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Treatment of Surgical Scars with Laser Therapy

  • Medical Surgery (M Alam, Section Editor)
  • Published:
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Abstract

Purpose of Review

Numerous lasers and other energy-based devices have been explored in the treatment of scarring. The following review of the literature examines types of post-operative scarring, features that distinguish scars from normal skin, the pathogenesis of these skin changes, the evidence for laser and other energy-based modalities in the treatment of postsurgical scars, scar prevention using lasers, and future directions for therapy.

Recent Findings

Utilization of laser and light-based therapies can induce scar remodeling and significantly improve scar appearance. Pulse dye lasers have been the mainstay in laser-based scar therapy. Fractional lasers have provided a major breakthrough in the treatment of scars in all skin types.

Summary

Based on current research, the most efficacious laser therapies include pulsed dye laser for erythematous, hypertrophic, or keloidal scars; fractional non-ablative lasers for atrophic, hypopigmented scars in almost all skin types; and fractional ablative lasers for patients and clinicians who wish to maximize scar improvements while reducing downtime relative to fully ablative laser technologies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Leitenberger Jj IS, Swanson NA, Lee KK. Revision of surgical scars. In: Jk R, editor. Surgery of the Skin. Thirdth ed. London, New York, Oxford, Philadelphia, St Louis, Sydney, Toronto: Elsevier Saunders; 2015. This was chosen to represent the initial findings of a laser category in the treatment of scars for comparative studies on scars, and for consensus papers.

    Google Scholar 

  2. English RS, Shenefelt PD. Keloids and hypertrophic scars. Dermatol Surg. 1999;25:631–8.

    Article  CAS  PubMed  Google Scholar 

  3. Nouri K, Vidulich K, Rivas MP. Lasers for scars: a review. J Cosmet Dermatol. 2006;5:14–22.

    Article  PubMed  Google Scholar 

  4. Alster TS. Laser treatment of hypertrophic scars, keloids and striae. Dermatol Clin. 1997;15:419–29.

    Article  CAS  PubMed  Google Scholar 

  5. Clark RA. Biology of dermal wound repair. Dermatol Clin. 1993;11:647–66.

    CAS  PubMed  Google Scholar 

  6. Elsaie ML, Choudhary S. Lasers for scars: a review and evidence-based appraisal. J Drugs Dermatol. 2010;9(11):1355–62.

    PubMed  Google Scholar 

  7. Min SU, Choi YS, Lee DH, Yoon MY, Suh DH. Comparison of a long-pulse Nd:YAG laser and a combined 585/1,064-nm laser for the treatment of acne scars. Dermatol Surg. 2009;35(11):1720–7.

    Article  CAS  PubMed  Google Scholar 

  8. Chacon AH, Leon JA, Nouri K. Lasers for scars. In: Nouri K, editor. Handbook of Lasers in Dermatology. London: Springer; 2014. p. 197–209.

    Google Scholar 

  9. Idriss N, Maibach HI. Scar assessment scales: a dermatologic overview. Skin Res Technol. 2009;15(1):1–5.

    Article  PubMed  Google Scholar 

  10. Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrelater reliability. J Burn Care Rehabil. 1995;16(5):535–8.

    Article  CAS  PubMed  Google Scholar 

  11. Frietas C, Melo C, Alexandrino AM, Noites A. Efficacy of low-level laser therapy on scar tissue. J Cosmet Laser Ther. 2013;15:171–6.

    Article  Google Scholar 

  12. Li J, Chen J, Kirsner R. Pathophysiology of acute wound healing. Clin Dermatol. 2007;25:9–18.

    Article  CAS  PubMed  Google Scholar 

  13. Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet. 1995;345(8959):1198–200.

    Article  CAS  PubMed  Google Scholar 

  14. Vrijiman C, van Drooge AM, Limpens J, et al. Laser and intense pulsed light therapy for the treatment of hypertrophic scars: a systematic review. Br J Dermatol. 2011;165:934–42.

    Article  Google Scholar 

  15. Nouri K, Jimenez GP, Harrison-Balestra C, Elgart GW. 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg. 2003;29:65–73.

    PubMed  Google Scholar 

  16. Alster TS. Improvement of erythematous and hypertrophic scars by the 585-nm flashlamp-pumped pulsed dye laser. Ann Plast Surg. 1994;32(2):186–90.

  17. Nouri K, Rivas MP, Stevens M, et al. Comparison of the effectiveness of the pulsed dye laser 585 nm versus 595 nm in the treatment of new surgical scars. Lasers Med Sci. 2009;24:801–10.

    Article  PubMed  Google Scholar 

  18. Kuo YR, Wu WS, Jeng SF, et al. Suppressed TGF-beta1 expression is correlated with up-regulation of matrix metalloproteinase-13 in keloid regrtession after flashlamp pulsed-dye laser treatment. Lasers Surg Med. 2005;36(1):38–42.

