A Clinical Safety Assessment of Hybrid Fractional Laser Use at Increased Depths for Facial Skin Rejuvenation in Patients Undergoing Rhytidectomy.

Background: Hybrid fractional lasers (HFLs) have revolutionized facial laser resurfacing treatments with their dual ablative and non-ablative wavelength technology. Although HFL therapy shows promising results, safety at skin depths beyond 150 μm is debated, particularly for its non-ablative wavelength. Some suggest deeper HFL delivery can enhance skin remodeling. Objectives: To assess the clinical safety of delivering HFL therapy at increased dermal depths up to 425 μm to induce collagen production and improve skin quality in patients undergoing rhytidectomy, and to determine whether this combination increases postoperative complications. Methods: A retrospective review (2017-2022) was conducted on patients undergoing rhytidectomy with or without concurrent intraoperative HFL therapy. Data on demographics, HFL parameters, and postoperative complications were collected and analyzed using descriptive statistics. Results: Of 169 patients (94.7% female, 97.0% Caucasian, average age: 63.3 years, Fitzpatrick score: 2.7), 62.1% received HFL treatment and 37.9% were controls. Patient characteristics were similar between groups. The average non-ablative laser depth was 355 μm ± 25, with a maximum of 425 μm. In the 12 months post-rhytidectomy, 7.6% of the HFL group experienced complications vs 3.0% in the control group, a non-significant difference (P = .13). No known HFL complications (burns, skin breakdown, hypo- and hyperpigmentation) were observed. Conclusions: HFL therapy at depths up to 425 μm may be safe for facial photorejuvenation. Patients with Fitzpatrick skin Types I to IV experienced no adverse effects. Combining HFL with rhytidectomy did not increase complication rates compared to rhytidectomy alone. These findings expand safety parameters for HFL use, optimizing clinical outcomes and long-term success of laser skin resurfacing. Level of Evidence: 3 (Therapeutic).