On the Today Show yesterday, many may have seen the burned triplets who had their scars treated with a ‘new’ laser technique. This is a very interesting story from both the perspectives of the girls themselves as well as the form of laser scar treatments that had been done on them.
The Berns triplets were just 17 months old when they were trapped in a house fire in Texas that took the life of their mother. With burns that covered up to 30% of their body, they underwent a long initial hospitalization with multiple burn debridements and skin grafts. Fortunately they recovered and healed and have gone on to have a relatively normal life. Like most children with disfigurements, they were not overly focused on their scars until they passed puberty and were in high school. As is unfortunately common, others then pointed out their scars and they began to suffer the ridicule that such differences can bring.
Like all burn victims, the scars that result fall into two categories. Hypertrophic scars, which are thick and raised scars, from burned skin which has healed but did not necessarily need skin grafting. And scarring from areas that had been skin grafted, which looks like pebbly thickened skin, which creates a very uneven skin texture. Either way, the healing of burned skin (unless it is a very superficial burn) does not result in skin that looks or feels remotely normal. To the surprise of many, skin grafting in general and in burns in particular (due to the need to mesh it to allow it to expand to get more surface coverage out of it) does not make for a normal appearance. The primary goal of skin grafting is to get a healed wound…which they do well. The secondary goals of a normal appearance and function…they do rather poorly.
These triplets, like many thousands of burn victims, have to live with these burn scars forever. Over the years, numerous non-surgical methods to improve burn scars have been tried, including laser resurfacing. Significant improvements in their appearance have yet to be consistently obtained.
The triplets were showcased on TV because they were treated with a variation of fractional laser resurfacing. While touted as a medical miracle and a new laser innovation, this is a significant overstatement. Fractional laser resurfacing as well as more traditional out surface laser skin removal is not new. The fractional or fractionated laser approach to skin treatments has been around for several years now. It is based on the concept of punching holes into and through the skin over just a portion or fraction of the treated area. By going deeper into the skin, its deeper layers or dermis is stimulated to heal by creating more collagen. This is in contrast to superficial laser resurfacing where 100% of the skin that is treated undergoes more superficial layer removal.
The one innovation, from a laser design standpoint, that these triplet scar treatments represent is that the manufacturer has combined both types of laser treatments into a single laser device and treatment. But their combined use is certainly not new. I have used this combination superficial and partial deeper approach in my Indianapolis plastic surgery practice now since early this year. I am certain that the recognition of the skin benefits to treating both depths simultaneously is recognized by many other plastic surgeons as well. My current approach is to use a needle roller of up to 2mms to get the ‘aeration’ of the scarred area and then do a more superficial (up to 50 micron) total laser resurfacing of the scarred area. Whether fractionating the skin (cutting these deeper holes) with a hot method (laser) or cold method (needle) is better, or any different, is as of yet unknown.
By attacking both the deeper and superficial levels of difficult scars, the scope of the scar problem is more thoroughly treated. In my opinion, this is clearly a better biologic approach than anything that has been done before. This approach in my experience is particularly helpful for refractory scar problems such as acne and burn scars. Two points should be emphasized however. First, we are talking about improvement in the scar appearance, not complete elimination. Secondly, multiple sessions or a series of laser treatments are required to obtain a significant level of improvement in the appearance of these scars.
I think these dual laser treatment approach offers an improvement over traditional scar treatment methods. But I would stop short of calling it a medical miracle.
Dr. Barry Eppley
Indianapolis, Indiana