Laser Scar Removal – Is it Right for You?

Reviewed by Mitchel P. Goldman, MD

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Laser scar removal is another popular use of laser technology. Laser treatment reduces the appearance of scars by 50 to 80 percent and helps prevent recurrence.

What Causes Scarring?

The wound-healing process begins with inflammation, progresses to tissue formation and ends with modifying specific factors in the anatomy – such as collagen, the main protein found in connective tissue that supports the skin, bone, cartilage and blood vessels.

Scarring occurs when the wound-healing process is disrupted by certain factors such as too much or too little collagen. For example, a keloid scar is a mass of collagen.

Applications of Laser Scar Removal

Today's laser scar removal techniques can reduce the appearance of several types of scars, including:

  • Keloid Scarring: Firm, raised and reddish-purple scars that extend beyond the initial wound area and build over time.
  • Hypertrophic Scarring: Firm, raised and pink scars that remain within the initial wound area and may fade over time.
  • Atrophic Scarring: Depressed pin-like pockets in the skin that can result from skin conditions or diseases such as acne.

Not everyone is a candidate for laser scar removal. People with skin disorders such as psoriasis, cystic acne and dermatitis may not be ideal candidates. Those using certain medications such as isotretinoin for acne must stop using the medication for six months prior to the procedure.

Lasers can greatly improve the appearance of acne scars. (Photos supplied by Reliant Technologies, manufacturer of Fraxel lasers.)

The Laser Scar Removal Procedure

During laser scar removal, the laser is moved along the scar. This can vaporize or remove a layer of skin and expose a more natural-looking skin layer, which heals over time to minimize scar appearance. Other lasers may target lower layers of the skin, stimulating new collagen growth and correcting scars from the inside out.

The laser scar removal procedure is often performed under local anesthesia in an outpatient surgery center, surgeon's office or hospital. Sometimes, general anesthesia is used. The surgery takes anywhere from a few minutes to an hour and a half.

Types of Lasers for Scar Removal

Many types of lasers are available, each of which has unique benefits for scar removal.

The CO2 and Er:YAG lasers are best suited for acne scarring. The CO2 is an ablative laser that basically sandblasts the skin away; resulting in some substantial downtime. The Er:Yag is also ablative, but less so than the CO2; meaning that it is less damaging. Many different companies manufacture CO2 and Er:YAG lasers.

Fractionated CO2 and Er:YAG lasers including the Fraxel and fractionated radiofrequency treatments also are very helpful for acne scarring, but they require multiple treatments. Fractionated lasers work by treating a fraction of the skin's surface. These lasers create tiny wounds in the deeper layer of the skin. Each wound is surrounded by untreated skin, helping to repair the treated area via a controlled wound-healing process. Both CO2 and Erbium YAG lasers as well as radiofrequency treatments can be fractionated.

The 585-595-nm pulsed dye laser technology which includes Cynosure and Candela lasers, is often used to treat hypertrophic and keloid scars. These lasers may be used with or without steroid or five percent 5-fluorouracil (5-FU) injections, both which can help flatten scars.

These lasers are considered non-ablative because they do not burn off the skin surface. Instead, they target the tissue under the skin surface and stimulate new collagen growth. There is little downtime with these lasers.

Until recently, African-Americans were not considered ideal candidates for laser scar removal, but times are changing. Certain lasers (such as fractionated infrared lasers) and radiofrequency devices such as Thermage may be helpful in treating acne scars among African-Americans. There is still little that lasers can do to treat keloid scars affecting this population.

Aftercare

Following the laser scar removal procedure, you are often advised to wash the treated area gently with a mild soap, pat it dry and apply an antibiotic ointment and a nonstick bandage. Your doctor may also prescribe an antibiotic to prevent infection.

Medicated creams can help the scar fade. A cool mask may also be recommended. You can take oral medication to treat any pain and discomfort. Let your doctor know immediately if the pain is unmanageable.

Your skin's regeneration process can begin as early as four days after treatment. Speed of regeneration depends on the type of laser used, individual skin characteristics and how well you follow your doctor's instructions. You can typically resume normal activities immediately after laser scar removal treatment. Your doctor will likely suggest a return visit for evaluation of the treated area six to eight weeks after treatment.

Complications and Risks of Laser Scar Removal

The most common side effect of laser scar removal is hyperpigmentation or hypopigmentation, both of which can be exacerbated by sun exposure. Infection or allergic reactions are also possible, and can be prevented or treated with medicated ointments, creams and oral antibiotics.

The Cost of Laser Scar Removal

The cost of laser scar removal is determined according to anesthesia fees, facility fees and physician fees. Since laser scar removal is often performed during a chemical peel or other procedure, anesthesia and facility fees can be combined.

Because of the wide range of scar issues, the potential for repeated treatments per scar, and combination of treatments that may be necessary, there is no way to estimate cost before you consult a surgeon. Ask your doctor for a cost estimate after your examination.

Purely cosmetic procedures, however, are not covered by insurance. If the cost is too much to pay at once, ask your surgeon about monthly payments.

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About the Reviewer of This Article

Mitchel P. Goldman, MD, is the founder and medical director of Goldman Butterwick Fitzpatrick Groff & Fabi: Cosmetic Laser Dermatology in San Diego. There, he directs the fellowship program accredited by the American Society for Dermatologic Surgery. He also is a Volunteer Clinical Professor in Medicine/Dermatology at the University of California, San Diego. Dr. Goldman is the 2013-14 President of the American Society for Dermatologic Surgery. He is founder and past president of the American College of Phlebology and past president of the San Diego Dermatological Society and the Sonoran Dermatology Society.