What causes scarring?
The wound-repair process starts with inflammation, moves on to tissue formation and ends with altering specific factors in the anatomy of skin cells – such as the production of collagen, the integral protein present in connective tissue that provides support to the skin, bones, cartilage and blood vessels. Scarring appears when the wound-repair process is disturbed by certain factors such as the production of too much or too little collagen. For instance, a keloid scar is caused by an excess of collagen.
Why laser scar therapy?
Laser is the abbreviation, which stands for Light Amplification by Stimulated Emission of Radiation.
Nowadays, skin laser technology has progressed to the point where there are many options available to treat scars. Laser scar removal or reduction is a frequently procedure carried out at a skin laser clinic or in a dermatologist’s office.
Cosmetic lasers form a large part of aesthetic medicine. Laser skin treatments are used to remove excess hair, reduce skin scars, tackle wrinkles, tighten skin, and eliminate warts.
Keloid scars may be removed with laser therapy
With skin laser technology, scars can be made significantly less prominent and may possibly disappear entirely, depending on how persistent they are. In this treatment, a high powered laser is used by dermatologists to remove the epidermis of skin that has been scarred. The laser also penetrates to the skin's central layers, tightening and smoothing the skin (1, 2, 3, 7).
How does laser scar treatment work?
Scars are removed by a procedure called laser resurfacing.
It is carried out as an outpatient procedure in a dermatologist’s office or skin laser clinic and takes about one to two hours. Patients have to wear protective goggles during the procedure to shield their eyes from the laser's bright light and are given a local anesthetic for the pain and twilight sedation. The patient is not unconscious but sedated. A doctor runs the laser, which looks like a handheld wand, over the scarred area to take out the damaged skin cells. Each “wave” of the wand will remove more cells.
Unlike invasive surgical procedures, laser scar treatment involves the use of short beams of micro-fine laser light that penetrates deeply into the inner layers of the skin, restoring the skin’s supportive structure. Then the natural healing mechanism of the skin sheds off any old, damaged tissue and replenishes it with new, fresh collagen and elastin – the essential building blocks of beautiful-looking skin. It’s a quick and easy procedure that is almost pain-free and requires little to no recovery time.
Overview of medical applications of laser for skin
Among many other medical applications, the laser is also used for cosmetic procedures. It is used for:
- Removal of moles, birthmarks and sun spots
- Eradication of warts
- Removal of unwanted hair
- Reducing the appearance of blemishes, wrinkles or scars
- Removal of tattoos
Laser therapy methods differ based on the particular procedure being performed. For instance, if a tumor is being removed, a flexible endoscope is used to direct the laser. This is an illuminated, thin tube used to see tissues inside the body. The endoscope is entered through an opening in the body, such as the oral cavity. The surgeon then focuses the laser that destroys or shrinks the tumor. Whereas for cosmetic procedures; lasers are applied directly to the skin.
Laser scar removal is not suitable for everyone. Patients with skin disorders such as dermatitis, cystic acne and psoriasis may not be suitable candidates for laser scar removal. Those using skin medications such as isotretinoin for the treatment of acne should stop using the medication for at least six months in advance.
Laser scar removal procedures
Different kinds of lasers are used for different medical purposes (3):
- Carbon dioxide lasers make both shallow and deeper cuts. They are often used as a treatment for superficial cancers, such as skin cancer but they can also be used in laser scar treatment.
- Argon lasers are also used to make shallow cuts. They can be used to set off photosensitizing or light activated drugs in Photodynamic therapy (PDT). This kind of cancer treatment employs light together with chemotherapy to eliminate more cancer cells.
- Nd:YAG lasers are capable of traveling along optical fibers. They are used during Laser-induced interstitial thermotherapy (LITT), a type of cancer treatment.
