The main long-term complication was hypopigmentation (loss of skin color), notably present in 13 percent of patients. One case of hyperpigmentation (patches of skin that become darker) righted itself within two years of treatment.
Some patients also developed milia, small cysts or acne. One participant developed an infection, and one had sagging of the eyelids.
"The biggest problem with CO2 is lightening of the skin. Essentially all of our patients got lightening to some degree, but a certain percentage got marked lightening where you could see quite a bit of difference on photographs," Baker said. "That's the cost of getting rid of wrinkles permanently or near-permanently."
"Part of it has to do with how aggressive you are with peeling," he added. "If there are more wrinkles, you have to do more energy levels, and you often do more than two or three passes, so the patients are going to get more lightening. The deeper you go, the more lightening you are going to get."
According to Nouri, today's treatments tend to be less aggressive than in the past, so healing is faster.
The lightening tended to be consistent across the face, but there was a demarcation between the color of the skin of the face and that of the neck.
"That's why we peel down below the jaw line to try to hide it in the shadow," Baker said.
The Cleveland Clinic has more on carbon dioxide laser resurfacing.
SOURCES: Shan R. Baker, M.D., director, Center for Facial Cosmetic Surgery, University of Michigan Medical School, Livonia; Keyvan Nouri, M.D., professor of dermatology and director of dermatologic and laser surgery, University of Miami Miller School of Medicine; July
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