Wound Healing Treatments After Ablative Laser Skin Resurfacing: A Review

November 2020 | Volume 19 | Issue 11 | Original Article | 1050 | Copyright © November 2020


Published online November 1, 2020

Hayley Leight-Dunn MDa, Margot Chima MDa, Elika Hoss MDb

aIcahn School of Medicine at Mount Sinai, Department of Dermatology, New York, NY
bMayo Clinic, Department of Dermatology, Phoenix, AZ

Abstract
Laser resurfacing has progressed since the 1980s to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. While laser technology has evolved to provide a more favorable safety profile and decrease wound healing time, advances in post-procedure healing agents have also helped to mitigate adverse effects, such as persistent erythema, dyspigmentation, acneiform eruptions, dermatitis, infections, and scarring. We reviewed the evidence of growth factors, stem cells, silicone and silicone polymers, botanical based treatments, fatty acids, probiotics, and closed dressings on post-ablative laser skin resurfacing. All reviewed agents demonstrated some evidence in improving post-procedure outcomes, albeit mixed in many cases. Additionally, these studies contain small numbers of participants, vary in type, strength, and clinical indication for which the resurfacing laser was used, and have differing postprocedural evaluation protocols and assessments. This highlights a need for standardization of clinical studies and the importance of choosing an optimal postprocedural skincare plan depending on every unique clinical scenario.

J Drugs Dermatol. 2020;19(11):1050-1055. doi:10.36849/JDD.2020.5386

INTRODUCTION

Laser resurfacing has progressed since the 1980s to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. While laser technology has evolved to provide a more favorable safety profile and decrease wound healing time, advances in post-procedure healing agents have also helped to mitigate adverse effects, such as persistent erythema, dyspigmentation, acneiform eruptions, dermatitis, infections, and scarring. We reviewed the evidence of growth factors, stem cells, silicone and silicone polymers, botanical based treatments, fatty acids, probiotics, and closed dressings on post-ablative laser skin resurfacing. All reviewed agents demonstrated some evidence in improving post-procedure outcomes, albeit mixed in many cases. Additionally, these studies contain small numbers of participants, vary in type, strength, and clinical indication for which the resurfacing laser was used, and have differing postprocedural evaluation protocols and assessments. This highlights a need for standardization of clinical studies and the importance of choosing an optimal postprocedural skincare plan depending on every unique clinical scenario.

First introduced in the 1980s, laser resurfacing has progressed throughout the years to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. The original continuous wave carbon dioxide (CO2) laser (10,600 nm) vaporized epidermal tissue, but had erratic depths of ablation and caused significant thermal damage to adjacent normal skin leading to high rates of post-procedure scarring and pigmentary changes.1,2 Further advances in technology and safety led to discontinuous ablative lasers, with high energy and short duration laser pulses, that would rapidly ablate tissue while limiting the surrounding thermal damage.While these lasers had superior clinical results and a more favorable safety profile, significant down time and persistent pigmentary changes still limited the mass use of these lasers.1 Developed in the early 2000s, fractionated ablative laser technology admixed focused laser beamlets with intervening areas of normal, untouched epidermis, improving laser safety, and decreasing wound healing time.1

The clinical efficacy of ablative laser technology lies in the vaporization of normal tissue structures, triggering a wound healing response in the body with neocollagenesis. Normal healing proceeds through a complex cascade of hemostasis, inflammation, proliferation, and remodeling, driven largely by the local cytokine milieu. After the acute inflammatory phase, recruited fibroblasts synthesize new collagen while the keratinocytes must migrate from wound edges or proliferate from stem cell reserves to epithelize and recreate the epidermal barrier.3 Full laser ablation destroys epidermal stem cell populations, thus stem cells must be recruited from deeper structures like hair follicles and sebaceous glands. In fractionated ablative technology, the intervening areas of normal epidermis can contribute to the stem cell reserve synergistically with the deeper skin structures and significantly decrease overall healing time.1