Fractional laser photothermolysis for early correction of ecchymoses: development of an effective therapeutic protocol

BACKGROUND: The correction of ecchymoses remains a pressing issue in dermatology and esthetic medicine. Persistent skin discoloration caused by hemoglobin breakdown (oxyhemoglobin → deoxyhemoglobin → methemoglobin → biliverdin → bilirubin → hemosiderin) leads to psychological discomfort for patients and prolongs rehabilitation after trauma, surgery, or invasive procedures. The limited effectiveness of conventional approaches (topical heparin-containing agents, cold/heat therapy) highlights the need for physical technologies to accelerate hematoma resolution.

AIM: The work aimed to provide scientific and practical justification for the use of fractional CO₂ laser photothermolysis (10,600 nm) with an optimized L-shaped pulse in patients with ecchymoses and to develop an effective therapeutic protocol.

METHODS: It was a prospective comparative study of the efficacy and safety of fractional CO₂ laser photothermolysis for ecchymosis correction. The study included 25 patients with post-traumatic or postoperative ecchymoses of 1–5-day duration, divided into the observation group (laser therapy, n = 15) and the reference group (conventional therapy, n = 10). Parameters: CO₂ laser (10,600 nm) operated in fractional photothermolysis mode with L-shaped pulse, power 6–8 W, microthermal zone density 400–500 dots/cm², 1 pass, pulse duration 500–600 µs. Trends were assessed using photographic documentation, colorimetric scales, and videodermoscopy.

RESULTS: The laser therapy group showed a pronounced positive response: resolution time was reduced by 40%–50% (mean 5 ± 1.8 days vs. 14 ± 2.3 days in the reference group; p < 0.05). Accelerated transition from blue-purple to yellow coloration was observed (by days 3–4), with minimal risk of residual pigmentation. The overall efficacy reached 85% (marked improvement). The safety profile was high: 20% of patients showed mild transient erythema, which resolved within 24 hours.

CONCLUSION: Fractional CO₂ laser photothermolysis with an L-shaped pulse is an effective method for early correction of ecchymoses, providing targeted ablation of pigmented epidermis and stimulation of lymphatic drainage. Optimized parameters (6–8 W, 400–500 MTZ/cm², 500–600 µs, 1 pass) ensure controlled impact on hemoglobin breakdown products without risk of damaging surrounding intact tissues.