Laser Scar Removal: A Simple Primer

Laser

Lasers use light and heat energy to improve the unwanted characteristics of scar tissue. A more desirable esthetic appearance, color, and texture are the ultimate goals. A great starting point in your journey toward learning about laser scar removal is to understand the differences between ablative and non-ablative lasers.

Ablative Laser Scar Removal

Ablative laser scar removal uses lasers that cause controlled damage to the upper skin layer (epidermis). These lasers also work on the deeper layers to a lesser or greater extent depending on how the machine settings are selected. Because ablative lasers denude (remove) the upper skin, they produce wounds similar to a severe sunburn. They take longer to heal and recover from than non-ablative lasers and have more potential complications.

Non-Ablative Laser Scar Removal

These types of lasers bypass the skin’s upper layers to work on deeper tissues only. They take less time to heal and recover from than ablative lasers and have fewer potential complications.

ablative and non-ablative laser scar removal
Ablative lasers (left) burn and remove the upper skin layer stimulating new skin formation. Non-ablative lasers (right) do not damage the upper skin layer but work on deeper layers to stimulate collagen production.

Laser Scar Removal For Hypertrophic Scars And Keloids:

Hypertrophic scars and keloids are raised, elevated, thick scars. They can result from surgery, injury, acne, and other causes. Non-ablative lasers are most effective for this type of laser scar removal.

Pulsed Dye Laser (PDL) is a non-ablative laser that can improve the color of these scars as well as soften and flatten them. Other types of lasers that have shown very good results for hypertrophic and keloid scars are the Nd:YAG and Diode non-ablative lasers. Two to three treatment sessions spaced about a month apart is one common regimen.

a hypertrophic pigmented scar like this can undergo laser scar removal
A hypertrophic scar like this can undergo laser scar removal.

Atrophic Acne Scars

Atrophic acne scars are the most common types of acne scars. They are depressed and indented and come in three forms: ice pick, boxcar, and rolling.

image of rolling type acne scar on skin
Atrophic acne scars like these can benefit from laser scar removal.

Both ablative and non-ablative lasers play roles in the treatment of atrophic acne scars.

The atrophic acne scars that respond best to non-ablative lasers are rolling and boxcar acne scars. Downtime is minimal. A relatively new advance in laser scar removal is fractional non-ablative lasers. These lasers treat the skin in many pinpoint areas while leaving the spaces in between untreated. This type of laser has shown great promise for atrophic acne scars including ice pick acne scars.

Ablative lasers that remove the upper layers of the skin can also be useful for atrophic acne scars. They help to resurface the skin and build up collagen where these depressed and indented scars are missing it. These lasers have more downtime and can cause hyperpigmentation (darkening of the skin) so must be used carefully. They are generally not a good choice for people with darker skin tones. Fractional ablative lasers overcome many of the issues associated with ablative lasers by treating only pinpoint areas of the skin. The areas in between are left untreated, decreasing healing and recovery time. Fraxel is a popular brand of the ablative fractional laser.

fraxel laser system for laser scar removal
Fraxel is a brand of fractional ablative laser

Hyperpigmentation:

Some scars are reasonably flat but are conspicuous because of being hyperpigmented (too dark). Laser scar removal can be an excellent choice to depigment these scars and allow them to blend much better into the surrounding skin. The Pulsed Dye Laser (PDL) and Intense Pulsed Light (IPL) systems are popular choices for hyperpigmented laser scar removal.

Complications of Laser Scar Removal:

Non-ablative lasers have quicker recovery times and fewer complications than ablative lasers. Generally, some amount of discomfort during treatment and bruising and swelling make up the complications profile for this type of laser scar revision

Ablative lasers have a more significant list of potential complications because they are more invasive, and cause sunburn-like damage to the upper skin layers. Post-treatment pain, crusting, and oozing are common. Swelling occurs and can last for days. Redness of the treated areas occurs and can last for months before resolving. Some people experience acne-type breakouts and cold sore breakouts. Because the skin has been denuded, infection is also possible. Permanent hyperpigmentation can occur, especially in darker-skinned people.

hyperpigmentation of skin after laser scar removal
Hyperpigmentation can occur from ablative lasers, especially with darker-skinned people.

Fractional ablative lasers have the same potential complications as non-fractional ablative lasers but healing time is much less and the chance of complications is far less. This is because the fractional systems treat only small, pinpoint areas of the skin while leaving all the skin in between the treated areas unaffected.

Which Laser Scar Removal Is Right For You?

As with many medical therapies, a number of choices and options can seem overwhelming and confusing. In many cases, a combination of laser treatments will work best. Find a reputable clinic staffed by Board-Certified, and fully licensed practitioners to maximize your chances of success and complication-free outcomes. Check online reviews specific to laser scar removal outcomes. Approach the situation with a combination of faith in a trusted practitioner and a good understanding of the key issues outlined above.

Medical References:

Xiao A, Ettefagh L. Laser Revision Of Scars. [Updated 2020 Sep 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539686/

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