COSMETIC TOWN JOURNAL

Laser Scar Removal

Laser scar removal uses laser treatments to reduce the appearance of scars by vaporizing each layer of skin in order to expose a smoother layer. Laser treatments usually can not completely erase a scar or its visibility.  Laser scar removal is a non-invasive procedure that can improve the look of a scar by 50% to 80% with little to no downtime. Scars come in different shapes, sizes, density and colors. Laser scar removal may not be the first treatment choice for every scar and your surgeon should guide you to chose the right treatment after examination of your scar. Modern technology has grown from one laser option to various laser devices for resurfacing skin and treating the different scars and locations on the body. Each laser delivers a different wavelength of heat and can reach various depth of penetration. The laser uses short pulses of a micro-fine laser light to either remove the damaged layers of skin, or to heat under the skin, to allow for a more natural shedding of the skin cells.  

Am I a Good Candidate for Laser Scar Removal?

A GOOD CANDIDATE for laser scar removal is:

  • Any patient with a completely healed scar which they would like minimized
  • Patients with acne scars, an overactive red scar or a raised scar that they would like flattened
  • Patients with either light or very dark skin

Patients with the following scars can also see vast improvement in their appearance:

  • Surgical scars – Scars that occur from surgery often do not heal as nicely as anticipated and end up wider than expected
  • Box scars – Scars that are shallow, but wide, like a crater
  • Ice pick scars – Very narrow, but deep, scars like an ice pick that are also referred to as an atrophic scar
  • Keloid scars – Scars that are red, thick and raised due to a continuous healing process that produces too much collagen and ends up extending beyond the area of their original formation
  • Hypertrophic Scars – Scars that are firm, raised and usually pink in color that do not extend beyond their original formation

Patients who are NOT GOOD CANDIDATES include:

  • Patients, with scars that are not completely healed, since the scar is still changing and having laser treatments too soon can have unpredictable results
  • Patients with skin conditions such as psoriasis, dermatitis or cystic acne may not be suitable until the skin is clear
  • Accutane can interfere with the response of the skin to laser scar removal so patients who are taking, or have been taking this medication within the past 6 to 12 months, may be ineligible for this treatment

How is Laser Scar Removal Performed?

Booking a consultation with a board-certified doctor is the first step for laser scar removal. During the consultation, all medical history and current medications or supplements should be discussed since certain medications should be discontinued prior to the procedure. Medications such as aspirin, ibuprofen and vitamin E can hinder the healing process and should be stopped at least two weeks prior to treatment. The doctor will evaluate the skin and the scar to determine the best course of action to meet the patient’s needs. If the patient is a good candidate, the doctor may suggest taking supplements like Bromelain or Arnica Montana to help minimize the possibility of bruising and swelling.

The treatment is generally performed as an outpatient procedure under local anesthesia but sometime general anesthesia may be used. Laser scar removal can take as little as a few minutes, or as long as a few hours, depending on the size of the scar or scars. Since there are different types of scars and lasers, the doctor will determine the type of laser and the amount of treatment for the best outcome.

Types of Lasers

There are two types of lasers and they are ablative lasers and non-ablative lasers.

1. Ablative lasers are moved over the scar and pass beams of light into the treatment area. The laser will remove the outer layers of the skin by heating the water in the skin to a boiling point which vaporizes the skin cells. This method is also known as a controlled burn. The two most common ablative lasers are the CO2 and the Erbium: YAG and they have some variations:

  • CO2 and Erbium: YAG lasers remove the top layers of skin, one layer at a time. The CO2 laser is more ablative than the Erbium: YAG and has more of a recovery time than the other. These types of lasers work well for acne scarring. CO2 also works well for atrophic scarring since it stimulates new collagen to grow and fill-in the depressions in the skin. The CO2 laser can be used alone or in combination with dermal fillers.
  • Fractionated CO2 and Fractionated Erbium: YAG lasers can also be used to treat scarring caused by acne but may require several treatment sessions. This is because these types of lasers work by targeting a fraction of the skin’s surface and they create tiny wounds in the deeper skin layer while leaving the surrounding skin unscathed. This controlled-wound healing allows the skin to repair itself quicker and with less downtime.