There are three major types of skin laser treatments offered:
- Laser resurfacing, also known as “ablative” laser resurfacing
- Non-ablative laser resurfacing
- Fractionated laser resurfacing
Ablative laser resurfacing
Two kinds of lasers are used for skin resurfacing, each with their own advantages and disadvantages:
- CO2 laser: it is a strong laser that passes deep into the skin layers and is better at eradicating deeper and thicker scars. As a result, recovery time is lengthy and may take up to two weeks. The process may also be painful, which means that you might need to take some pain killers (4).
- Erbium:YAG laser: is less powerful compared to the CO2 laser and is mostly used to treat superficial or shallow scars. You will need to take fewer painkillers and sedatives when laser scar removal is performed with this laser, and the recovery time is shorter (about a week) (5).
Skin laser resurfacing can be quite costly, price starting at around $2,700 to treat just one area of the face.
Fractionated laser resurfacing
This laser therapy uses small rays of light that penetrate deep into the skin.
This results in dozens or even hundreds of tiny, microscopic holes from where skin cells have been removed, encircled by healthy skin. The holes help in breaking down damaged skin cells while triggering collagen production in the deeper layers of skin (4, 6). The healthy skin surrounding them helps to swiftly repair the damage inflicted by the laser therapy, resulting in renovated, fresh, new skin cells.
A topical anesthetic is administered to prevent pain. This therapy is less invasive and requires very little recovery time — it also doesn't result in the same degree of skin enhancement as ablative (full-blown) laser resurfacing.
After this procedure, you may experience redness or slight swelling that disappears within a few days. You would most probably require three to five treatment sessions, with a gap of one week between every session. While some progress will be observed immediately, the full-fledged results of therapy appear after a few months.
A full-face treatment costs about $1,500, so if you are having a particular area of skin treated the price range will be less than that.
Non-ablative laser resurfacing
Skin specialists use infrared skin lasers to warm up the interior layers of the skin while leaving the surface intact. This stimulates collagen production and production of fresh new skin cells that take the place of the scarred and damaged cells. The advantage of this procedure is the time it takes. It does not need the lengthy amount of recovery time required following laser skin resurfacing and the patient also has to spend lesser time in the dermatologist’s office, fifteen to thirty minutes tops for each session.
As for the disadvantages, the process can be a bit painful, but while the laser is working, it emits a cooling spray to prevent any hurt to your uppermost skin layer.
Also, because the restoration process is taking place deep within your skin, it may take months before you see results.
Four to six therapy sessions may be required to acquire the full results of the therapy, with each session costing about $400 to $600.
The category of skin laser treatment that will be most beneficial for you depends on the type of scarring you have.
Consult a skin expert experienced in laser scar removal to determine the best strategy.
Choice of laser depends on scar characteristics
It is of crucial importance to classify scars properly as variations in clinical scar characteristics determine the type of laser scar removal protocol. Color, texture, and morphology of the scar, as well as previously used treatments, will influence the laser parameters and a number of treatment sessions required for best results.
- Hypertrophic scars: these are elevated, firm, erythematous scars which develop as the result of excess collagen production coupled with limited collagen lysis during the remodeling stage of wound healing. As a result, thick, hyalinized collagen stacks composed of fibroblasts and fibrocytes are formed. In spite of the noticeable tissue proliferation, hypertrophic scars stay put within the boundaries of the original integument injury and may fade with time.
- Keloid scars: these are elevated, reddish-purple, raised, nodular scars which, on examination, are found to be firmer than hypertrophic scars. Keloids show an extended, proliferative phase leading to the development of thick hyalinized collagen bundles similar to those produced by hypertrophic scars, but they cross the margins of the inciting wound and do not fade over time. Even though they have been observed in all skin types, keloids appear most often in individuals with darker skin tones and are connected to an inherited metabolic alteration in collagen.
- Atrophic scars: these are depressions on the skin most frequently brought about by collagen breakdown during the course of an inflammatory skin condition such as cystic acne or varicella. Scarring that appears after inflammation or cystic acne may manifest itself as the boxcar, atrophic, ice pick, saucerized scars. While ice pick and boxcar scars are best treated by dermal filler augmentation or punch excision, laser scar removal therapy is best for atrophic scars.