    Article  PubMed  Google Scholar 

  19. Cao Y, Wang F, Jia Q, et al. One possible mechanism of pulsed dye laser treatment on infantile hemangioma: induction of endothelial apoptosis and serum vascular endothelial growth factor (VEGF) level changes. J Lasers Med Sci. 2014;5(2):75–81.

    PubMed  PubMed Central  Google Scholar 

  20. Abergel RP, Dwyer RM, Meeker CA, et al. Laser treatment of keloids: a clinical trial and an in vivo study with NdYAG laser. Lasers Surg Med. 1984;4(3):291–5.

    Article  CAS  PubMed  Google Scholar 

  21. Cho SB, Lee JH, Lee SH, et al. Efficacy and safety of 1064-nm Q-switched Nd:YAG laser with low fluence for keloids and hypertrophic scars. J Eur Acad Dermatol Venereol. 2010;24(9):1070–4.

    CAS  PubMed  Google Scholar 

  22. Abergel RPMC, Lam TS, et al. Control of connective tissue metabolism by lasers: recent developments and future prospects. J Am Acad Dermatol. 1984;11(6):1142–50.

    Article  CAS  PubMed  Google Scholar 

  23. Lim TC, Tan WC. Carbon dioxide laser for keloids. Plast Reconstr Surg. 1991;88(6):1111.

    Article  CAS  PubMed  Google Scholar 

  24. Tanzi EL, Alster TS. Comparison of a 1450-nm diode laser and a 1320-nm Nd:YAG laser in the treatment of atrophic facial scars: a prospective clinical and histologic study. Dermatol Surg. 2004;30(2 Pt 1):152–7.

    PubMed  Google Scholar 

  25. Kunishige JH, Katz TM, Goldberg LH, et al. Fractional photothermolysis for the treatment of surgical scars. Dermatol Surg. 2010;36(4):538–41.

    Article  CAS  PubMed  Google Scholar 

  26. Chua SH, Ang P, Khoo LS, Goh CL. Nonablative 1450-nm diode laser in the treatment of facial atrophic acne scars in type IV to V Asian skin: a prospective clinical study. Dermatol Surg. 2004;30(10):1287–91.

    PubMed  Google Scholar 

  27. Alster T, Zaulyanov L. Laser scar revision: a review. Dermatol Surg. 2007;33:131–40.

    CAS  PubMed  Google Scholar 

  28. Alster TS. Cutaneous resurfacing with CO2 and erbium:YAG lasers: preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg. 1999;103:619–32.

    Article  CAS  PubMed  Google Scholar 

  29. Wheeland RG. Revision of full-thickness skin grafts using the carbon dioxide laser. J Dermatol Surg Oncol. 1988;14(2):130–4.

    Article  CAS  PubMed  Google Scholar 

  30. Nanni CA, Alster TA. Complications of carbon dioxide laser resurfacing: an evaluation of 500 patients. Dermatol Surg. 1998;24(3):315–20.

    Article  CAS  PubMed  Google Scholar 

  31. Alster TS, West TB. Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. Dermatol Surg. 1996;22(2):151–4.

    Article  CAS  PubMed  Google Scholar 

  32. Alter TS. Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous resurfacing. Lasers Surg Med. 1999;24(2):87–92.

    Article  Google Scholar 

  33. Vasily DB, Cerino ME, Ziselman EM, Zeina ST. Non-ablative fractional resurfacing of surgical and post-traumatic scars. J Drugs Dermatol. 2009;8(11):998–1005.

    PubMed  Google Scholar 

  34. Rahman Z, Tanner H, Herron S, Jiang K. Comparison of high energy versus low energy treatment for resurfacing with the 1550 nm erbium-fiber fractional laser. Lasers Surg Med. 2006;38 suppl 18:62.

    Google Scholar 

  35. Manstein D, Herron GS, Sink RK, et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426–38.

    Article  PubMed  Google Scholar 

  36. Stumpp OF, Bedi VP, Wyatt D, Lac D, Rahman Z, Chan KF. In vivo confocal imaging of epidermal cell migration and dermal changes post nonablative fractional resurfacing: study of the wound healing process with corroborated histopathologic evidence. J Biomed Opt. 2009;14(2):024018.

    Article  PubMed  Google Scholar 

  37. Ozog DM, Moy RL. A randomized split-scar study of intraoperative treatment of surgical wound edges to minimize scarring. Arch Dermatol. 2011;147:1108–10.

    Article  PubMed  Google Scholar 

  38. Choe JH, Park YL, Kim BJ, et al. Prevention of thyroidectomy scar using a new 1550 nm fractional erbium-glass laser. Dermatol Surg. 2009;35:1199–205.

