Laser Scar Treatment
Laser scar removal
¿ Is It Better to Treat a Scar with Injections or Laser Therapy?
Injections and lasers are frequently used in a complementary manner. When a scar presents activity, injections help control active fibrosis, while lasers progressively improve color and texture. In the case of an old atrophic scar, infiltration with hyaluronic acid is very useful.
Infiltrations into active scars are treated with a dilution of 5-Fluorouracil and Betamethasone/triamcinolone. Firmness, increased thickness, persistent redness, and symptoms such as itching or tenderness may suggest that the scar is still developing fibrosis. In these situations, injections help control the biological activity of the scar and limit its progression. Once they progress, the infiltration time is usually 2 to 3 years.
Year 3 of treatment with infiltrations in scar after rhytidoplasty
However, superficial old atrophic scars can be reversed by stimulating their bed, a stimulus that can be evidenced months after the session with the appropriate dose of laser.
The photo on the left showed no changes with the Fraxel laser compared to the start of treatment at month 9. The second session with a change in parameters did achieve results at month 9.
Lasers act on different components of the scar. Depending on the type of laser used, they may reduce redness, improve pigmentary changes, and enhance skin texture.
Sequential laser treatment and infiltrations with 5Fu-Betamethasone for 6 months
The sequence of treatment is important. In highly active scars, controlling fibrosis is often the first priority. Once scar activity has subsided, treatment is usually directed toward improving the residual changes through laser therapy, fillers, or selected surgical procedures.
For this reason, the decision is rarely a matter of choosing between injections and laser therapy. Instead, it involves determining which component of the scar requires treatment at each stage of its evolution.
Why do scars recur so often, and what can be done?
The treatment of scars with laser deserves some considerations:
When Is the Right Time to Treat a Scar?
Some develop persistent scarring activity, while others change according to the tension exerted on the wound, developing a mixed state between fibrosis and atrophy that leads to surgical revision.
Active scars will exhibit redness, hardening, symptoms, and progressive growth until they mature into fibrosis. Non-surgical intervention becomes the only way to limit scarring once surgical revision is no longer possible to relieve tension at the scar edges.
Widening due to tension of the surgical closure is common in anatomical areas such as the back, shoulders, areolas or knees. Mechanical forces exerted on the scar can gradually separate its edges during maturation.
Increased volume at a tension-free incision site can occur in any anatomical area and is a hyperreactive phenomenon where the volume of the maturing scar increases, subsiding spontaneously in the first few months. When this does not occur and the scar continues to thicken, it gives the impression that the laser treatment/injections are being performed too late.
Traumatic scar condition at months 3 and 15
Another common alteration in scars are linear depression, with or without preservation of dermal thickness. In the most superficial depressions, we have obtained complete leveling responses with stimulation from subablative lasers such as the Fraxel 1550, and the persistence of well-defined borders can be compensated for with ablative lasers. Deeper depressions can be “leveled” in selected cases with hyaluronic acid fillers, since fillers will not be effective when there is complete dermal loss.
Repigmentation and remodeling of scar tissue created by Fraxel
Which scars improve with laser?
Most of them. The exception is when the surgical alternative is faster and necessary.
Progressive growth of the papillary dermis secondary to Fraxel laser stimulation.
5fu-Bethametasone treatment
6th Month of 5-FU/Betamethasone Treatment for a Keloid Scar.
What does the laser improve in scars?
It homogenizes pigment, reduces redness, and improves skin texture.
Result of a second edge remodeling of a cheek scar with poor aesthetic result at 70 days. After 56 days of using the Fraxel laser, a decrease in redness and leveling is achieved.
If I have a sunken scar, can it be improved?
Mild depressions respond to subablative lasers (Fraxel 1550). Depressions with very defined edges will need point or complete dermabrasions.
The leveling achieved with Fraxel was due to a virtually immediate realignment of the scar tissue. The effect was maintained on day 37 and subsequently, one year later.
¿Can red scars be improved?
The laser coagulates the scar vessels that give the red color to the scars.
Immature scar following biopsy showing erythema at the dissection site for closure and fibrosis along the suture line. Fraxel laser treatment reduced the erythema but not the fibrosis by day 37.
¿ Can Wide Scars Be Improved?
Yes. Scars with mild thickening generally respond poorly, if at all, to injections, but they can be improved with fractional laser treatments.
The effect of fractional laser treatment is gradual and cumulative. In mildly thickened scars, improvement may be noticeable immediately after the first session and can be maintained over time.
When there is a high density of irregularities or a greater volume of scar tissue, the initial changes may be subtle. In these cases, improvement becomes more noticeable as the effects of multiple sessions accumulate. As a general rule, the best results are achieved after reaching a cumulative improvement exceeding 100%, which requires a series of treatments performed progressively.
How much do acne scars improve?
In general, while ablative lasers are used for specific defects, fractional lasers reduce irregularities more broadly due to a stimulating and leveling effect on the treated surfaces.
With fractional lasers, coverage density must be considered; that is, achieving cumulative coverage greater than 60%. A single session at this level of coverage is practically equivalent to dermabrasion, which results in a longer period of postoperative erythema and the possibility of large areas of permanent depigmentation.
Partial regression of acne scars may be observed at the beginning of treatment, so sessions should be continued at intervals of 3 to 4 months for a minimum of 2 to 3 years.
¿ How much does laser scar treatment hurt?
The Fraxel 1550 laser can generate thousands of points per square centimeter. Thousands of stimuli that are perceived as heat. Sometimes, it is necessary to use it without local or topical anesthesia because a deeper remodeling effect is desired, which would be reduced with anesthetic infiltration. Fractional ablative lasers (CO2 or Erbium-YAG) will also cause more pain with higher exposure density. In this indication, using anesthetic application techniques such as transcutaneous delivery avoids the need for injections or nerve blocks.
Lasers like the Erbium-YAG are well tolerated, as is the pulsed CO2 laser system.
Can stretch marks be improved with laser?
The superficial ones do respond because there is material to reform the skin in the dermis.
