Consensus Statement on the Prevention and Management of Complications of Fully Ablative Laser Resurfacing of the Face

Bianca Y. Kang, Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA.
Joel L. Cohen, AboutSkin Dermatology and AboutSkin Research, Greenwood Village, Colorado, USA.
Roy Geronemus, Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York, USA.
Suzanne L. Kilmer, Laser & Skin Surgery Medical Group, Inc, Sacramento, California, USA.
Edward Victor Ross, Scripps Clinic, San Diego, California, USA.
Elizabeth L. Tanzi, George Washington University School of Medicine, Washington, DC, USA.
Jill S. Waibel, Miami Dermatology & Laser Institute, Miami, Florida, USA.
Brian J. Wong, Beckman Laser Institute & Medical Clinic, University of California Irvine, Irvine, California, USA.
Murad Alam, Departments of Dermatology, Otolaryngology, Surgery, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Macrene Alexiades, Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA.
Kenneth A. Arndt, SkinCare Physicians, Chestnut Hill, Massachusetts, USA.
Mathew Avram, Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Ashish C. Bhatia, Department of Dermatology, Northwestern University, Chicago, Illinois, USA.
Brian Stuart Biesman, Departments of Ophthalmology, Dermatology, and Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Jason D. Bloom, Department of Otolaryngology: Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
A Jay Burns, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Henry H. Chan, Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China.
Catherine M. DiGiorgio, CMD Dermatology, Laser & Aesthetics, Boston, Massachusetts, USA.
Jeffrey S. Dover, Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA.
Sam Fathizadeh, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
Sara C. Esteves, Creighton University School of Medicine, Phoenix, Arizona, USA.
Michael H. Gold, Gold Skin Care Center, Nashville, Tennessee, USA.
Gerald N. Goldberg, Banner University Medical Center, Tucson, Arizona, USA.
Merete Haedersdal, Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Elika Hoss, Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA.
Omar A. Ibrahimi, Connecticut Skin Institute, Stamford, Connecticut, USA.
H Ray Jalian, Rebecca Fitzgerald MD, Los Angeles, Connecticut, USA.
Kristen M. Kelly, Beckman Laser Institute & Medical Clinic, University of California Irvine, Irvine, California, USA.
Woraphong Manuskiatti, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Bangkok, Mahidol University, Thailand.
Lisa A. Marks, Mayo Clinic Libraries, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona, USA.
Girish S. Munavalli, Department of Dermatology, Wake Forest University, Salem, North Carolina, USA.
Jason N. Pozner, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Document Type

Journal Article

Publication Date

6-11-2025

Journal

Lasers in surgery and medicine

DOI

10.1002/lsm.70035

Keywords

complications; consensus; face; fully ablative; laser; management; prevention; resurfacing; statement

Abstract

OBJECTIVES: To achieve consensus among expert laser surgeons on standards for the prevention and management of adverse events from fully ablative laser resurfacing of the face. MATERIALS AND METHODS: Delphi study with two rounds of ratings and revisions until consensus was achieved. The draft set of statements was developed by a steering committee based on expert clinical experience. This was followed by two rounds of rating and revisions completed by an expert panel, then a virtual consensus meeting. In both rounds, respondents rated the draft statements on a 9-point Likert scale (1 = strongly disagree; 9 = strongly agree) and optionally provided comments. The consensus meeting was supplemented by the results of a systematic review of the literature (from 2000 to 2023). RESULTS: Two rounds of Delphi survey were completed by 34 participants across four countries. Represented specialties were dermatology, facial plastic surgery, plastic surgery, and oculoplastic surgery. The initial 105 statements from round 1 expanded to 112 in round 2, with 96 statements achieving consensus. These included possible adverse events (11 statements); absolute and relative contraindications to treatment (5 statements); preoperative care and antimicrobial prophylaxis precautions (16 statements); intraoperative precautions (17 statements); postoperative care (21 statements); monitoring for and management of infection (16 statements); management of pigmentation changes (6 statements); and management of scarring and incipient scarring (4 statements). CONCLUSION: An international consensus statement was developed for the prevention and management of complications associated with fully ablative laser resurfacing of the face. While expert practices vary, key factors for optimizing outcomes include careful patient selection, counseling, and meticulous pre- and postoperative care. Further research will improve our understanding of this treatment technique.

Department

Dermatology

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