Lasers in Medical Science

, Volume 34, Issue 9, pp 1881–1887 | Cite as

Early intervention with pulse dye and CO2 ablative fractional lasers to improve cutaneous scarring post-lumpectomy: a randomized controlled trial on the impact of intervention on final cosmesis

  • Tamar Safra
  • Waseem Shehadeh
  • Amir Koren
  • Fares Salameh
  • Or Friedman
  • Eli Sprecher
  • Ofir ArtziEmail author
Original Article


Light-based modalities appear to be effective for ameliorating surgical scar appearance; however, protocols for achieving such outcomes have yet to be established. We studied the safety and efficacy of a combination of pulsed dye laser (PDL) and fractional ablative CO2 laser (FACL) for the attenuation of post-lumpectomy scarring. We conducted a prospective, evaluator-blinded, comparative split-scar study in post-lumpectomy patients. One-half of the scar was treated with three sessions of 595-nm PDL and FACL at 1-month intervals, starting within 6 weeks after suture removal. The entire scar was also treated with standard moisturizers and silicone gels. Six months after the last treatment, the two halves of the scar were assessed by three uninvolved physicians who used the Observer Scar Assessment Scale as well as by the patients who used the Patient and Observer Scar Assessment Scale. Eighteen female patients (mean age, 51.3 years) with a mean scar length of 7.8 cm completed the treatment and follow-up. Six months after the last treatment, both the physician evaluators and the patients noted significant improvements for all assessed scar parameters in the laser-treated scar area compared with the untreated scar area. The treatment was well tolerated, and no remarkable adverse events were reported. All 18 participants were satisfied with the treated scar areas. A combination PDL and FACL protocol starting up to 6 weeks after suture removal is a safe and effective method for the attenuation of post-lumpectomy scar formation.


