Can I Get Facial Laser Resurfacing If I Am An Organ Transplant Patient On Immunosuppression Medications?
Q: Dr. Eppley, Hello. I am interested in fraxel CO2 laser surgery for skin resurfacing. I am 48 yrs old and have sun damage, wrinkles and some acne marks. I do not know if I would be a candidate for this procedure. I had a kidney/pancreas transplant almost 22 years ago after being a type I diabetic for 20 years. I am on cyclosporine, prednisone, imuran immunosuppressive medications daily. Please let me know if there are any risks. Thank you.
A: The risks of laser skin resurfacing on someone who is taking immunosuppressive medications is two-fold. First, most long-term immunosuppressed transplant patients develop skin thinning due to dermal atrophy. This can lead to increased depths of penetration (injury) of the laser not seen in immunocompetent patients. Therefore typical laser settings may be too deep in the immunosuppressed patient. There is no way to accurately predict the skin’s response to any depth/power setting of the laser. Secondly, as you know, your healing capabilities are diminished. Since the laser essentially creates a burn injury, the skin must be able to heal the expansive skin wound. In the immunocompromised patient this could be an understandable issue. One can partially overcome the delayed healing effects of steroids with pre-treatment high-dose vitamin A supplements, but that may not be enough to reverse the effects of the other medications.
While all of this sounds very pessimistic, it is fair to say that one has to be cautious about laser resurfacing with your medical history. Fractional laser resurfacing is better than completely ablative laser resurfacing because it only treats a portion or fraction of the skin’s surface, leaving areas of normal skin between the vertical columns of the fractional laser beams. The best way to approach whether you are a good candidate or not is to do a test patch area. Only treat a small area first and see what the healing response is.
Dr. Barry Eppley