{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:20:17Z","timestamp":1763702417202,"version":"3.45.0"},"reference-count":84,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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 CO\u2082 laser regimen can mitigate these complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A multicenter retrospective cohort enrolled 562 adults undergoing elective rhinoplasty, liposuction, breast augmentation, facelift, abdominoplasty, or Botox. Laser eligibility (incision &amp;gt;3\u202fcm, Fitzpatrick I\u2013IV, 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\u2019s\n                      <jats:italic>t<\/jats:italic>\n                      -test and Fisher\u2019s exact test; infection-free survival was assessed by Kaplan\u2013Meier curves, and IPTW-adjusted Cox models quantified laser effects on SSI risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 562 patients, 324 (58%) received laser therapy. Baseline demographics and comorbidities were balanced across groups (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05). Laser-treated patients had faster healing (13.8\u202f\u00b1\u202f5.7 vs. 17.0\u202f\u00b1\u202f3.2\u202fdays;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), lower CRP (11.3\u202f\u00b1\u202f7.4 vs. 14.9\u202f\u00b1\u202f4.4\u202fmg\/L;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), thinner scars (2.44\u202f\u00b1\u202f1.39 vs. 3.14\u202f\u00b1\u202f0.78\u202fmm;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and greater elasticity (0.85\u202f\u00b1\u202f0.03 vs. 0.65\u202f\u00b1\u202f0.03\u202fAU;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Pigmentation, vascularity, and collagen III\/I ratios were all significantly improved (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). SSIs were reduced (15% vs. 59%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), as were keloids (1.9% vs. 11%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Satisfaction, quality-of-life scores, and return to activity favored the laser group (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Kaplan\u2013Meier curves confirmed superior 30-day infection-free survival (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001); IPTW-adjusted Cox regression showed a 72% reduced infection hazard (HR\u202f=\u202f0.28; 95% CI: 0.19\u20130.41;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Standardized fractional ultra-pulse CO\u2082 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1642041","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:15:23Z","timestamp":1763702123000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reduction of surgical-site infections and improvement of scar parameters with a uniform fractional ultra-pulse CO\u2082 laser protocol in cosmetic surgery: a five-center retrospective cohort"],"prefix":"10.3389","volume":"12","author":[{"given":"Qinghua","family":"Xu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haoran","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juhui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofeng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e17","DOI":"10.1055\/s-0036-1572360","article-title":"Overview 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