Facial laser complications (A Five Year Review)

Lasers have become integral to dermatology and plastic surgery, with expanding applications for skin rejuvenation, scar revision, and pigmentary disorders. Despite technological advances, complications remain a significant concern, particularly in patients with darker skin types. A systematic review was performed following PRISMA 2020 guidelines. PubMed, Embase, and Scopus were searched for English-language studies published between January 2019 and September 2025 reporting complications of facial laser treatments. Search terms combined controlled vocabulary (MeSH/Emtree) and keywords across three domains: device/energy (e.g., lasers, IPL, RF, microneedle RF, HIFU/MFUS, CO₂, Er:YAG, PDL, Nd:YAG, 532/755/1064 nm), anatomic site (face, periocular, eyelid), and complications (adverse events, erythema, purpura, PIH, hypopigmentation, scarring, infection, ocular injury), with Boolean operators applied. Peer-reviewed clinical studies, systematic reviews, and meta-analyses were included; animal, in vitro, editorial, conference abstracts, and duplicate publications were excluded. Two reviewers independently screened titles and abstracts and performed full-text review, with disagreements resolved by consensus. Extracted data included laser type, patient demographics, Fitzpatrick skin type, and reported adverse events. Adverse events were summarized using pooled descriptive analysis stratified by laser modality and skin phototype; formal meta-analysis was not performed due to heterogeneity. The search identified 2,435 records; after duplicate removal (n = 180) and screening, 13 studies met inclusion criteria (n = 2,010 cases). Exclusions were due to non laser-based treatments (n = 25), incomplete data (n = 18), or irrelevant outcomes (n = 122). A PRISMA flow diagram illustrating this process is provided (Fig. 1). Extracted data included device type, treatment indication, patient age, sex, Fitzpatrick type, complications, management, and outcomes. Data were tabulated and analyzed descriptively, and findings were cross-referenced with FDA MAUDE adverse-event reports to contextualize real-world complications. Across 2,010 cases reviewed, post-inflammatory hyperpigmentation (PIH) emerged as the most frequently reported complication, particularly in Fitzpatrick IV–VI skin types. Ablative lasers (CO₂, Er:YAG) carried the highest risks of scarring and infection, while non-ablative (FDA 26), (MAUDE, 2024 27) fractional lasers were associated with erythema and textural changes. Ocular complications, though less common, were among the most severe, emphasizing the importance of rigorous eye protection. Fractional and hybrid laser technologies demonstrated improved recovery profiles but still carried risks of PIH and persistent erythema. Analysis of MAUDE data reinforced these findings, highlighting recurring safety issues with ablative devices and periocular applications. Despite improvements in laser technology, complications such as PIH, scarring, and ocular injuries remain clinically significant. Patient-specific protocols—including careful screening, device selection, pre-treatment preparation, intra-procedural safety measures, and structured aftercare—are essential to minimize risks. The absence of standardized guidelines underscores the need for consensus-driven best practices to optimize outcomes and reduce complications in facial laser therapy.