Scars are a source of frequent concern, whether they be young just after an injury or a surgery or whether they have been present for years. Lasers have caught much fascination for many applications and their use in medicine is not exception. In my Indianapolis plastic surgery practice, I get frequent in-office questions and e-mails inquiring about removing or improving their scars with a ‘laser’.
The concept of scar treatment using laser resurfacing employs CO2or erbium laser technology. These lasers work by their light energy being strongly absorbed by water, turning into heat and resulting in skin tissue vaporization. Recontouring of scars, particularly on the face, has become popularized in recent years. Through control of the laser beam and the power behind it, predictable vaporization of tissue occurs resulting in better control compared to traditional dermabrasion.
Whether laser resurfacing is effective for any scar depends on numerous characteristics about it. Laser are NOT effective for all scars and, as a matter of fact, are really only effective for a small number of them. Laser resurfacing is most effective for many small scars that are clustered together (such as fine acne scars) or very shallow or raised scars that would not benefit from surgical revision. It is not effective for changing a scar’s color, whether it be getting redness to fade or bringing pigment back to a white scar.
CO2 lasers go deeper (remove more of the outer skin layer) and, in general, are more effective. They have a long history of use since the early 1990s and their effects are well known from full face laser resurfacing for wrinkles and aging. While erbium lasers do not go as deep and cause less skin injury than the CO2, this is countered by an overall decrease in how much improvement is obtained. Therefore, erbmium lasers should only be used in resurfacing skin of very slight scars that qualify or after an initial CO2 laser resurfacing treatment.
Regardless of the system, the goals of laser scar treatment are (1) to soften the transition between the irregularity of the scar and the intact skin surrounding it and (2) to stimulate collagen production within the scarred area. It may take more than one treatment to get the best result but it is far better to be not go too deep. More laser treatments can always be done. Treatment with either laser system has the potential to cause some transient hyperpigmentation. While this process is self-limiting, its resolution may be hastened with bleaching creams.
In properly selected patients, laser resurfacing can yield mean improvements of 30 – 50%. Collagen remodeling of the scar improvement can continue for up to 6 months after treatment, so re-treatment of residual scars is postponed for at least that long. Resurfacing with either a CO2 or Er:YAG laser may be beneficial. After the initial treatment, allow with the erbium laser requires less time between treatments. In either case, expect some postoperative redness which may last for up to 12 weeks.
Dr. Barry Eppley
Indianapolis, Indiana