Non-ablative Fractional Lasers

Compare To Other Treatments

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

Certain/Likely Side Effects

SHORT TERM Skin redness (erythema)up to 100%
SHORT TERM Swelling (edema)up to 100%
SHORT TERM Bleedingup to 71%
SHORT TERM Skin darkening (post-inflammatory hyperpigmentation)up to 71%
SHORT TERM Crustsup to 36%
SHORT TERM Skin redness (erythema) lasting longer than 5 daysup to 25%
SHORT TERM Blisters (bullae)up to 23%
SHORT TERM Swelling (edema) lasting longer than 5 daysup to 15%
SHORT TERM Red/Purple discolored spots on the skin (purpura)up to 15%
SHORT TERM Acne flare-upup to 15%

Possible/Rare Side Effects

SHORT TERM Pain lasting longer than 2 hoursup to 14%
SHORT TERM Dryness lasting longer than 5 daysup to 10%
SHORT TERM Crusting lasting more than 7 daysup to 3%
SHORT TERM Pustulesup to 3%
SHORT TERM Cold sore flare-up (herpes eruption)up to 2%
SHORT TERM Itching (pruritus)incidence not known

Studies:

Seven studies have looked at the side effects of treatment with non-ablative fractional lasers.1-7

  • Study 1:

    • Authors: Alexis et al.1
    • Total # of patients: 7
    • # of female patients: 3
    • # of male patients: 4
    • Age of patients: 18-65
    • Laser type: Erbium-doped fractional laser
    • Laser settings: Low density: 200 MTZ/cm2, 11% coverage, 40 mJ
      • Duration of treatment and follow-up: 4 treatments
      • Side effects:
        • Side effects during procedure: Bleeding: 14%
        • Erythema (redness): 100%
        • Edema (swelling): 100%
        • Side effects after procedure: Erythema (redness): 14%
        • Hyperpigmentation (skin darkening): 43%
    • Laser settings: High density: 393 MTZ/cm2, 20% coverage, 40 mJ
      • Duration of treatment and follow-up: 4 treatments
      • Side effects:
        • Side effects during procedure:
          • Bleeding: 71%
          • Erythema (redness): 100%
          • Edema (swelling): 100%
        • Side effects after procedure:
          • Erythema (redness): 14%
          • Hyperpigmentation (skin darkening): 71%
  • Study 2:

    • Authors: Chae et al.2
    • Total # of patients: 20
    • # of female patients: 7
    • # of male patients: 13
    • Age of patients: 20-39 Average: 25.5
    • Laser type: Er:glass fractional laser
    • Laser settings: 500 MTZ/cm2, 15-20 mJ/MTZ
    • Duration of treatment and follow-up: 3 treatments, follow-up at 8 weeks
    • Side effects:
      • Erythema (redness) lasting over 5 days: 25%
      • Edema (swelling) lasting over 5 days: 15%
      • Dryness lasting over 5 days: 10%
      • Acne flare-up: 10%
      • Post-inflammatory hyperpigmentation (skin darkening): 10%
  • Study 3:

    • Authors: Cachafeiro et al.3
    • Total # of patients: 22
    • # of female patients: (not reporter)
    • # of male patients: (not reporter)
    • Age of patients: 16-50 Average: 26.33
    • Laser type: Fractional erbium laser
    • Laser settings: 120 mJ/microbeam, 100 microbeams/cm2, 5 ms pulse duration
    • Duration of treatment and follow-up: 3 treatments, follow-up at 2 and 6 months
    • Side effects:
      • Crusts: 36.4%
      • Pustules: 4.5%
      • Bullae (blisters): 22.7%
      • Pain lasting longer than 2 hours: 13.6%
      • Post-inflammatory hyperpigmentation (skin darkening): 13.6%
  • Study 4:

    • Authors: Isarría et al.4
    • Total # of patients: 20
    • # of female patients: 18
    • # of male patients: 2
    • Age of patients: Average: 34.7
    • Laser type: Er:glass fractional laser
    • Laser settings: 10 mm spot size, 100 microbeams/cm2, 50-60 mJ/microbeam, 10 ms or 15 ms pulse duration
    • Duration of treatment and follow-up: 4 treatments, follow-up at 12 weeks
    • Side effects:
      • Pain after treatment: 10%
      • Erythema (redness): 100%
      • Edema (swelling): 100%
      • Purpura (purple/red discolored spots on the skin): 15%
      • Acneiform reaction (acne-like lesions): 15%
      • Post-treatment hyperpigmentation (skin darkening): 5%
  • Study 5:

    • Authors: Shi et al.5
    • Total # of patients: 22
    • # of female patients: 18
    • # of male patients: 4
    • Age of patients: Average 29.7
    • Laser type: Er:glass fractional laser
    • Laser settings: 65-70 J/cm2; 1,540 nm
    • Duration of treatment and follow-up: 4 treatments, follow-up at 1 month after the last treatment
    • Side effects:
      • Pain after treatment: (incidence not reported)
      • Erythema (redness): (incidence not reported)
      • Edema (swelling): (incidence not reported)
      • Purpura (purple/red discolored spots on the skin): (incidence not reported)
      • Crusts: (incidence not reported)
      • Post-treatment hyperpigmentation (skin darkening): (incidence not reported)
      • Post-treatment hypopigmentation (skin lightening): (incidence not reported)
      • Itching (pruritus): (incidence not reported)
  • Study 6:

    • Authors: Taheri et al.6
    • Total # of patients: 30
    • # of female patients: 22
    • # of male patients: 8
    • Age of patients: 10-38
    • Laser type: Er:glass fractional laser
    • Laser settings: 10 mm spot size, 100 microbeam/cm2, 40-60 mJ/microbeam, 15 ms pulse duration
    • Duration of treatment and follow-up: 1-6 treatments, follow-up at 6 months
    • Side effects:
      • Post-treatment hyperpigmentation (skin darkening): 32.4%
      • Erythema (redness): 21.6%
      • Edema (swelling): 8.1%
      • Blisters: 6.67%
      • Pustules: 3.33%
  • Study 7:

