Ablative CO2 Laser Resurfacing: A Disappointing Outcome?
Caution: Sensitive Topic Ahead! Profile: 30-year-old male, 6 ft tall, 75 kg, non-smoker, moderate alcohol use, no recreational drugs. I've been living with lichen sclerosus, an autoimmune skin disorder that left unsightly white plaques on the glans of my penis. These scars were quite pronounced, and previous treatments yielded minimal improvement. After researching, I learned that ablative laser treatments were being explored for lichen sclerosus in sensitive areas using a specially designed laser (MonaLisa Touch). I found a clinic willing to provide treatment. We conducted patch tests with both fractional and ablative lasers to determine their effectiveness. Unfortunately, the fractional laser had no visible results due to the severity of the scars. However, the ablative laser showed potential, so I proceeded with full ablative resurfacing. Although the procedure sounded intense given the sensitive location, I felt desperate to enhance my appearance, as it impacted my self-esteem significantly. The treatment targeted two primary scar areas, with one being notably worse than the other. The ablative resurfacing spanned both scars and included a significant portion of adjacent, healthier skin — notably more pink and without any scarring. I am unclear about why this surrounding skin was treated; perhaps it was to ensure a smooth appearance post-healing and to adequately address the edges of the main scars. Additionally, I wonder if the treatment area was shaped like a teardrop to preserve skin elasticity during the healing process, given the need for flexibility in such a delicate area. Alongside the ablative laser, the main scar regions also underwent fractional laser treatment for an added effect. The healing process took longer than I had anticipated, but the results have left me with mixed emotions. The prominent white plaques have mostly disappeared (one is completely gone while the other has only a small remnant). The skin now displays a more normal pink hue, which is a positive outcome as this was my primary goal. However, I am disappointed to share that the surrounding skin, treated with the ablative laser (but not combined with fractional, I believe), has developed an even whiter appearance than before. This is particularly stark when erect, making the treatment seem even more problematic than the original scars. Now, I find myself uncertain about my next steps. I anticipated that the worst-case scenario would be little to no change, and the best would be some improvement. But I never expected the treated areas, which were initially in better condition, would look worse than the areas I aimed to rectify. At the start of the healing, those regions were not white at all, which led me to hope that the scars had been effectively addressed. But as everything healed, the edges turned white, putting me back at square one, or worse. I'm perplexed by the cause of this change — could it be hypopigmentation induced by the laser? Is it a reaction from the laser that exacerbated my existing autoimmune condition? Or something entirely different? Should I halt any further treatments to prevent worsening the condition? Should I consider additional treatments in hopes of improving the newly affected areas? Would another full ablative procedure be necessary, or would fractional resurfacing suffice considering I've already undergone one ablative session? I welcome any advice or suggestions you may have. Thank you.
Answers (1)
3/26/2025, 6:21:10 PM
OpenHealth AI
Thank you for sharing your experience with ablative CO2 laser resurfacing for lichen sclerosus. It's understandable to feel a mix of emotions given the complex outcomes you’ve encountered, especially considering the sensitive nature of the treated areas and the impact on your self-esteem.
Key Points:
- Mixed Results: The laser treatment reduced the prominent white plaques but has left you with hypopigmented areas that are concerning.
- Potential Causes: The lighter patches could be due to hypopigmentation, which can occur after laser treatments, or might be a reaction linked to your underlying autoimmune condition.
- Next Steps: It's essential to approach further treatment thoughtfully, considering the potential risks and benefits.
Explanation:
Ablative laser treatments can indeed stimulate skin rejuvenation, but they may also lead to changes in pigmentation, especially in individuals who have underlying skin or autoimmune conditions. The white appearance of the skin could be due to hypopigmentation, where the skin loses its normal color, or could signify a reaction influenced by your lichen sclerosus. This condition can affect skin healing and response, making it challenging to predict outcomes based solely on general principles of laser therapy.
Actionable Next Steps:
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Monitor and Manage: Keep a close eye on the healing process of the treated areas. Document any changes, especially in color or texture, to discuss with a healthcare provider later.
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Avoid Further Treatments for Now: Give your skin time to heal completely before considering any additional procedures. Adding more treatments too soon could complicate healing or exacerbate the situation.
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Explore Options: After a healing period (typically at least a few months), consider consulting a dermatologist or specialist experienced with lichen sclerosus and post-laser care. They can evaluate if further treatments—such as fractional laser therapy, topical treatments for pigmentation, or other interventions—are appropriate based on your healing progress and concerns.
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Skin Care Routine: Maintain a gentle skincare routine, using mild, fragrance-free cleansers and moisturizers to keep the affected areas hydrated. Sunscreen is important to protect the skin from UV damage, which can worsen pigmentation changes.
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Psychological Support: Given the emotional impact this treatment has had, consider seeking support from a counselor or support group. Addressing self-esteem and body image can be an important part of recovery.
Feel free to follow up if you have specific questions about skin care or treatment options, as your journey is unique and may require tailored advice. Your feelings of frustration and uncertainty are completely valid, and you're taking important steps in seeking support for your condition.
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