The effectiveness of laser scar removal may vary with race. It is less effective among African –Americans. Some types of lasers (for example fractionated infrared lasers) and radiofrequency lasers such as Thermage may be useful in acne scars among African-Americans. It is difficult to treat keloid scars with laser therapy among this population.
What are the advantages of laser scar removal?
Laser scar removal is an advanced, non-invasive therapeutic approach towards scar treatment that yields brilliant results without the discomfort and complications of surgery. It uses powerful fractional laser techniques to improve the appearance of scars without inflicting any damage to the surrounding skin. In just a few quick, easy laser therapy sessions, scars are become less prominent, leaving behind healthier and more attractive looking skin.
Trying to hide your scars with makeup products and expensive clothing takes a lot of effort and money. These are not permanent options.
With laser scar removal treatment, undesirable scars can be made less visible and the cosmetic appearance of your skin can be improved.
Opt for laser scar removal for:
- Effective, non-invasive treatment sessions
- Quick treatment of unattractive scars
- Uncomplicated procedures with minimum discomfort
- Treatments with little to no recovery period
- Superb scar removal results
Other potential advantages of receiving laser therapy over conventional surgery are:
- Lasers are more accurate than traditional surgical tools. Cuts can be made shorter and shallower. This causes less damage to the tissues.
- Laser therapy sessions are usually shorter than traditional surgeries. They can mostly be done on an outpatient basis. Patients don’t have to spend time in a recovery room or indoor ward. If general anesthesia is administered, it is usually used for a shorter time.
- Patients usually recover faster. They may have less swelling, complications, pain and scarring than with conventional surgeries.
- Laser scar removal reduces the appearance of scars by up to 70 percent and helps in preventing a recurrence (8, 9).
Risks and adverse effects of laser scar removal
Laser scar removal is one of the most invasive and intense facial procedures you can get administered on your skin. Each type of laser treatment has some adverse effects (10, 11).
Risks associated with laser scar removal
Here is a list of the most frequently occurring side effects linked with cosmetic laser use. They may not appear after every single laser procedure and the patient may not even experience all of these side effects, but these generally observed side effects are mentioned for informational purposes
Post-operative pain and complications are not an issue when it comes to laser scar removal treatment but sometimes, pain encountered during the actual procedure may be difficult for some patients to endure.
Usually, topical anesthetics are administered to the patient’s skin before the cosmetic laser therapy to alleviate as much pain as possible. However, the patient may still feel a bit of discomfort following the procedure.
For more invasive laser skin treatments, dermatologists even recommend taking pain pills. It may also be mentally strenuous to wait for your skin to recover.
Redness, itching, and/or swelling
This is a frequent side effect of laser scar removal therapy. Conventional ablative lasers actually vaporize the top layer of the patient’s skin, leaving it tender and red for several months until it recovers on its own.
Non-ablative laser are less intensive and claim to require no downtime, but facial redness (erythema), itching, and even swelling are common post-laser therapy side effects.
These symptoms generally subside after a few days, though raw “pink” skin may linger for several weeks later.
Sensitivity to the sun
As laser scar removal treatment pretty much damages or hurts your skin to encourage it to heal, it is no surprise that laser skin therapy will make your skin more vulnerable to sunburn. After you the laser scar removal treatment is complete, it is very important to stay out of the sun during peak daylight hours and apply sunscreen properly for skin protection. You don't want to get any kind of sunburn when your skin is already sensitive.
Changes in skin pigmentation
Laser scar removal therapy is not a suitable option for everyone. Usually, cosmetic lasers work better on patients with lighter skin tones than on individuals with darker skin tones, but all kinds of skin tones face a risk of lightening of the skin (hypopigmentation) or darkening of the skin (hyperpigmentation). Asian skin is especially prone to hyper pigmentation, particularly when high strength or deeply penetrating cosmetic lasers are used. Even though, some laser skin therapy procedures, for instance, those that treat pigmented lesions or sun spots, will turn the pigmentation spots darker before they improve.
