Consensus Statement on the Prevention and Management of Complications of Fully Ablative Laser Resurfacing of the Face
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.
Conflicts of Interest
The views expressed are those of the authors and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government. Drs. Kang, Alam, Geronemus, Arndt, Avram, Bloom, Chan, Dover, Gold, Haedersdal, Hoss, Jalian, Manuskiatti, Robb, Saedi, Stankiewicz, Wu, Wulkan, Ortiz, as well as Mr. Fathizadeh, Ms. Marks, and Ms. Esteves have stated explicitly that there are no conflicts of interest in connection with this article. Dr. Cohen has served as a consultant for Acclaro, Allergan/AbbVie, Biofrontera Bioscience, Biopelle, BTL, Cutera, Cynosure, Elta, Galderma, Merz, Oxygen Lab, PCA, Raziel, Revance, RION, Sciton; has received payment or honoraria from Galderma; and is a clinical investigator for Acclaro, Accure, Allergan/AbbVie, Avita, Biofrontera Bioscience, Biopelle, BTL, Castle Bioscience, CROMA, DermTech, Elta, Galderma, InMode, Merz, Novan, Pfizer, Raziel, Revision, Sciton, SWIFT, and Timer Pharmaceuticals. Dr. Kilmer has received payment or honoraria from Lumenis and Acclaro and holds stock or stock options in Acclaro. Dr. Ross has grants or contracts from Cynosure, Acclaro, Benev, and Venus Concepts; has received consulting fees from Lumenis, Benev, Cynosure/Lutronic, and Venus Concepts; has received payment or honoraria from Lumenis, Benev, Lutronic, Agnes Medical, and Candela; is a Senior Advisor for Lasers in Surgery and Medicine; and holds stock or stock options in Acclaro. Dr. Tanzi has received consulting fees from Sciton; has received payment or honoraria from Sciton and SofWave, has participated on a data safety monitoring or advisory board for Sciton, Solta, and Cynosure/Lutronic; and has received equipment or other services from Sciton, Solta, Cytrellis, SofWave, and BTL. Dr. Waibel has received grants or contracts from Amgen, Bristol Myers Squibb, Emblation, Horizon Pharma Inc Janssen/Johnson & Johnson, Pfizer, Sanofi, Shanghai Biopharma, ArgenX, Cytrellis Biosystems, Galderma, Eli Lilly, Neuronetics, RegenX, Skinceuticals; has received consulting fees from Allergan, Candela, Galderma, Proctor & Gamble, and Skinceuticals; has received payment or honoraria from Candela, Proctor & Gamble Company, Skinceuticals/L'Oreal, and Lumenis; has received support for meetings from Lumenis and Skinceuticals/L'Oreal; has participated on a data safety monitoring or advisory board for Lumenis and BellaMia, and has had a leadership or fiduciary role with the FSDS and the ASLMS Nominating Task Force. Dr. Wong is a Board Member for the American Academy of Facial Plastic and Reconstructive Surger and previous editor-in-chief of Lasers in Surgery and Medicine. Dr. Alexiades has received grants or contracts from Candela, InMode, Lumenis, and AbbVie; royalties or licenses from Elsevier and Wiley; and has participated on a data safety monitoring or advisory board for the Laser Institute of America. Dr. Bhatia has received grants or contracts from Bausch Health/Solta, Cutera, and Lutronic/Cynosure; consulting fees from Lutronic/Cynosure, Cytrellis, Bausch Health/Solta, Cutera, Theravant, and Sentient Lasers; payment or honoraria from Cutera, Theravant, and Cytrellis; support for attending meetings from Cutera, Theravant, and Cytrellis; has participated on a data safety monitoring or advisory board for Cutera and Bausch Health/Solta; holds leadership or fiduciary roles at Theravant and ASLMS; holds stock or stock options in Bausch Health/Solta, Theravant, and Cutera; and has received equipment or other services from Lutronic/Cynosure, Cutera, and Theravant. Dr. Biesman has received grants or contracts from Lumenis, Acclaro, and Solta; payment or honoraria from Acclaro and Solta; and holds stock options in Acclaro. Dr. Burns has served as an advisory board member, speaker, and consultant for Sciton and has received discounted equipment from the company. Dr. DiGiorgio has served on the ASDS Board of Directors; has stock options in Quthero Inc.; and has received equipment from Acclaro. Dr. Goldberg has received university support for attending the ASLMS annual conference. Dr. Ibrahimi has served as Vice President of ASLMS and was on the ASDS Board of Directors from 2021 to 2024. Dr. Kelly has received grants or contracts from Sciton, FDZJ, Lutronic, and Michaelson Diagnostics; has received consulting fees from Primus Pharmaceuticals; has served as Executive Secretary for ASLMS; and has received equipment or other services from Cutera, Candela, Sciton, Solta, and Michaelson Diagnostics. Dr. Munavalli has received consulting fees and payment or honoraria from Candela. Dr. Pozner has received consulting fees from, support for attending meetings or travel from Sciton; has received payment or honoraria from Sofwave and Sciton; has planned, issued, or pending patents with Sofwave; has participated on a data safety monitoring or advisory board for Sciton and GetHairMD; has stock or stock options in Sciton, Avavaskin, Cynosure, Cytrellis; and has received equipment or other services from Sciton and Cytrellis. Dr. Rossi has received research funding from ASLMS, the Skin Cancer Foundation, Regen, LeoPharma, and Biofrontera; consulting fees from Evolve CME, Almirall, Mavig, Merz, Dynamed, Canfield Scientific, Allergan, Evolus, Biofrontera, Quantia MD, Lam Therapeutics, Regeneron, Cutera, Skinfix, DAR Companies, and L'Oréal; and has served on the ASDS Board of Directors and committees for AAD, ASDS, and ASLMS. Dr. Shumaker has served on committees for ASLMS. Dr. Wanner has received grants or contracts and equipment from Bausch Health; consulting fees from Nu Skin and EllaOla; has participated on advisory boards for EllaOla, Nu Skin, Sorette, MK2002, and Akeyna; has held equity in EllaOla, Akeyna, Sorette, MK2002, and Seen; and has served as Treasurer of ASLMS.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the authors upon reasonable request.