Scar Lumpectomy Pulsed dye laser Fractional ablative carbon dioxide laser Patient and Observer Scar Assessment Scale 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Chen K, Li S, Li Q, Zhu L, Liu Y, Song E, Su F (2016) Breast-conserving surgery rates in breast cancer patients with different molecular subtypes: an observational study bvased on Surveillance, Epidemiology, and End Results (SEER) database. Medicine 95(8):e2593. PubMedPubMedCentralGoogle Scholar
  2. 2.
    Carver CS, Pozo-Kaderman C, Price AA, Noriega V, Harris SD, Derhagopian RP, Robinson DS, Moffat FL Jr (1998) Concern about aspects of body image and adjustment to early stage breast cancer. Psychosom Med 60(2):168–174PubMedGoogle Scholar
  3. 3.
    Hartl K, Janni W, Kastner R, Sommer H, Strobl B, Rack B, Stauber M (2003) Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients. Ann Oncol 14(7):1064–1071PubMedGoogle Scholar
  4. 4.
    Kraus PL (1999) Body image, decision making, and breast cancer treatment. Cancer Nurs 22(6):421–427 quiz 428–429PubMedGoogle Scholar
  5. 5.
    Son D, Harijan A (2014) Overview of surgical scar prevention and management. J Korean Med Sci 29(6):751–757. PubMedPubMedCentralGoogle Scholar
  6. 6.
    de las Alas JM, Siripunvarapon AH, Dofitas BL (2012) Pulsed dye laser for the treatment of keloid and hypertrophic scars: a systematic review. Expert Rev Med Devices 9(6):641–650. Google Scholar
  7. 7.
    Kim DH, Ryu HJ, Choi JE, Ahn HH, Kye YC, Seo SH (2014) A comparison of the scar prevention effect between carbon dioxide fractional laser and pulsed dye laser in surgical scars. Dermatol Surg 40(9):973–978. PubMedGoogle Scholar
  8. 8.
    Cohen JL, Geronemus R (2016) Safety and efficacy evaluation of pulsed dye laser treatment, CO2 ablative fractional resurfacing, and combined treatment for surgical scar clearance. J Drugs Dermatol 15(11):1315–1319PubMedGoogle Scholar
  9. 9.
    Ha JM, Kim HS, Cho EB, Park GH, Park EJ, Kim KH, Kim LS, Kim KJ (2014) Comparison of the effectiveness of nonablative fractional laser versus pulsed-dye laser in thyroidectomy scar prevention. Ann Dermatol 26(5):615–620. PubMedPubMedCentralGoogle Scholar
  10. 10.
    Hantash BM, Bedi VP, Chan KF, Zachary CB (2007) Ex vivo histological characterization of a novel ablative fractional resurfacing device. Lasers Surg Med 39(2):87–95. PubMedGoogle Scholar
  11. 11.
    Ryu HW, Cho JH, Lee KS, Cho JW (2014) Prevention of thyroidectomy scars in Korean patients using a new combination of intralesional injection of low-dose steroid and pulsed dye laser starting within 4 weeks of suture removal. Dermatol Surg 40(5):562–568. PubMedGoogle Scholar
  12. 12.
    Goldman MP (2006) Cutaneous and cosmetic laser surgery. Elsevier Inc., PhiladelphiaGoogle Scholar
  13. 13.
    Rahman Z, MacFalls H, Jiang K, Chan KF, Kelly K, Tournas J, Stumpp OF, Bedi V, Zachary C (2009) Fractional deep dermal ablation induces tissue tightening. Lasers Surg Med 41(2):78–86. PubMedGoogle Scholar
  14. 14.
    DeBruler DM, Blackstone BN, Baumann ME, McFarland KL, Wulff BC, Wilgus TA, Bailey JK, Supp DM, Powell HM (2017) Inflammatory responses, matrix remodeling, and re-epithelialization after fractional CO2 laser treatment of scars. Lasers Surg Med 49(7):675–685. PubMedGoogle Scholar
  15. 15.
    Capon A, Iarmarcovai G, Gonnelli D, Degardin N, Magalon G, Mordon S (2010) Scar prevention using laser-assisted skin healing (LASH) in plastic surgery. Aesthet Plast Surg 34(4):438–446. Google Scholar
  16. 16.
    Souil E, Capon A, Mordon S, Dinh-Xuan AT, Polla BS, Bachelet M (2001) Treatment with 815-nm diode laser induces long-lasting expression of 72-kDa heat shock protein in normal rat skin. Br J Dermatol 144(2):260–266PubMedGoogle Scholar
  17. 17.
    Capon A, Mordon S (2003) Can thermal lasers promote skin wound healing? Am J Clin Dermatol 4(1):1–12PubMedGoogle Scholar
  18. 18.
    Shah M, Revis D, Herrick S, Baillie R, Thorgeirson S, Ferguson M, Roberts A (1999) Role of elevated plasma transforming growth factor-beta1 levels in wound healing. Am J Pathol 154(4):1115–1124PubMedPubMedCentralGoogle Scholar
  19. 19.
    DeJong HM, Phillips M, Edgar DW, Wood FM (2017) Patient opinion of scarring is multidimensional: an investigation of the POSAS with confirmatory factor analysis. Burns 43(1):58–68. PubMedGoogle Scholar
  20. 20.
