OVERVIEW:Every scar has a story. From childhood adventures to bouts of teenage acne to cancer surgery, scars can remind people of life events both good and bad. Unfortunately, time doesn’t heal all wounds. While some people may be proud of their scars, for others, their scars are a constant reminder of something they would rather forget. In addition, it is also difficult to ignore scars that are painful or itchy, or that make it tough to use the body part where the scar appears.
While complete scar removal is not possible, dermatologists are harnessing a laser technology originally developed as an anti-aging treatment to improve the appearance of scars – especially hard-to-treat or older ones. This new treatment option is bringing renewed self-confidence to patients, helping to ease traumatic memories, and in some cases, increasing lost mobility.
AMERICAN ACADEMY OF DERMATOLOGY EXPERT:Board-certified dermatologist Jill S. Waibel, MD, FAAD, clinical voluntary professor at the University of Miami and subsection chief of dermatology at Baptist Hospital of Miami.
FOCUS ON TOP AND DEEP LAYERS OF SKIN TO REVISE SCARSFractional lasers – both ablative and non-ablative – can improve the appearance of scars, said Dr. Waibel. Non-ablative fractional lasers work by stimulating collagen growth and tightening skin underneath the scar without wounding the top layer of skin. This treatment requires several sessions in order to be effective for scars.
Ablative fractional lasers work by delivering very tiny columns of heat quickly to the top and deeper layers of scarred skin, which produces a new wound. This wound, with the help of the surrounding healthy skin tissue, often heals more evenly than the scar, which makes ablative fractional a more effective laser treatment for scars. In addition to improving a scar’s appearance, ablative fractional lasers have also been shown to improve a patient’s range of motion while reducing pain and itch resulting in an improved quality of life.
Dr. Waibel recommends ablative fractional lasers as an effective treatment for traumatic scars, such as burns, as well as acne and surgical scars. Dr. Waibel said fractional lasers are becoming the mainstay of laser therapy and are often combined with other devices such as pulsed-dye lasers and Q-switched Nd:YAG lasers to reduce scar redness and skin thickness. Visible results with ablative lasers can be seen within days to weeks after each treatment.
FRACTIONAL LASERS EFFECTIVE ON NEWER SCARSAccording to Dr. Waibel, scars that have not healed over time and have not responded well to other treatment options, such as scar revision surgery, can often be improved with fractional laser resurfacing.
While conventional treatments for scar improvement are currently recommended only after the scar has matured for one year or longer to allow for natural healing, Dr. Waibel said fractional laser treatments are well tolerated significantly earlier. However, treatment is not recommended for scars in the first one to three months after injury as these wounds are too new and the body is still working hard to heal the wound.
COMBINATION TREATMENTS MAY LEAD TO GREATER IMPROVEMENTAs Dr. Waibel noted, fractional lasers may be combined with other treatment methods, including pulsed-dye lasers or surgery, for enhanced results. Combination treatments are recommended depending on the characteristics of the scar, including texture, impact on range of motion, pigmentation change, and redness.
In a recent study in which Dr. Waibel was an investigator, patients who had scars with deep collagen loss were treated with a combination of ablative laser and poly-l-lactic acid (PLLA), an injectable filler used to restore facial volume. These are scars that leave behind deep pits on the skin, such as acne scars which may not respond well to ablative fractional laser treatment alone.
Dr. Waibel and the other investigators surmised that laser-treated skin would better absorb the filler since the laser creates microscopic columns of injury in both the top and deeper layers of the skin. The combination of using an ablative fractional laser and PLLA takes advantage of the fact that both can help the skin produce new collagen.
After reviewing 20 patient photos at baseline and three months after treatments began, four independent dermatologists agreed that 95 percent of scars had improved and the average improvement in the size, color and contour of the scar was 33 percent.
CONSIDERED SAFE AND EFFECTIVEMultiple fractional laser treatments are usually recommended over a one to three month period. Dr. Waibel said the procedure, when performed with a gentle touch, has a very low rate of complications.
AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE:“Many patients I talk with have struggled with the physical and emotional effects of their scar for years without knowing the improvements that lasers can make in a scar’s appearance,” said Dr. Waibel. “Dermatologists are at the forefront of researching the laser treatment of scars. Since fractional laser resurfacing for scars is not yet widely performed, it’s important to find a board-certified dermatologist who has expertise in using this new technology for scar improvement.”
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Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 18,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology), Twitter (@AADskin) and YouTube (Academy of Dermatology).
Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR, Uebelhoer NS, Waibel JS. “Laser Treatment of Traumatic Scars With an Emphasis on Ablative Fractional Laser Resurfacing: Consensus Report.” JAMA Dermatol. 2014 Feb;150(2):187-93.Rkein A, Ozog D, Waibel JS. “Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid.” Dermatol Surg. 2014 Jun;40(6):624-31.