Complications and Best Practices in Laser Resurfacing Around the Mouth

Conclusions

• Full-field ablative erbium resurfacing can produce substantial and durable improvement in perioral rhytides, often in one or two sessions, and may be preferable to CO2 for this region because it causes less thermal injury and less persistent hypopigmentation.
• Around the mouth and eyes, combining full-field and fractional resurfacing can yield strong aesthetic results, but the choice of modality must be tailored to the anatomy and the specific skin problem.
• The most common post-ablative effects are expected transient erythema, edema, drainage, and crusting, and patients need counseling and follow-up so normal healing is not mistaken for infection.
• Post-inflammatory erythema can last for months, and tinted sunscreen plus time are among the most useful ways to help patients cope with it.
• Hyperpigmentation is usually temporary and often resolves with sun protection, while hypopigmentation is more likely to be persistent and harder to correct.
• Risk for post-inflammatory hyperpigmentation can be anticipated in some patients, including those with palmar crease pigmentation patterns that suggest greater susceptibility.
• If hypopigmentation occurs, non-ablative fractional laser treatment and laser-assisted delivery of bimatoprost or similar agents may improve repigmentation in selected cases.
• Laser-assisted drug delivery appears useful beyond pigment problems, with potential roles for treating scars, rhytids, melasma, and other laser complications using agents such as steroids, 5-FU, and tranexamic acid.
• Ocular complications remain an important safety issue in laser resurfacing, with ectropion being a major concern and left-sided injuries appearing more common in practice.
• A careful pre-procedure history is essential because resurfacing can reactivate prior filler reactions, HSV, fungal or bacterial infections, contact dermatitis, or even reveal unrelated pathology such as melanoma.
• Antiviral prophylaxis matters for resurfacing and peri-oral procedures, because HSV can spread during healing and may worsen if patients do not complete the prescribed course.
• Strict post-procedure instructions and avoidance of irritants like neomycin-containing ointments are important because nonadherence can provoke dermatitis and secondary pigment changes.
• Patients with recent or ongoing sun exposure, even from seemingly minor activities like kayaking or golfing, are at increased risk for unwanted pigmentary complications after resurfacing.