ORIGINAL RESEARCH article
Front. Med.
Sec. Dermatology
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
Provisionally accepted
- Hanzhong Central Hospital, Hanzhong, China
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Background: Postoperative infections and suboptimal scar outcomes remain persistent challenges in cosmetic surgery, impairing patient satisfaction and quality of life. This study evaluates whether a standardized fractional Ultra-Pulse CO₂ laser regimen can mitigate these complications. Methods: A multicenter retrospective cohort enrolled 562 adults undergoing elective rhinoplasty, liposuction, breast augmentation, facelift, abdominoplasty, or Botox. Laser eligibility (incision > 3 cm, Fitzpatrick I–IV, no collagen-vascular disorder) was determined by an EMR-embedded checklist; 324 patients received a uniform three-stage laser protocol (pre-incision, immediate post-closure, day 10). All patients followed a five-day antibiotic regimen (oral cefalexin + topical mupirocin). Baseline covariates were balanced via IPTW. SSIs were microbiologically confirmed (aerobic, anaerobic, fungal, mycobacterial cultures with MALDI-TOF). Comparative analyses used Welch's t-test and Fisher's exact test; infection-free survival was assessed by Kaplan–Meier curves, and IPTW-adjusted Cox models quantified laser effects on SSI risk. Results: Of 562 patients, 324 (58 %) received laser therapy. Baseline demographics and Comorbidities were balanced across groups (all p > 0.05). Laser-treated patients had faster healing (13.8 ± 5.7 vs. 17.0 ± 3.2 days; p < 0.001), lower CRP (11.3 ± 7.4 vs. 14.9 ± 4.4 mg/L; p < 0.001), thinner scars (2.44 ± 1.39 vs. 3.14 ± 0.78 mm; p < 0.001), and greater elasticity (0.85 ± 0.03 vs. 0.65 ± 0.03 AU; p < 0.001). Pigmentation, vascularity, and collagen III/I ratios were all significantly improved (p < 0.001). SSIs were reduced (15% vs. 59%; p < 0.001), as were keloids (1.9% vs. 11%; p < 0.001). Satisfaction, quality-of-life scores, and return to activity favored the laser group (all p < 0.001). Kaplan–Meier curves confirmed superior 30-day infection-free survival (log-rank p < 0.001); IPTW-adjusted Cox regression showed a 72% reduced infection hazard (HR = 0.28; 95% CI: 0.19–0.41; p < 0.001). Conclusion: Standardized fractional Ultra-Pulse CO₂ laser therapy reduces SSIs, improves scar outcomes, and enhances patient satisfaction in cosmetic surgery. These findings support wider adoption of laser protocols, warranting further prospective, pathogen-specific research.
Keywords: Ultra-Pulse CO₂ laser, cosmetic surgery, Post-surgical infections, Scar quality, laser
Received: 05 Jun 2025; Accepted: 07 Nov 2025.
Copyright: © 2025 Xu, Li, Zhao, He, Zhao and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaofeng Zhang, duoyong1024@163.com
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