Overview of Laser Revision of Scars
When your skin heals from an injury, it usually leaves a scar. This is due to a process known as fibrosis, where the look and feel of your skin change. Every wound leads to some sort of scar and they can come from things such as surgery, accidents, or skin conditions. Scars can cause various issues, including affecting how you look, causing physical discomfort, or upsetting you emotionally. Because of these impacts, many people decide to get treatment for their scars.
There are many ways to treat scars, and one effective treatment method is using lasers. Research shows that laser treatments can help improve different kinds of scars, such as keloids (thick, larger scars), hypertrophic scars (raised scars), atrophic scars (indented scars), and acne scars. Laser technology has become quite advanced in recent years, improving its capabilities. As a result, lasers can now help enhance how scars look and feel, reduce any symptoms caused by scars, and make scars softer and stretchier.
Anatomy and Physiology of Laser Revision of Scars
Scars form when your skin gets injured. Several factors influence how a scar ends up looking. These include inherited traits, the type, depth, and location of the injury, how much tension or pressure the skin was under, whether there was a local infection or inflammation, and hormones.
Hypertrophic scars and keloids are types of scars where the skin raises due to excessive collagen production, a protein that helps wounds heal. Scars of this type are often found in families. People between the ages of 10 and 30 most commonly experience hypertrophic scars and keloids, and they affect both men and women equally. Additionally, keloids are more common among African-American, Hispanic, and Asian populations.
In hypertrophic scars, the issue lies in the fact that the body creates too much collagen, but cannot break down the excess during the healing process. This leads to the formation of thick bundles of collagen. Keloids, on the other hand, are due to the body producing too much of something called transforming growth factor-beta, which results in a drawn-out healing process and even more collagen production.
On the flip side, atrophic scars are depressed or sunken areas on the skin because of collagen damage due to inflammation. Atrophic scars are found in inflammatory diseases like acne, chickenpox, lupus, and they can also appear after surgery or other types of physical trauma. People who have acne, which affects up to 80% of those ages 11 to 30, mostly have atrophic scars and are three times more likely to have these scars than keloids or hypertrophic scars. Atrophic scars happen when the body does not produce enough collagen due to a mismatch between the creation of scar components and their breakdown.
Why do People Need Laser Revision of Scars
Laser scar revision is a treatment patients may choose to improve the look and feel of certain types of scars. These include atrophic, hypertrophic and keloid scars. Hypertrophic scars are firm bumps that are pink or red, and they stay within the border of the original injury. These kinds of scars will usually appear within the first month of the injury and may fade away over time on their own.
Keloid scars, on the other hand, are pink to purple, nodular (bumpy), and are harder than hypertrophic scars. These scars stretch beyond the area of the original wound and may appear weeks or even years after the injury. Unlike hypertrophic scars, keloid scars don’t fade away on their own.
Atrophic scars, or indented scars, are divided into three types: ice pick, boxcar, and rolling scars. Ice pick scars are narrow, deep and have sharp edges. They look like small holes that go deep into the skin. Boxcar scars are round to oval in shape and wider than ice-pick scars, with an appearance similar to chickenpox scars. Rolling scars are wider than both ice pick or boxcar scars, and they give the surface of the skin a wavy appearance. This is caused by abnormal fibrous connections from the outer layer of the skin to the deeper layers.
When a Person Should Avoid Laser Revision of Scars
There are certain situations where laser therapy cannot be used. These include if a person has taken oral retinoids (a type of medication for skin problems) in the past year, if they are pregnant or breastfeeding, if their immune system is suppressed, or if they have disorders affecting the body’s connective tissues. It is also not recommended if there is any other skin condition present in the area where the laser treatment would be applied.
Your doctor will also need to know if you have a history of herpes simplex virus (which causes cold sores or genital sores). This is because people with this virus may need to start taking antiviral medicine before having laser treatment, to prevent the virus from causing problems.
Equipment used for Laser Revision of Scars
The equipment needed to use a laser to improve the appearance of scars include:
* A machine that creates the laser
* A digital camera
* A tray containing:
– Local anesthetic (a substance that causes loss of sensation)
– Post-laser emollient cream (a moisturiser to soothe the skin after laser treatment)
– Anti-irritation gel (a substance that calms any possible irritation after treatment)
– Measurement tape
Who is needed to perform Laser Revision of Scars?
If you’re getting a laser treatment to improve the look of a scar, you’ll be working with a team of professionals. This team includes a dermatologist, who’s a specialist in skin conditions. If there are concerns about how the scar looks, an aesthetic medicine specialist can use their knowledge of beauty and health to help. A plastic surgeon might also be involved, particularly if the scar is severe or affects the function of a part of your body.
You’ll also have a dermatology nurse who assists in care related to skin procedures. Next, you’ll have a laser technician or technologist; this is the person who looks after the proper functioning of the laser machine and assists during the procedure. An aesthetic technologist is another crucial part of this team who focuses on the procedures that enhance physical appearance.
All these professionals work together to make sure your scar treatment happens safely and effectively!
Preparing for Laser Revision of Scars
When assessing scars, doctors use a mix of looking at the scar and talking to the patient about it to decide the best treatment approach. Doctors classify scars into four different categories: raised scars (hypertrophic), thick and bumpy scars (keloidal), sunken or pitted scars (atrophic), or normal, flat scars (conventional). The doctor will ask about how old the scar is, any previous treatments you’ve tried for the scar, and what caused the scar (like an injury, surgery, or inflammation). They’ll also look at your skin type using something called the Fitzpatrick skin phototype.