    • Authors: Akerman et al.7
    • Total # of patients: 11
    • # of female patients: 6
    • # of male patients: 5
    • Age of patients: 19-73
    • Laser type: Nd:YAG fractional laser
    • Laser settings: 600–1200 mJ/pulse, 10 Hz
    • Duration of treatment and follow-up: 3-6 treatments, follow-up for 3 months
    • Side effects:
      • Erythema (redness): 100%
      • Edema (swelling): 100%
      • Minimal pain: 100%

Study 1: In a study published in 2016 in the journal Dermatologic Surgery, Alexis and colleagues treated 7 patients with acne scarring with erbium-doped fractional laser. Patients were randomly given low-density fractional laser treatment on one side of the face and high-density treatment on the other side of the face. All patients experienced redness and swelling on both sides of the face during treatment. Bleeding was more common on the side of the face treated with the high-density laser treatment. In addition, patients were more likely to develop hyperpigmentation (skin darkening) after the high-density treatment compared to the low-density treatment.1

Study 2: In a study published in 2015 in the Journal of Cosmetic Dermatology, Chae and colleagues treted 20 patients with atrophic (indented) facial acne scars with Er:glass fractional laser. Patients received 3 treatments at 4-week intervals and were followed up 8 weeks after the last treatment. Some patients experienced temporary side effects such as redness lasting over 5 days, acne flare-up, and in some cases, post-inflammatory hyperpigmentation (skin darkening). None of the patients developed an infection or hypertrophic (raised) scars as a result of the treatment.2

tudy 3: In a study published in 2016 in Dermatologic Surgery, Cachafeiro and colleagues treated 22 patients with moderate to severe boxcar, rolling, and/or icepick acne scars with fractional erbium laser. The patients were given 3 treatments at monthly intervals and were followed up at 2 and 6 months. Most of the side effects were minor, such as formation of crusts, blisters, and pimples.3

Study 4: In a study published in 2011 in the Journal of Drugs in Dermatology, Isarría and colleagues treated 20 patients with acne scars with Er:glass fractional laser. The patients received 4 treatments at 4-week intervals and were followed up 12 weeks after the last treatment. All patients developed erythema (redness) and edema (swelling) immediately after laser treatment, and half of the patients experienced pain during treatment. A minority of patients developed additional side effects.4

Study 5: In a study published in 2021 in the Annals of Translational Medicine, Shi and colleagues treated 24 patients with acne scars with Er:glass fractional laser. The patients received 4 treatments at 4-week intervals and were followed up 1 month after the last treatment. Patients experienced pain during the procedure and developed redness and swelling immediately after laser treatment, but the exact incidence of these side effects was not reported. Authors also reported post-treatment skin lightening, darkening, and itching that lasted for a month after the last session.5

Study 6: In a study published in 2020 in the Lasers in Surgery and Medicine, Taheri and colleagues treated 30 patients with atrophic acne scars with Er:glass fractional laser. The patients received 1-6 treatments at 4-week intervals and were followed up for 6 months after the last treatment. Authors reported redness, swelling, and skin darkening as side effects of non-ablative fractional laser treatment. All of the reported side effects resolved within 6 months after the last treatment.6

Study 7: In a study published in 2021 in Lasers in Surgery and Medicine, Akerman and colleagues treated 11 patients with atrophic acne scars with Nd:YAG fractional laser. The patients received 3-6 treatments at 4 to 6-week intervals and were followed up for 3 months after the last treatment. The authors reported only mild redness, swelling, and pain during the treatment as side effects that resolved within a few days.7

References
  1. Alexis AF, et al. Nonablative Fractional Laser Resurfacing for Acne Scarring in Patients With Fitzpatrick Skin Phototypes IV-VI. Dermatol Surg. 42(3), 392-402 (2016).
  2. Chae WS, et al. Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar. J Cosmet Dermatol. 14(2), 100-6 (2015).
  3. Cachafeiro T, Escobar G, Maldonado G, Cestari T, and Corleta O. Comparison of Nonablative Fractional Erbium Laser 1,340 nm and Microneedling for the Treatment of Atrophic Acne Scars: A Randomized Clinical Trial. Dermatol Surg. 42(2), 232-41 (2016).
  4. Isarría MJ1, Cornejo P, Muñoz E, Royo de la Torre J, and Moraga JM. Evaluation of clinical improvement in acne scars and active acne in patients treated with the 1540-nm non-ablative fractional laser. J Drugs Dermatol.10(8), 907-12 (2011).
  5. Shi Y, Jiang W, Li W, Zhang W, Zou Y. Comparison of fractionated frequency-doubled 1,064/532 nm picosecond Nd:YAG lasers and non-ablative fractional 1,540 nm Er: glass in the treatment of facial atrophic scars: a randomized, split-face, double-blind trial. Ann Transl Med. 9(10), 862 (2021).
  6. Taheri AR, Mashayekhi-Goyonlo V, Salehi M, Mohammadzadeh H. Non-Ablative Fractional 1,540-nm Er:Glass Laser in the Treatment of Atrophic Cutaneous Leishmaniasis Scars. Lasers Surg Med. 52(2), 182-7 (2020).
  7. Akerman L, Solomon-Cohen E, Rozenblat M, Hodak E, Lapidoth M, Levi A. 1064-nm Q-switched fractional Nd:YAG laser is safe and effective for the treatment of post-surgical facial scars. Lasers Med Sci. 36(4), 871-4 (2021).

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