Depending on the kind of laser skin treatment you dermatologist recommends, bruising could be one of the side effects you experience after the procedure. Bruising is more common experienced after use of pulsed-dye lasers where affected areas may develop purpura, or purple patches on the skin when blood vessels beneath the skin begin to leak. The bruising usually disappears on its own; however, the process can be augmented with the use of KTP lasers.
A demarcation line shows an alteration in your skin color where the cosmetic laser was administered and which area of the skin remained unscathed. If this happens, it usually shows up around the eyes, lips, and jawline of your face. Demarcation takes place when you encounter a loss of pigment in your skin from the application of laser in the treated area compared to the unaffected area of your skin.
There is not much that can be done to treat demarcation lines other than trying to depigment the remainder of your skin to match the lighter skin tone, though this is a hard task. Makeup is generally the best (yet bothersome and impermanent) way out for demarcation lines.
Infection is not a common adverse effect of laser scar removal therapy, but it does occur sometimes, especially as a result of the more invasive cosmetic laser procedures. Most dermatologists will recommend antibiotic creams or pills to take after the procedure to prevent any kind of infection from developing.
If scabs appear on your skin after receiving laser treatment, you should also resist the urge to pick or scratch them off or you will risk infection as well.
It's ironic how cosmetic laser scar removal therapy is used to cure scars yet cause scarring on your skin. Any kind of therapy that damages your skin to heal it will carry a danger of scarring.
Probability of scarring largely depends upon your skin type. If you are prone to scarring or raised scars (keloids), laser scar removal therapy might be a risky procedure for you to undertake.
Blistering and/or crusting
These are medium to harsh side effects of cosmetic lasers and laser-based facial procedures like IPL. In most cases, the patient might have sunburn post-laser, but sometimes scabbing, blistering and even crusting can develop on your face. These symptoms must be left on their own to heal.
Fat loss, particularly facial fat loss, is more frequently associated with laser scar removal treatments.
As laser therapy constricts fat cells, a lot of patients have experienced a gaunter looking face after the procedure. There is nothing that can be done to overcome the effects of fat loss except for fat grafting surgery.
Recurrence of the scar issue
Usually, it takes more than one laser scar removal session therapy to get your desired outcome. However, even after multiple laser therapy sessions, some scars may come back.
This is more commonly observed with invasive lasers that treat skin lesions and remove scars. With broken blood vessels, for example, lasers can obliterate the blood vessels, but a laser treatment will not destroy the ability of your skin to grow more blood vessels.
Some patients who have received laser scar removal therapy experience "purging" or minor breakouts after the procedure.
This could be a result of the stimulation of your skin by the laser rays or from the emollient healing creams patients have to apply after the procedure.
Patients are generally advised to not get laser treatments if they have active acne or inflamed or irritated skin. While some manufacturers claim that lasers treat acne, it has been observed that that lasers are best for treating acne marks and scars, not active acne itself.
Besides facing the probability of having to deal with the above mentioned adverse effects, laser scar removal procedures are also very costly.
The patient may end up feeling disappointed after shelling out thousands of dollars on laser treatment if he/she doesn’t maintain realistic expectations.
Make sure that you are a suitable skin type for the kind of cosmetic laser you are opting for and take good care of your skin before and after the procedure. Keep in mind that the effects of laser therapy will not appear immediately.
Hypertrophic scarring with the use of medicines
Patients intending to get laser resurfacing for treatment atrophic acne scars usually have a history of severe acne, which may presently be or in the past may have been treated with isotretinoin. Concurrent use of this medication with laser resurfacing can result in hypertrophic scarring, caused by isotretinoin’s effects, which are weakened wound healing and inhibition of collagenase production. Therefore, laser resurfacing should be performed at least six months after cessation of isotretinoin therapy.
A letdown due to unrealistic expectations
Unluckily, no treatment available at present yields 100% improvement. It must be made clear that some degree of scarring may endure and even multiple therapy sessions may not completely eliminate the scar. Nevertheless, patient acquiescence should be promoted to achieve best results and minimize complications.
