Reduction of surgical-site infections and improvement of scar parameters with a uniform fractional ultra-pulse CO₂ laser protocol in cosmetic surgery: a five-center retrospective cohort.

Summary

Across five centers and 562 cosmetic procedures, a standardized three-stage fractional CO2 laser protocol was associated with fewer microbiologically confirmed SSIs and improved scar outcomes after IPTW balancing. The regimen is feasible perioperatively and may be broadly adoptable.

Key Findings

• In a 5-center cohort (n=562), 324 patients received a uniform three-stage fractional ultra-pulse CO2 laser protocol.
• After IPTW balancing, laser use was associated with reduced microbiologically confirmed SSIs and improved scar outcomes.
• Feasibility demonstrated across multiple cosmetic procedures with EMR-based eligibility and standardized antibiotics.

Clinical Implications

Consider integrating a three-stage fractional CO2 laser protocol (pre-incision, post-closure, day 10) alongside standard antibiotics to reduce infections and improve scarring; prospective validation is needed before routine adoption.

Limitations

• Retrospective observational design limits causal inference and may have residual confounding.
• Incomplete reporting of effect sizes and subgroup outcomes in the abstract.

Future Directions

Prospective randomized trials to quantify effect sizes by procedure type and pathogen; cost-effectiveness and patient-reported outcome measures over longer follow-up.