    Article  CAS  PubMed  Google Scholar 

  39. Fisher G, Geronemus R. Short-term side effects of fractional photothermolysis. Dermatol Surg. 2005;31:1245–9.

    Article  CAS  PubMed  Google Scholar 

  40. Graber EM, Tanzi EL, Alster TA. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg. 2008;34:301–7.

    CAS  PubMed  Google Scholar 

  41. Sherling M, Friedman PM, Adrian R, Burns AJ, et al. Consensus recommendations on the use of an erbium-doped 1,550-nm fractionated laser and its applications in dermatologic laser surgery. Dermatol Surg. 2010;36:461–9.

    Article  CAS  PubMed  Google Scholar 

  42. Rahman Z, Tanner H, Jiang K. Treatment of atrophic scars with the 1550 nm erbium-fiber fractional laser. Lasers Surg Med. 2006;38 suppl 18:24.

    Google Scholar 

  43. Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg. 2007;33(3):295–9.

    CAS  PubMed  Google Scholar 

  44. Tierney E, Mahmoud BH, Srivastava D, et al. Treatment of surgical scars with nonablative fractional laser versus pulsed dye laser: a randomized controlled trial. Dermatol Surg. 2009;35(8):1172–80.

    Article  CAS  PubMed  Google Scholar 

  45. Glaich AS, Rahman Z, Goldberg LH, et al. Fractional resurfacing for the treatment of hypopigmented scars: a pilot study. Dermatol Surg. 2007;33:298–301.

    Google Scholar 

  46. Brauer JA, Kazlouskaya V, Alabdulrazzaq H, et al. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. JAMA Dermatology. 2015;151(3):278–84.

    Article  PubMed  Google Scholar 

  47. Goncalves RV, Sarandy MM, da Matta SL, et al. Comparative study of the effects of laser photobiomodulation and extract of Brassica oleracea on skin wounds in wistar rats: a histomorphometric study. Pathol Res Pract. 2013;209(10):648–53.

    Article  CAS  PubMed  Google Scholar 

  48. Erol OO, Gurlek A, Agaoglu G, et al. Treatment of hypertrophic scars and keloids using intense pulsed light (IPL). Aesth Plast Surg. 2008;32:902–9.

    Article  Google Scholar 

  49. Bellew SG, Weiss MA, Weiss RA. Comparison of intense pulsed light to 595-nm long-pulsed pulse dye laser for treatment of surgical scars: a pilot study. J Drugs Dermatol. 2005;4(4):448–52.

    PubMed  Google Scholar 

  50. Hopkins JT, Mcloda TA, Seegmiller JG, Baxter DG. Low-level laser therapy facilitates superficial wound healing in humans: a triple-blind, sham controlled study. J Athl Train. 2004;2004(39):223–9.

    Google Scholar 

  51. Gaida K, Koller R, Isler C, et al. Low level laser therapy—a conservative approach to the burn scar? Burns. 2004;30:362–7.

    Article  PubMed  Google Scholar 

  52. Capon AC, Goss AC, Larmacovai GN, et al. Scar prevention by laser-assisted scar healing (LASH): a pilot study using an 810-nm diode-laser system. Lasers Surg Med. 2008;40:443–5.

    Article  PubMed  Google Scholar 

  53. Yun JS, Choi YJ, Kim WS, Lee GY. Prevention of thyroidectomy scars in Asian adults using a 532-nm potassium titanyl phosphate laser. Dermatol Surg. 2011;37(12):1747–53.

    Article  CAS  PubMed  Google Scholar 

  54. Kim HS, Lee JH, Park YM, Lee YH. Comparison of the effectiveness of nonablative fractional laser versus ablative fractional laser in thyroidectomy scar prevention: a pilot. J Cosmet Laser Ther. 2012;14:89–93.

    Article  PubMed  Google Scholar 

  55. Jung JY, Jeong JJ, Roh HJ, et al. Early postoperative treatment of thyroidectomy scars using a fractional carbon dioxide laser. Dermatol Surg. 2011;37:217–23.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Dermatology, Stanford University, 450 Broadway Street, Pavillion B, 4th floor, MC 5338, Redwood City, CA, 94063, USA

    Laurel Naversen Geraghty & Zakia Rahman

Authors
  1. Laurel Naversen Geraghty
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  2. Zakia Rahman
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Corresponding author

Correspondence to Zakia Rahman.

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Conflict of Interest

Dr. Laurel Naversen Geraghty declares that she has no conflict of interest. Dr. Zakia Rahman reports equipment for medical use from Solta Medical and from Sciton, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Medical Surgery

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Geraghty, L.N., Rahman, Z. Treatment of Surgical Scars with Laser Therapy. Curr Derm Rep 5, 143–149 (2016). https://doi.org/10.1007/s13671-016-0152-7

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  • DOI: https://doi.org/10.1007/s13671-016-0152-7

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