Partially or fully ablative lasers are safe and effective tools to treat many types of scars and keloids, Dr. Suzanne L. Kilmer reported.
In treating scars, "the challenge is to normalize the color and the texture and to somehow repopulate that area with normal collagen and return it to normal skin color for that individual," she said in an interview.
Photo courtesy Dr. Suzanne L. Kilmer
A patient's chin scar is show before (left) and after fractional ablative laser treatment.
A key challenge to treatment is managing patient expectations. She described three treatment techniques to improve the appearance of scars and keloids at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF): pulsed dye lasers, fractional lasers, and fully ablative erbium/CO2 laser resurfacing.
Each of these lasers has its pros and cons for scar treatment, Dr. Kilmer explained. "In most cases now I will go straight to a fractional device, and depending on location, patient's tolerance for downtime, pain, and budget constraints, I will proceed with the best choice."
Pulsed-dye lasers help improve erythema by targeting hemoglobin, and they can also aid in collagen remodeling, reported Dr. Kilmer of the Laser & Skin Surgery Center of Northern California, Sacramento.
Fractional lasers heat up or even ablate thousands of tiny 120-mcm columns of tissue, allowing tissue remodeling and the regeneration of more normal collagen. This normal collagen gradually takes over the area with scar tissue and helps to return the skin to its prescar appearance. This is also helpful for striae (stretch marks), she noted.
Fractional resurfacing is often effective for pigment, texture, or vascular changes. The fractional laser produces a microthermal zone up to 1,500 mcm deep that creates lateral reepithelialization and promotes skin healing. A Fraxel 1550-nm erbium laser (Solta) or a StarLux 1540-nm laser (Palomar) is a good choice for these procedures.
Most patients find the Fraxel 1550-nm laser more painful, and anesthesia is needed for the entire procedure, she reported. However, the Fraxel is faster, so it is a better choice for procedures involving the full face, and provides a more even treatment.
By contrast, the StarLux 1,540-nm laser often allows the clinician to treat small areas without the need for anesthesia, and these areas blend easily into nontreated skin, Dr. Kilmer pointed out. Small areas of the skin can be treated quickly, but the StarLux can be slow and uneven when used on larger areas.
Dr. Suzanne L. Kilmer
Swelling is common – but not usually painful – after nonablative fractional resurfacing, she explained, and most patients need only minimal aftercare. Usually ice or hydration is sufficient.
Fractional ablative laser resurfacing carries more risk and requires more downtime than do other scar treatments, but it offers "the greatest efficacy for a single treatment," noted Dr. Kilmer. This treatment allows the clinician to sculpt more deeply with less thermal damage, and provides the most predictable results, including skin tightening and smoothing of acne scar ridges. The fractional ablative component allows for deeper scar remodeling and can be done at the same time, but with caution, she noted.
Dr. Kilmer emphasized that clinicians who are new to laser scar treatments should go slowly while they become familiar with the device. "And go lighter when you are off the face," she added.
Dr. Kilmer has received research support from Palomar and Solta. SDEF and this news organization are owned by Elsevier.