Laser therapy medical treatment employs the use of focused light. Laser light is a unique kind of light. Unlike other light sources, it is tuned to very precise wavelengths.
This causes it to be focused into strong beams. Laser light is so powerful that it can be used to shape diamonds or cut steel. Lasers equip surgeons with the ability to work very accurately. They can focus on a small portion and cause minimum damage to the surrounding tissue.
Patients who undergo laser therapy experience less swelling, pain, and scarring than with conventional surgery techniques.
However, laser therapy is very costly.
It may also require multiple sessions.
What is the aftercare?
After administration of laser scar removal therapy, patients are advised to wash the affected area carefully with a mild soap, dry it with a clean towel and dab on an antibiotic ointment and a bandage. Your dermatologist may also prescribe an antibiotic to avoid development of any infection.
Medicated ointments can help the scar fade. Sometimes, a cool mask is also recommended. You may take oral anesthetics to alleviate any pain and discomfort. Let your doctor know at once if the pain is unmanageable.
Your skin's rejuvenation process can begin as early as three days after laser scar removal therapy. The speed of recovery and repair depends on the kind of laser used, skin type and how well you act upon your doctor's directions. Patients can usually continue day-to-day activities immediately after laser scar removal treatment. Your dermatologist will most likely ask you to make a return visit for a follow-up examination of the treated area six to eight weeks after treatment.
What is the cost of laser scar removal?
The expense of laser scar removal therapy varies according to anesthesia charges, facility fees and doctor fees.
As laser scar removal is often done as part of a chemical peel or other cosmetic procedure, anesthesia, and facility fees may be combined. Due to the large range of scar issues, the possibility of multiple treatments per scar, and the combination of procedures that may be necessary, there is no sure-fire way to determine cost before you consult a doctor. Ask your dermatologist for a cost estimate after your first examination.
Purely cosmetic procedures are not covered by insurance. If the sum is too big to be paid at once, ask your doctor if you can pay in monthly installments.
What is the suitable age for laser scar removal therapy?
This procedure can be performed at any age. However it is not suitable for everyone and you should always talk to your dermatologist before selecting this procedure.
What should be my postoperative expectations?
You may experience some discomfort depending on your tolerance for pain and the type of laser used following laser scar revision. Your dermatologist will give you a list of aftercare instructions.
When will the results of laser scar removal therapy begin to appear?
Results should begin to appear within the first week after treatment, but it can take up to a whole year for the skin to fully heal.
How should I get ready for laser scar removal?
You should talk to your skin expert (e.g. dermatologist) about what to do before laser scar removal. Some of the advice you may get, include:
- Avoid tanning salons before laser scar removal therapy: Tanning should be avoided 4-6 weeks prior to the treatment, as this can have an impact on the effectiveness of the treatment. This means avoiding self-tanning creams and sprays as well.
- Apply sun block regularly: Apply sun block generously of at least SPF 50 before you step out in the sun and avoid sun exposure for a month before treatment. Patients with darker skin complexion are advised to use Retin A and Hydroquinone for two weeks before the laser scar removal therapy.
- Cleanse your skin to remove oil, debris and secretions from its surface.
Things to remember
Laser scar removal can be an effective way to get rid of ugly looking hypertrophic, atrophic or keloid scars.
Benefits of laser scar removal
Various laser scar removal methods are available, including ablative laser resurfacing, non-ablative laser resurfacing and fractional laser resurfacing. Selection of method depends on the looks of your scar, your expectations. You should always ask your doctor for proper medical advice before opting for laser scar removal.
Like any other medical treatment laser scar removal procedures have some advantages and some drawbacks.
While they may make your scar less visible, the results do not appear overnight and it takes time to see proper results.
This means that you may actually need more than one treatment session, which may get expensive. Also these procedures are associated with some discomfort (pain, swelling, redness, etc.). These problems usually disappear without any treatment in a few days but sometimes laser scar removal may result in more extensive scar tissue growth and your scar may look even uglier than before. This does not happen very often but it may happen to you so chose wisely.