Non-ablative Fractional Laser

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 Bleeding14% to 71%
SHORT TERM Skin darkening (post-inflammatory hyperpigmentation)5% to 71%
SHORT TERM Crustsup to 36.4%
SHORT TERM Skin redness (erythema) lasting longer than 5 days14% to 25%
SHORT TERM Blisters (bullae)up to 22.7%
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-up10% to 15%

Possible/Rare Side Effects

SHORT TERM Pain lasting longer than 2 hours10% to 13.6%
SHORT TERM Dryness lasting longer than 5 daysup to 10%
SHORT TERM Crusting lasting more than 7 daysup to 3%
SHORT TERM Cold sore flare-up (herpes eruption)up to 2%

Studies:

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

  • Study 1:

    • Authors: Alexis et al.4
    • 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.7
    • 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.24
    • 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.25
    • 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 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.4

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.7

Study 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.24

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.25

References
  1. Sobanko JF, and Alster TS. Management of acne scarring, part I: a comparative review of laser surgical approaches. Am J Clin Dermatol. 13(5), 319-30 (2012)
  2. Preissig J, Hamilton K, and Markus R. Current laser resurfacing technologies: A review that delves beneath the surface. Semin Plast Surg. 26(3), 109–116 (2012).
  3. Uptodate.com. Management of acne scars. Available from: https://www.uptodate.com/contents/management-of-acne-scars?source=search_result&search=subcision&selectedTitle=1~4. Last retrieved on 30 June, 2017.
  4. 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).
  5. Alster TS, and West TB. Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. Dermatol Surg. 22(2), 151-4 (1996).
  6. Bhatia AC, Dover JS, Arndt KA, Stewart B, and Alam M. Patient satisfaction and reported long-term therapeutic efficacy associated with 1,320 nm Nd:YAG laser treatment of acne scarring and photoaging. Dermatol Surg. 32(3), 346-52 (2006).
  7. 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).
  8. Ahmed R, Mohammed G, Ismail N, and Elakhras A. Randomized clinical trial of CO₂ LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars. J Cosmet Laser Ther. 16(1), 8-13 (2014).
  9. Engın B, et al. Evaluation of effectiveness of erbium:yttrium-aluminum-garnet laser on atrophic facial acne scars with 22-MHz digital ultrasonography in a Turkish population. J Dermatol. 39(12), 982-8 (2012).
  10. Jeong JT, and Kye YC. Resurfacing of pitted facial acne scars with a long-pulsed Er:YAG laser. Dermatol Surg. 27(2), 107-10 (2001).
  11. Lee SJ, Kang JM, Chung WS, Kim YK, and Kim HS. Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians. Lasers Med Sci. 29(2), 615-9 (2014).
  12. Wanitphakdeedecha R, Manuskiatti W, Siriphukpong S, and Chen TM. Treatment of punched-out atrophic and rolling acne scars in skin phototypes III, IV, and V with variable square pulse erbium:yttrium-aluminum-garnet laser resurfacing. Dermatol Surg. 35(9), 1376-83 (2009).
  13. Tanzi EL, and Alster TS. Treatment of atrophic facial acne scars with a dual-mode Er:YAG laser. Dermatol Surg. 28(7), 551-5 (2002).
  14. Bjørn M, Stausbøl-Grøn B, Braae Olesen A, and Hedelund L. Treatment of acne scars with fractional CO2 laser at 1-month versus 3-month intervals: an intra-individual randomized controlled trial. Lasers Surg Med. 46(2), 89-93 (2014).
  15. Cho SB, Lee SJ, Kang JM, Kim YK, Chung WS, and Oh SH. The efficacy and safety of 10,600-nm carbon dioxide fractional laser for acne scars in Asian patients. Dermatol Surg. 35(12),1955-61 (2009).
  16. Hedelund L, Haak CS, Togsverd-Bo K, Bogh MK, Bjerring P, and Haedersdal M. Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation. Lasers Surg Med. 44(6), 447-52 (2012).
  17. Majid I, and Imran S. Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars. J Cutan Aesthet Surg. 7(2), 87-92 (2014).
  18. Manuskiatti W, Triwongwaranat D, Varothai S, Eimpunth S, and Wanitphakdeedecha R. Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. J Am Acad Dermatol. 63(2), 274-83 (2010).
  19. Manuskiatti W, Iamphonrat T, Wanitphakdeedecha R, Eimpunth S. Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians. Dermatol Surg. 39(1 Pt 1), 111-20 (2013).
  20. Nirmal B, et al. Efficacy and safety of erbium-doped yttrium aluminium garnet fractional resurfacing laser for treatment of facial acne scars. Indian J Dermatol Venereol Leprol. 79(2), 193-8 (2013).
  21. Wang YS, Tay YK, and Kwok C. Fractional ablative carbon dioxide laser in the treatment of atrophic acne scarring in Asian patients: a pilot study. J Cosmet Laser Ther. 12(2), 61-4. (2010).
  22. Yuan XH, Zhong SX, and Li SS. Comparison study of fractional carbon dioxide laser resurfacing using different fluences and densities for acne scars in Asians: a randomized split-face trial. Dermatol Surg. 40(5), 545-52 (2014).
  23. Zhang Z, Fei Y, Chen X, Lu W, and Chen J. Comparison of a fractional microplasma radio frequency technology and carbon dioxide fractional laser for the treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg. 39(4), 559-66 (2013)
  24. 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).
  25. 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).