    Lee Y, Kim W (2017) Combination laser treatment for immediate post-surgical scars: a retrospective analysis of 33 immature scars. Lasers Med Sci 32(5):1111–1119. PubMedGoogle Scholar
  21. 21.
    Shin JU, Gantsetseg D, Jung JY, Jung I, Shin S, Lee JH (2014) Comparison of non-ablative and ablative fractional laser treatments in a postoperative scar study. Lasers Surg Med 46(10):741–749. PubMedGoogle Scholar
  22. 22.
    Sobanko JF, Vachiramon V, Rattanaumpawan P, Miller CJ (2015) Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: a split-scar, evaluator-blinded study. Lasers Surg Med 47(1):1–5. PubMedGoogle Scholar
  23. 23.
    Davari P, Gorouhi F, Hashemi P, Behnia F, Ghassemi A, Nasiri-Kashani M, Firooz A (2012) Pulsed dye laser treatment with different onset times for new surgical scars: a single-blind randomized controlled trial. Lasers Med Sci 27(5):1095–1098PubMedGoogle Scholar
  24. 24.
    Lee SJ, Suh DH, Lee JM, Song KY, Ryu HJ (2016) Dermal remodeling of burn scar by fractional CO2 laser. Aesthet Plast Surg 40(5):761–768Google Scholar
  25. 25.
    Truong PT, Lee JC, Soer B, Gaul CA, Olivotto IA (2007) Reliability and validity testing of the Patient and Observer Scar Assessment Scale in evaluating linear scars after breast cancer surgery. Plast Reconstr Surg 119(2):487–494. PubMedGoogle Scholar
  26. 26.
    Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A (2008) The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 61(9):1049–1058. PubMedGoogle Scholar
  27. 27.
    Karmisholt KE, Haerskjold A, Karlsmark T, Waibel J, Paasch U, Haedersdal M (2018) Early laser intervention to reduce scar formation—a systematic review. J Eur Acad Dermatol Venereol 32(7):1099–1110. PubMedGoogle Scholar
  28. 28.
    Park KY, Oh IY, Seo SJ, Kang KH, Park SJ (2013) Appropriate timing for thyroidectomy scar treatment using a 1550-nm fractional erbium-glass laser. Dermatol Surg 39(12):1827–1834. PubMedGoogle Scholar
  29. 29.
    Nouri K, Jimenez GP, Harrison-Balestra C, Elgart GW (2003) 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg 29(1):65–73PubMedGoogle Scholar
  30. 30.
    Chan HH, Wong DS, Ho WS, Lam LK, Wei W (2004) The use of pulsed dye laser for the prevention and treatment of hypertrophic scars in Chinese persons. Dermatol Surg 30(7):987–994PubMedGoogle Scholar
  31. 31.
    Kim HS, Kim BJ, Lee JY, Kim HO, Park YM (2011) Effect of the 595-nm pulsed dye laser and ablative 2940-nm Er:YAG fractional laser on fresh surgical scars: an uncontrolled pilot study. J Cosmet Laser Ther 13(4):176–179PubMedGoogle Scholar
  32. 32.
    Mehrvarz S, Ebrahimi A, Sahraei H, Bagheri MH, Fazili S, Manoochehry S, Rasouli HR (2017) Effects of topical tamoxifen on wound healing of burned skin in rats. Arch Plast Surg 44(5):378–383PubMedPubMedCentralGoogle Scholar
  33. 33.
    Mousavi SR, Raaiszadeh M, Aminseresht M, Behjoo S (2010) Evaluating tamoxifen effect in the prevention of hypertrophic scars following surgical incisions. Dermatol Surg 36(5):665–669PubMedGoogle Scholar
  34. 34.
    Gragnani A, Warde M, Furtado F, Ferreira LM (2010) Topical tamoxifen therapy in hypertrophic scars or keloids in burns. Arch Dermatol Res 302(1):1–4PubMedGoogle Scholar
  35. 35.
    Caponio R, Ciliberti MP, Graziano G, Necchia R, Scognamillo G, Pascali A, Bonaduce S, Milella A, Matichecchia G, Cristofaro C, Di Fatta D, Tamborra P, Lioce M (2016) Waiting time for radiation therapy after breast-conserving surgery in early breast cancer: a retrospective analysis of local relapse and distant metastases in 615 patients. Eur J Med Res 21:32PubMedPubMedCentralGoogle Scholar
  36. 36.
    Balduzzi A, Leonardi MC, Cardillo A, Orecchia R, Dellapasqua S, Iorfida M, Goldhirsch A, Colleoni M (2010) Timing of adjuvant systemic therapy and radiotherapy after breast-conserving surgery and mastectomy. Cancer Treat Rev 36(6):443–450PubMedGoogle Scholar
  37. 37.
    Jobsen JJ, van der Palen J, Baum M, Brinkhuis M, Struikmans H (2013) Timing of radiotherapy in breast-conserving therapy: a large prospective cohort study of node-negative breast cancer patients without adjuvant systemic therapy. Br J Cancer 108(4):820–825PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OncologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Department of DermatologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  4. 4.Department of Reconstructive and Plastic SurgeryTel Aviv Sourasky Medical CenterTel AvivIsrael

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