Management of infections associated with laser-assisted cosmetic skin resurfacing

Abstract

The last decade has seen a large increase in the number of cosmetic surgical procedures performed in the United States. New operations, techniques, and technologies seem to appear each year. Although the exact reason for this increase is not totally clear, cultural and social factors have played a role. Once limited only to older women, cosmetic surgery is currently sought by younger people, men, and even children. Much controversy has been generated concerning the wisdom of our society seeking the performance of totally elective surgery. Proponents make arguments based on psychological well-being and the relative safety of these procedures, whereas critics point out that even with all the technologic advances, cosmetic surgery is still associated with a low, but inevitable, degree of morbidity and even occasional mortality. Among the more recent advances in aesthetic facial surgery has been the development of laser-assisted cosmetic skin resurfacing (CSR), which has become one of the most popular procedures performed by maxillofacial cosmetic surgeons [1]. Similar in effect to chemical peeling and dermabrasion (which also are associated with the same incidence and types of infections), CSR has gained in popularity because of new advances in laser technology that allow precise, targeted, tissue ablation and the fact that these devices are relatively affordable and portable enough for office-based use. Combining this technology with a better understanding of the physiology of skin wound healing and the availability of new scientifically based pharmaceuticals for preoperative and postoperative skin care has made the procedure easily and safely performed by various practitioners. Thousands of these procedures have been performed with generally excellent aesthetic results. Although currently well accepted as a useful surgical procedure in the cosmetic surgeon’s armamentarium, CSR has had its share of controversy. As with many technology-based procedures, the rapid availability of the ever-changing types of hardware, coupled with the need and desire of the practitioner to generate a positive cash flow from these expensive devices, has brought with it an immediate influx of practitioners of varying backgrounds, surgical expertise, and laser experience. Unfortunately, the rapid advances in laser technology and widespread use of CSR preceded the ability of researchers to provide a clear understanding of the pathophysiology involved, the mechanism of laser action, the indications and contraindications for their use, and some of the potential and inevitable complications that were to be expected. As a consequence, CSR has been associated with several serious and occasionally disastrous complications. With time and much scientific research, many of the unknowns that led to some of the initial problems have been answered. Reasonable technique and patient selection protocols, based on defensible science, have decreased the incidence of complications dramatically. They do occur, however, and the wise surgeon always should be wary and diligent in looking for early evidence of untoward intraoperative and postoperative sequelae. Some of the complications seen to date include scarring, hypopigmentation and hyperpigmentation, blotchiness, pruritis, ectropion, and infection. Of these complications, infection associated with CSR