Scar treatment by laser therapy is a specialized procedure in aesthetic medicine to improve the appearance of skin with unsightly scars such as acne scars. Scars (cicatrix) are so-called replacement tissues that the body forms to close wounds. Various types of scars are distinguished:
- Hypertrophic scars – thickened scars that initially appear reddened and can spontaneously regress.
- Atrophic scars – sunken scars such as acne scars that are below the normal level of the skin and can form bothersome craters
- Widened scars – these scars are usually surgical scars that widen over time and appear mainly on the back, thighs, as well as on the abdomen
- Keloids – exaggerated scarring, which is due to a genetic predisposition (predisposition).
Because scars can also be painful, itchy and tense, a therapeutic measure is worthwhile. Scar treatment by laser therapy is basically a physical peeling method, which can also be found under the name laser skin resurfacing. However, this text focuses on the indication area of scar treatment.
Indications (areas of application)
- Acne scars (acne vulgaris)
- Hypertrophic scars
- Keloids (bulge scars)*
- Postoperative scars
* Laser use is preferred only after the keloid has been treated by cortisone injection.
Before treatment
Before laser scar treatment, an intensive medical history discussion should be conducted that includes the medical history and motivation for the procedure. The procedure, any side effects, and the consequences of the surgery should be discussed in detail. A detailed anamnesis interview is necessary at the beginning. It should be asked whether the patient is prone to pigmentation disorders. Complications requiring information such as hypo- or hyperpigmentation, erythema, swelling or the possible unsuccessfulness of the treatment should be discussed. Note: The requirements of the explanation are stricter than usual, since courts in the field of aesthetic surgery demand a “relentless” explanation.Furthermore, you should not take acetylsalicylic acid (ASS), sleeping pills or alcohol for a period of seven to ten days before the procedure. Both acetylsalicylic acid (platelet aggregation inhibitor) and other analgesics delay blood clotting and can cause unwanted bleeding. Smokers should severely limit their nicotine consumption as early as four weeks before the procedure to avoid jeopardizing wound healing.
The surgical procedure
Formally, the procedure is similar to dermabrasion (abrasion of the skin), but the result of laser therapy is more homogeneous (uniform) and easier and gentler in sensitive areas such as the nose and periorbital (around the eye) and perioral (around the mouth). The scar tissue is precisely ablated or vaporized (vaporized) with the help of the laser. The following laser systems are used for scar treatment:
- Erbium-Yag Laser (Er:Yag Laser) – This infrared laser has a tissue penetration depth of 10-50 μm and produces a beam of light that is preferentially absorbed by aqueous tissue. Due to the low thermal damage to the adjacent tissue, this laser can be used to selectively ablate hypertrophic scars and align irregular scars with numerous level differences.
- Pulsed CO2 laser – The so-called ultra-pulsed carbon dioxide laser has a penetration depth of approximately 40-100 μm and emits infrared light. It causes carbon-free and bloodless vaporization of the skin with controlled thermal effect in the surrounding tissue. This laser system is used to tighten bowl-shaped superficial scars and to correct hypertrophic scars and keloids.
Other laser systems use the principle of selective photothermolysis: this is a physical principle of action that is used in the application of laser therapy and achieves selective destruction of a target structure (in this case, the scar) by generating heat without damaging the surrounding area. This method is used for active scars such as keloids and hypertrophic scars. The laser selectively obliterates small vessels that supply the scar tissue, thus preventing progressive growth. The following systems are used here:
- Flashlamp-pulsed dye laser; FPDL (wavelength: 585 nm; energy density: 10 joules/cm²; pulse duration: 450 μs) – A dye solution is excited to fluoresce (glow by reflection of colored light) by flashes of light. A specific wavelength of light can now be amplified and then used for treatment.
- Intensed Pulsed Light – IPL – The so-called high-energy flash lamps differ from normal laser systems. IPL technology uses polychromatic light (light with many different wavelengths) and the wavelengths range from 560 nm to 1020 nm. Filters can be used to select a specific wavelength range to treat scar tissue.
After treatment
Following the scar treatment by laser therapy, the patient is treated with antibiotics and antiviral (drug treatment against viruses and bacteria). Redness, swelling, and mild pain occur. Ointments and bandages protect the freshly treated skin. In the further course, the patient should pay attention to a very good sun protection. Further notes
- Non-ablative fractional laser treatment (NAFL) with a 1540 nm erbium laser showed good long-term effects of wound therapy: there were mainly slight advantages in vascularization after one year, i.e. In the control area, the skin around the scars was slightly more reddened.Note: The non-ablative laser uses a wavelength in which the water in the tissue does not evaporate (ablate), but the laser energy heats the tissue in a controlled manner. In fractional laser treatment, the laser here penetrates the epidermis (top layer of skin) into the dermis (dermis) to create thousands of microscopic vertical “holes” or “channels”. Limitation: small study and small therapeutic effects.
Benefit
The use of laser therapy for scar treatment is a useful and promising measure that is both gentle and effective. Patients who suffer from excessive scarring in particular benefit from the treatment.
