Fractional CO2-Laser Resurfacing Improves Appearance of Skin Grafts

Skin graft
Skin graft
Investigators assessed cosmetic outcomes of split-thickness and full-thickness skin grafts.

Fractional CO2-laser resurfacing can improve adaptation of a skin graft to the surrounding skin, and improves skin roughness, melanin variation, and patient satisfaction with the skin graft, according to results published in Lasers in Surgery and Medicine.

The study included 26 participants with 29 skin grafts. Half of each participants’ skin graft was randomly assigned to treatment with fractional CO2-laser resurfacing 2 times with a 4-week interval, with the first treatment occurring 3 to 8 weeks after surgery. After treatment, 2 independent dermatologists assessed the adaptation of both the treated and untreated area using follow-up pictures and an 11-point scale.

The primary outcome was adaptation of the skin graft to the surrounding skin 2, 6, and 12 months after the second laser treatment, and secondary outcomes included melanin variation, skin roughness, resizing of the skin graft, and participant satisfaction with the cosmetic results.

Before treatment, mean ratings indicated that the grafts had poor adaptation to the surrounding skin (treatment group: 2.24±1.00; control group: 1.95±1.27; P <.001). During follow-up visits, the grafts showed significant improvement in adaptation. At 8 weeks, the treatment group had scores of 6.38±1.47 and the control group had scores of 5.29±1.27 (P <.001). At 6 months, the treatment group scores were 7.31±1.24 compared with control group scores of 6.04±0.91. At 12 months, the treatment group scores were 7.6±1.26, compared with control group scores of 6.57±1.02.

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After participants received laser treatment, the appearance of the skin graft was significantly improved at all follow-up points. Profilometric analysis indicated that laser treatment resulted in significantly reduced skin roughness at 1 year after treatment compared with the control area (P =.003). In addition, laser treatment resulted in significantly more uniform melanin distribution 1 year after treatment compared with the control area (P =.034).

Although participants were reasonably satisfied with both sides of the skin graft before laser treatment, later follow-up indicated that they were more satisfied with the laser-treated side after treatment (P <.001).

“Because patient satisfaction was also significantly improved after laser treatment, fractional ablative laser treatment can be offered to patients who receive a skin graft and have high aesthetic demands,” the researchers wrote.


Datz E, Schönberger C, Zeman F, et al. Fractional carbon dioxide laser resurfacing of skin grafts: long-term results of a prospective, randomized, split-scar, evaluator-blinded study [published online June 17, 2018]. Lasers Surg Med. doi:10.1002/lsm.22950