2. Non-ablative lasers include Pulsed-Dye lasers (PDL), Fractionated Infrared lasers and V-Beam lasers. Non-ablative lasers do not remove the outer layers of skin but they do target the deeper layers. The light heats the water in the skin while causing a coagulation of blood vessels. In turn, this causes the skin to peel off through a natural shedding process. Furthermore, the heat stimulates new collagen growth for smoother, tighter skin. Here is a closer look at these non-ablative lasers:

  • Pulse Dye lasers, including Cynosure and Candela lasers, work well to treat hypertrophic and mild to moderate keloid scars. However, severe keloid scars are difficult to treat and generally receive only slight improvement. Pulse Dye lasers heat the skin and absorb pigments to reduce redness. This type of laser is often paired with steroid injections to help flatten the scar.
  • Fractionated Infrared lasers can be used to treat acne scars in patients with darker skin tones when other lasers are not appropriate. This is because this type of laser treatment leaves the outermost layer of skin intact and heals from the inside out.
  • V-Beam lasers can treat an overactive scar which is red due to continuous blood flow. This type of laser uses a wavelength of yellow light to absorb the red blood cells in the blood vessel. The light heats the blood vessels from the inside-out to damage the lining of the vessel. The body will respond over a few weeks by destroying the vessels causing the redness. By decreasing this vessel, the overproduction of collagen in the scar is stopped. This allows the scar to flatten, become softer and less painful.

Punch Graft

Patients with a multitude of narrow and deep scars may need a surgical technique referred to as a punch graft. This involves cutting out the deep scar and patching it with a graft of skin taken from behind the patient’s ear. However, this method is only a prelude to laser scar removal since laser resurfacing will still be necessary.

Combining Lasers

Some laser treatments can be done in combination with others for an optimal outcome. The V-Beam laser is often used with the Fraxel laser and each is rotated at 2-week intervals.

Alternative Treatments

  • Silicone sheeting or gels can be placed over the scar to help it fade or flatten. This type of treatment can take weeks or months and may not provide the best results.
  • Z-plasty is a surgical scar removal technique where the scar is repositioned so that it is better aligned with the natural folds of the skin. While the patient still has a scar, it is typically smaller and less noticeable.
  • W-plasty removes a linear scar and changes the orientation of the scar by irregularizing the scar. This can help scar edges to heal better and can also minimize the visibility of the linear scars.
  • Dermabrasion and deep chemical peels are other scar removal options but these methods are typically more invasive than laser scar removal.

What is the Cost of Laser Scar Removal?

The average cost of laser scar removal is about $1500-$8000. The price can vary depending on the size of the scar, type of laser used and the amount of treatments needed. The cost can also vary according to facility fees, physician fees and anesthetic fees. Since laser scar removal is typically for aesthetic purposes, it is generally an out-of-pocket cost. However, scar revision is sometimes considered reconstructive and the insurance company may cover a portion of the cost. Patients are encouraged to always discuss this matter with their insurance company prior to any treatment.

Recovery and Downtime

The RECOVERY time depends on several factors including the size and depth of the scar. The wavelength of the laser, meaning whether it is fractional or non-fractional, also makes a difference in the recovery and downtime. Patients will typically experience tender skin, redness and swelling for a few days after the procedure. Over-the-counter pain medications and an ice pack can help reduce the swelling and pain. The doctor may place some ointment and a bandage over the treated area. After laser scar removal, it is very important to keep the wound clean to avoid a secondary infection and further scarring. Approximately 4 to 5 times a day, the patient will need to gently wash the treated area with a mild soap and pat it dry. An antibiotic ointment, and a clean nonstick bandage, should be applied as directed.

