegazy RA, Fawzy MM, Fathy M. Autologous platelet rich plasma: topical versus intradermal after fractional ablative carbon dioxide laser treatment of atrophic acne scars. Dermatol Surg. 40(2), 152-61 (2014).
  6. Makki M, Younes AEKH, Fathy A, Abd ElDayem OY, Morsy H. Efficacy of platelet-rich plasma plus fractional carbon dioxide laser in treating posttraumatic scars. Dermatol Ther. 32(5), e13031 (2019).
  7. Kar BR, Raj C. Fractional CO2 Laser vs Fractional CO2 with Topical Platelet-rich Plasma in the Treatment of Acne Scars: A Split-face Comparison Trial. J Cutan Aesthet Surg. 10(3), 136-44 (2017).

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