Using lasers to remove scars has become a mainstay in the treatment of multiple types of scars. Laser scar treatments have been shown to improve the appearance of existing scars. Lasers have also been shown to help optimize surgical scarring. In addition to the cosmetic benefits of laser scar removal, treatments can also help to reduce itchiness and pain associated with certain types of scars and to increase the range of motion with scar contractures across joints.
You May Not Be A Candidate For Lasers To Remove Scars If:
Some people should delay or avoid laser scar removal treatments because they are at higher risk for complications. These include those that:
- have used oral retinoids (vitamin A products) within the past year
- are pregnant or breastfeeding
- have had recent herpes simplex breakout (like cold sores)
- are Immunocompromised
- have connective tissue disorders
- have any skin disease at the site of treatment (eg psoriasis, eczema)
Type Of Laser Scar Removal Systems:
Laser scar removal devices can be classified as ablative and non-ablative:
Ablative Lasers To Remove Scars
These lasers use light energy to destroy the upper layers of skin in a controlled manner. The result is something very similar to a moderate to severe sunburn. As the wound heals, a new upper layer of skin is created. This process smoothes out the skin’s contour and generally provides a glowing and rejuvenated look.
Non-Ablative Lasers To Remove Scars
Laser scar removal with this type of laser bypasses the skin’s upper layer. Stimulation of the deeper skin promotes collagen and elastin production which gives new fullness to the skin and a rejuvenated overall look.
Fractional Verus Non-Fractional Systems
Both ablative and non-ablative laser scar removal can be done in two ways. Fractional methods treat the skin in a grid-like pattern, like targeting only the corners of a checkerboard pattern. The skin between the treated areas is left untreated, making fractional treatments less invasive and therefore quicker and easier to recover from in general. Non-fractional laser scar removal treats the entire surface of the area involved (eg. the entire face). Non-fractional treatments, therefore, cause a larger surface area to require healing, making recovery time longer.
Hypertrophic And Keloid Scars:
These scars are raised, ropey, and often hyperpigmented (darker than surrounding skin). They can result from injury, surgery, piercings, tattoos, and in some cases, even seem to come out of nowhere. This type of scarring also often has a genetic component to it and is most common in darker races.
The pulsed dye laser (PDL) has been shown to be effective in improving the color and texture of hypertrophic scars and keloids. PDL can also flatten these scars. Some studies have reported between 57% to 83% improvement in the appearance and texture of hypertrophic scars after just one to two laser scar removal sessions with PDL.
Atrophic Scars:
Atrophic scars are also treatable with laser scar removal methods. Atrophic scars are pitted, indented scars. They most commonly result from skin conditions such as acne and chickenpox. There are three main types of atrophic scars: ice pick, rolling, and boxcar.
For this type of scarring, the most commonly used laser scar removal devices are Nd: YAG and diode. Up to 40 to 45% improvement in the cosmetic appearance of these scars has been documented. An average of three consecutive monthly treatment sessions is a typical regimen. These laser scar removal devices have minimal downtime and recovery time. Results often take between 3 and 6 months following the final laser treatment to show maximally.
More On Fractional Lasers To Remove Scars:
Fractional lasers are a relatively new development in laser scar removal. This type of laser targets the skin in a grid-like pattern instead of treating the entire area like non-fractional lasers do. The laser is used to treat small zones of the skin that are separated by untreated areas. This approach to laser scar removal decreases healing and recovery time. Complications and adverse side effects are also reduced using fraction laser systems. Fractional lasers have been shown to significantly improve the pigmentation and thickness of surgical scars, atrophic scars, hypertrophic scars, and hypopigmented scars.
Recent studies seem to indicate that people prefer the results obtained from fractional lasers over comparable non-fractionated laser scar removal treatments.
Recovering From Lasers To Remove Scars:
Recovery times will vary depending on the type of scars being treated and the type of laser system used. Fractionated, non-ablative lasers have the least downtime and may heal in several days. Other laser scar removal procedures can take weeks, or in some cases months to be fully healed. In general, ablative systems will take longer to heal than non-ablative systems.
Do’s And Dont’s:
- do not expose your skin to direct sunlight for four to six weeks after the procedure
- do not use makeup until all areas are fully healed
- do use ice packs to decrease redness and swelling
- do take pain medications if you need it
Conclusions:
Laser scar removal is amongst the most common ways that various sorts of scars are treated. Advents in ablative, non-ablative, fractional, and non-fractional systems have given providers a wide array of tools to choose from. All types of scars from hypertrophic, keloid, to atrophic and hyperpigmented, can be successfully improved with appropriate choices of laser scar removal devices. Because of the number of choices out there, it is imperative that you choose a highly reputable practitioner who understands the pros and cons of these powerful tools and who avoids a “one-size-fits-all” approach.
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/