The process of skin regeneration can begin as early as four days after laser scar removal. The skin may be red or raw looking and there will be some blistering which can produce oozing and crusting for up to seven days. Patient should allow the scabs to peel away on their own and should not scratch or pick at them. Pinkness will follow and can last for several weeks. All normal activities can resume immediately after the procedure and a follow-up evaluation will occur 6 to 8 weeks after treatment. Non-ablative lasers have less of a downtime than ablative lasers. However, depending on the aggressive nature of the treatment, some patients may need to take a week of recovery time for non-ablative and two weeks for ablative laser treatments.

Results

The results from laser scar removal vary according to the type of laser used and the condition of the skin. While ablative lasers can show immediate improvement, non-ablative lasers may take months before the results are visible. This is because the restoration process is happening deep under the skin’s surface and the outer layer of skin is left unharmed.

Most patients need several treatments no matter which type of laser treatment is used. The average patient requires three to five treatments and each session may be spaced out with a one-week gap. With each treatment, the scar becomes less prominent and the skin begins to look healthier. Therefore, the results are better noted a few months after treatment.

Depending on the type of laser used, improvements can continue even after a few months as new collagen is produced which continues to smooth and tighten the skin from underneath. Over time, the skin’s elasticity will become lax with the natural effects of aging and gravity. To maintain the results, patients are encouraged to use sunscreen when going outside since the harmful rays of the sun can cause the new skin to burn easily. Using sun protection, even after the area has properly healed, can keep the area from having a color change such as hyperpigmentation or hypopigmentation.  

Limitations and Risks of Laser Scar Removal

Patients with darker skin types may have a LIMITATION from receiving certain laser treatments since these can permanently alter skin pigmentation. Patients with habitually dry skin, including the scarred region, may be limited from having laser scar removal for at least a few weeks or until they can moisturize the area appropriately. The doctor may recommend applying a concentrated moisturizer, such as cocoa butter or vitamin E oil, for the best hydration therapy.

Some of the most common RISKS include:

  • Redness
  • Raw skin
  • Bruising
  • Itching
  • Burning
  • Stinging
  • Oozing of yellow fluid
  • Blistering
  • Crusting
  • Infection
  • Hyperpigmentation or hypopigmentation (darkening or lightening of the skin)
  • Patients prone to acne breakouts or cold sores (especially around the mouth) have a greater risk of a cold sore breakout after the treatment
  • A demarcation line, AKA a loss of pigmentation in the treatment area, which shows an alteration in the skin color between where the laser was administered and the surrounding skin

A Treatment for Better Looking Skin

When considering any surgical or cosmetic procedure, it is important to know all the facts ahead of time.  Laser treatments can be expensive since multiple sessions are generally needed. While laser scar removal cannot completely remove a scar, it can greatly reduce the appearance of a scar and help in the prevention of a recurrence. Since no two scars or patients are alike, the results of laser scar removal can significantly differ between people. Nevertheless, laser treatments for scar removal can provide less noticeable scarring and healthier looking skin.

 

Written By Cosmetic Town Editorial Team - SP

Based on an exclusive interview with Ronald Shelton, MD in New York, NY

Ronald Shelton, MD

October 09, 2015

Article Updated on October 18, 2017

Before After
V-Beam Laser
Elderly male woke up with a bruise not knowing that he had bit his own lip in his sleep. The wound is small but noticeable in the photograph. One treatment with the 595nm. wavelength V-beam laser eradicated the bruise as shown 3 days later.
Before After
Fraxel Dual Laser
Young adult male with acne scars of the cheeks treated with Fraxel Dual, 1550nm. wavelength. Two sessions. Only needed topical numbing cream prior to the treatment. He was happy enough after these two treatments he didn’t need a third.
Before After
Non-Ablative Fractional Laser
This young middle aged woman was treated with a non-ablative fractional laser (Fraxel Restore, 1550nm.) to reduce the appearance of her forehead scar obtained from reconstruction after a large skin cancer was removed with Mohs micrographic surgery.