Before diving into a detailed discussion of laser scar removal, it is important to know that a scar is a permanent part of the body. Scars come in different shapes, sizes and types and are caused by various factors. Some scars are the result of surgery while others are the result of falls, scrapes, or acne. Some examples include:
- Box Scars - scars that are shallow and wide in nature, like a crater.
- Ice pick Scars - very narrow but deep
- Surgical Scars from a surgical procedure that do not heal as nicely as desired can often end up wide and thin.
- Keloids - scars that are red, thick, and raised because the body does not stop healing and produces too much collagen.
It is very hard to erase a scar. It can be flattened but the width is not going to shrink. Surgery is not a guaranteed removal of the scar. Laser scar removal will reduce the scar size for a short period of time but it may still widen to the same size or larger. Even if it does remain thin, it is still a new scar in place of a different scar. There are a variety of laser options currently available to perform laser scar removal.
If a scar begins to rise and become overactive, a good first step is using a laser for the blood flow to limit the redness. This is accomplished by a V-Beam laser which uses a wavelength of yellow light. The energy is absorbed by the red blood cells in the blood vessels which heat the blood vessels inside out in order to damage the lining. The body will respond over a few weeks by destroying the vessels causing the redness. Decreasing the vessels shuts down the cells overproducing the collagen. In turn, the scars start to flatten and become softer and less painful.
The two most commonly performed lasers for scar revision are carbon dioxide and fractional erbium laser. The carbon dioxide laser induces more wound contraction than the erbium laser and both induce collagen remodeling. The edges of the scar that are raised can be removed by the use of the erbium laser. Fractional lasers allow miniscule amounts of skin in between the microlaser beams to be left intact. Leaving these small islands of skin intact between the microbeams allows for faster healing.
As mentioned earlier, there are a variety of lasers available for laser scar removal. The various lasers produce different scar removal results. Some laser choices include:
- Fraxel Laser/Fraxel Dual/Fraxel Restore – “Fraxel” is the brand name of the laser that was used to pioneer the usage of fractional lasers. Fractional lasers remove the layers of skin that are top-most on a person. They ablate (remove or evaporate) the tissue in small areas so the areas surrounding the tissue are not damaged or injured. The Fraxel Dual laser uses an erbium 1550 nanometer wavelength and a thulium 1927nm. Wavelength.
- Carbon Dioxide Fractional – A laser that stimulates dermal collagen production. The process of improving physical scar characteristics may require this wavelength in addition to other wavelengths, or as a sole treatment. The fractional carbon dioxide, which is called the Fraxel repair laser can perform this process on a patient.
Fractional lasers have a lower risk of creating more scarring or changing the color of the skin compared to fully ablative non fractional lasers (which will be addressed later in this article). They also allow for a quicker recovery time and the ability to treat more areas of the body besides the face. However, the fact that they are fractional means multiple treatments might be necessary to achieve the desired results.
In general, above the neck scars respond better than below the neck scars. The same laser that produces great results on the face might be too risky to use below the neck. If a patient has a multitude of very wide, depressed or raised scars, the V-Beam laser can be used for the redness and to help flatten some scars.
If a patient has a multitude of narrow and deep acne scars, (icepick scars) they can be removed and replaced by taking patches of skin from behind the ear, cutting out the deep scar and plugging the patch into where the scar was located. These are referred to as punch grafts. However, that is a prelude to still doing a laser treatment. The replacements are done knowing that a form of resurfacing will be performed by using Fractional Carbon Dioxide, Fractional, Fraxel Dual/Fraxel Restore, or a new laser called the Pico laser.
There have been some dramatic improvements with Fractional laser resurfacing for scars. Most of the scars remain but they improve. How much the scar can be improved depends on genetic make-up, the location on the body, the depth or the thickness of the scar, the width of the scar and the orientation of the scar.
Scars that are resurfaced need to be kept out of the sun in order to avoid more redness. Sun exposure can make the scar thicker and cause pigmentation problems.
Patients who have a tendency towards post-inflammatory hyperpigmentation might have discoloration induced by the laser. A person with results that initially look better could see their skin mount a response to the laser and become discolored again. This is often seen in Latin-American, Asian and African-American skin.
It is not unusual to do both the V-Beam and the Fraxel on the same day. If there is a risk of post-inflammatory hyperpigmentation, the laser treatments can be spaced out. Since both of them are done once every four weeks, a patient can have the V-Beam laser one day and the Fraxel two weeks later. Then two weeks after that, the V-Beam again so they are still at a one month interval between specific treatments.
A patient can have five or six fractional treatments and then wait six months before resuming again. There is continued natural collagen production underneath the skin to improve the scars for up to a year or a year and a half after the initial treatments are over. The peak production is around the six month point but there is still improvement after that period.
The recovery time after laser scar removal depends on the size as well as the depth of the treated area, and the wavelength of the laser as well as if it is fractional or non-fractional. Patients typically experience tender skin, redness and some swelling for several days following the treatment. Aspirin and cold packs can help reduce the swelling and pain.
In general for laser scar revisions, the biggest concern is making sure someone does not develop more scarring. If a patient does not take care of their skin and are not hygienic, they can cause a secondary infection and more scarring.
When a person is looking at having laser scar removal, the most important thing is to realize these treatments can be very expensive. In the end, there will still be scars. They might look better but often they cannot be completely erased. There are many types of scars that after a series of treatments and time to heal, may look very good. It is vital that a patient is aware of these facts before they commit to laser scar removal.
Written By Cosmetic Town Editorial Team - MA
Based on an exclusive interview with Ronald Shelton, MD in New York, NY