Dystrophic Calcification and Accentuated Localized Argyria After Fractionated Carbon Dioxide Laser Therapy of Hypertrophic Scars

L aser therapy is apowerful tool for the treatmentof scars.The ablative laser, more widely used in the 1980s and1990s, is known to be effective but involves a signifi-cant riskofadverseeffects.Althoughreducedwithproper tech-niqueandpostoperativemanagement, erythema,dyspigmen-tation, acneiform eruptions (milia and acne), eczematous dermatitis, infections, and scarring are not uncommon. The subsequent development of nonablative lasers yielded a sub-stantial reduction in adverse effects but at the expense of de-creasedefficacy.1Thus, fractionalphotothermolysishasgained significantpopularitybecauseof its increasedefficacy andde-creased adverse effect profile when compared with nonabla-tive and ablative laser therapy, respectively. The concept in-volves the formation of multiple, evenly spaced microscopic treatment zones, which generate columns of thermal dam-age without spread to adjacent tissue. The surrounding, un-damaged tissue acts as a reservoir of viable cells to promot