Before they start a laser treatment on your scar, they will often take pictures and measurements to track how the scar is improving over time. At every visit, they will check the color of the scar, how flexible it is, and how high it is. To make the treatment less painful, the doctor will apply a numbing cream to the scar area about 30 to 60 minutes before the laser treatment begins. They’ll also clean the area with a germ-killing solution to prevent infection.
How is Laser Revision of Scars performed
Laser scar treatment uses light and heat energy to target cells within the scar. This stimulates the skin to rebuild collagen and elastin – the proteins that give our skin its strength and elasticity. Different types of lasers have been used to treat scars since the 1980s. The latest treatment uses fractional photothermolysis with ablative and non-ablative fractionated lasers (types of lasers), which can effectively treat scars.
For thickened (hypertrophic) scars and keloids (large and dark scar tissues), the pulsed dye laser is often used. Pulsed dye laser (PDL) can help to improve different aspects of hypertrophic scars and keloids’ such as color, flexibility, their blood vessels, and how high they are. Some studies show that after 1 to 2 PDL treatments, we can see 57% to 83% improvement in the look and feel of hypertrophic scars.
Non-ablative lasers (a type of lasers that heats the skin without hurting the surface) are commonly used to treat atrophic facial scars (scars due to loss of skin tissue). On average, after 3 consecutive monthly treatment sessions, we can see an improvement of 40 to 45% in the appearance of these scars, as shown by patient satisfaction surveys and skin check-ups. These lasers cause less downtime (time when one might need to recover) and produce results gradually, with the most significant improvement noted between 3 and 6 months after the final laser treatment.
Moreover, non-ablative fractional lasers have been very effective in improving the color and thickness of surgical, atrophic, hypertrophic, and hypopigmented (light-colored) scars.
Ablative lasers (a type of lasers that remove thin layers of skin) with CO2 or Er: YAG lasers can effectively treat traumatic and surgical scars, especially if they are used within 6 to 10 weeks after the injury or surgery. They are also beneficial for atrophic scars as they smooth out the scar texture and stimulate collagen production within the facial atrophic scars. These lasers may require more recovery time but often produce better results.
It’s claimed that the CO2 laser gives better results for acne scars, whereas the Er:YAG laser is more tolerable with less downtime.
Most recently, fractional ablative laser treatment, where only a small portion of the skin is altered, has become a popular treatment for atrophic and surgical scars, as it results in rapid skin repair and reduced recovery time. Studies have shown that more than 90% of patients preferred the scar area treated with fractional ablative resurfacing. Another study has found this laser treatment to be effective in treating atrophic traumatic scars in 70% of the patients treated with 6 monthly sessions of fractional CO2 laser treatment.
Possible Complications of Laser Revision of Scars
Negative effects from non-ablative laser treatments, which don’t destroy the tissue, are usually mild. They can result in temporary skin redness that goes away within a day. Uncommon side effects can include skin blistering, crust formation, scarring, and darkening of the skin after inflammation. These are more likely to happen in people with darker skin types. After a particular type of laser treatment called PDL, people might experience a side effect where their skin turns a purplish color for one week.
With non-ablative fractional resurfacing laser treatments, people may feel mild to moderate pain during the procedure. Afterward, they will likely experience redness and swelling, which could last between two and four days.
Ablative laser treatments, which do destroy tissue, have more side effects. They can cause temporary pain that feels like burning, oozing, crusts forming, painful sores, redness, swelling, breakouts of pimples, skin inflammation that looks like eczema, and infections. More long-term side effects can include discoloration of the skin and scarring. Redness and swelling often get worse in the first one to two days after treatment and can sometimes last up to four months afterward. Darkening of the skin after inflammation (temporary post-inflammatory hyperpigmentation) may occur about two to four weeks afterward. It is more common in people with darker skin. A study of these skin types found that almost half of the people tested had this darkening, which went away within about three months in 90% of the patients.
The side effects of fractional ablative laser resurfacing, which destroys only sections of the skin rather than all of it, are usually temporary and less severe than fully ablative resurfacing. People often report skin redness, crusts forming, a burning sensation, swelling, and bruising after this type of treatment. Persistent redness and color changes in the skin after inflammation are less likely with this treatment compared to one that affects all of the skin.
What Else Should I Know About Laser Revision of Scars?
Laser therapy is a safe and effective way to treat many types of scars. Research shows high levels of satisfaction among people who have had scars improved by this approach. Laser treatments have evolved to the point where ‘fractional ablative laser devices’ (lasers that remove sections of scar tissue) now lead to better results while causing less damage to the skin than older types of laser treatments.
One of the advantages of these laser treatments is that the recovery time is much shorter than with the more old-fashioned ones. As a result, more people are choosing these options. Not only can laser therapy make existing scars less visible, but it can also be used to reduce scarring after surgery.
For those who have ‘symptomatic scars’ (scars that cause itching or pain), laser treatment can provide relief. And, in cases where a scar limits movement, laser therapy can help improve your range of motion. In short, it’s a versatile and effective tool to manage a variety of scar-related issues.
