Periocular laser complications

Abstract

Laser periocular surgery has achieved an increased popularity, particularly since the widespread use of CO(2) and erbium:yttrium aluminum garnet laser and more recently with the development of nonablative laser technology. The main target of these techniques is to treat photoaging changes to obtain a rejuvenated skin. Despite the relatively safety of these procedures on experienced hands, postoperative complications affecting the periocular region, and the eye itself, may follow laser surgery. More common complications include persistent erythema, hyper- and hypopigmentation, and hypertrophic scarring. Viral, bacterial, or fungal skin infections may also jeopardize the postoperative period after periocular laser treatment. Severe burns, transitory or permanent lower lid ectropion, and even corneal injuries or ocular perforation are among the most severe hazards. The majority of these complications are related to the use of ablative technologies. A thoughtful preoperative evaluation, conscientious patient selection, comprehensive informed consent, adequate training, and a cautious and conservative approach are reinforced to minimize moderate or even severe aesthetic and functional periocular complications. Nonablative laser therapies are notably safer; however, their ability to significantly improve photoaged skin characteristics is still limited.

Keywords: Laser surgery; complication; periorbital; rejuvenation.

Figure 1

Prolonged and excessive upper and midface erythema involving the periocular region after combined CO₂-erbium full-face resurfacing. Complete resolution was attained with the use of a short course of topical steroids.

Figure 2

(A) Hyperpigmentation affecting mainly the lower eyelids after full-face CO₂-erbium resurfacing and bilateral upper lid blepharoplasty. (B) The same patient in the late postoperative phase with significant pigment reduction after the use of topical kojic acid 2%.

Figure 3

(A) Upper eyelid bilateral xanthelasma in a heavily pigmented patient. (B) Same patient after CO₂ resurfacing of the lesions displaying a moderate hypopigmentation in the treated area.

Figure 4

(A) Impetiginization affecting lower lid, frontal, cheek, and nasal region after full-face resurfacing and bilateral upper lid blepharoplasty. (B) Resolution of the cutaneous infection with a mild residual periocular hyperpigmentation mainly affecting the right eye.