Skip to main content

Laser Therapy for Scars

  • Chapter
  • First Online:
Total Scar Management

Abstract

Over the last 30 years, laser therapy has emerged as an effective primary and adjuvant treatment modality for scars. Laser therapy facilitates the selective destruction of discrete structures within the skin, as well as microscopic, spatially selective injuries to scars that result in both local and distant tissue remodeling. This remodeling process capitalizes on the patient’s native tissue reservoirs to facilitate a process of normalization leading to improved scar function, aesthetics, and a reduction in scar-associated symptoms. This chapter will review the basic principles of laser therapy for scars, as well as an evidence-based therapeutic approach for specific scar characteristics. It is critical that any physician managing scars be familiar with these invaluable tools for scar optimization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Leblebici B, Adam M, Bağiş S, Tarim AM, Noyan T, Akman MN, et al. Quality of life after burn injury: the impact of joint contracture. J Burn Care Res. 2006;27(6):864–8.

    Article  PubMed  Google Scholar 

  2. Stekelenburg CM, Marck RE, Tuinebreijer WE, de Vet HC, Ogawa R, van Zuijlen PP. A systematic review on burn scar contracture treatment: searching for evidence. J Burn Care Res. 2015;36(3):e153–61. https://doi.org/10.1097/BCR.0000000000000106.

    Article  PubMed  Google Scholar 

  3. Bijlard E, Uiterwaal L, Kouwenberg CA, Mureau MA, Hovius SE, Huygen FJ. A systematic review on the prevalence, etiology, and pathophysiology of intrinsic pain in dermal scar tissue. Pain Physician. 2017;20(2):1–13.

    PubMed  Google Scholar 

  4. Parnell LKS. Itching for knowledge about wound and scar pruritus. Wounds. 2018;30(1):17–36.

    PubMed  Google Scholar 

  5. Van Loey NE, Van Son MJ. Psychopathology and psychological problems in patients with burn scars: epidemiology and management. Am J Clin Dermatol. 2003;4(4):245–72.

    Article  PubMed  Google Scholar 

  6. Stoddard FJ Jr, Ryan CM, Schneider JC. Physical and psychiatric recovery from burns. Surg Clin North Am. 2014;94(4):863–78. https://doi.org/10.1016/j.suc.2014.05.007.

    Article  PubMed  Google Scholar 

  7. Bock O, Schmid-Ott G, Malewski P, Mrowietz U. Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res. 2006;297(10):433–8. https://doi.org/10.1097/01.BCR.0000245652.26648.36.

    Article  PubMed  Google Scholar 

  8. Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A. The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg. 2008;61(9):1049–58. https://doi.org/10.1016/j.bjps.2008.03.020.

    Article  CAS  PubMed  Google Scholar 

  9. Bijlard E, Kouwenberg CA, Timman R, Hovius SE, Busschbach JJ, Mureau MA. Burden of keloid disease: a cross-sectional health-related quality of life assessment. Acta Derm Venereol. 2017;97(2):225–9. https://doi.org/10.2340/00015555-2498.

    Article  PubMed  Google Scholar 

  10. Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and Z-plasty for facial burn scars: the alternative to excision. Ann Plast Surg. 2008;60:480–6.

    Article  CAS  PubMed  Google Scholar 

  11. Levi B, Ibrahim A, Mathews K, Wojcik B, Gomez J, Fagan S, et al. The use of CO2 fractional photothermolysis for the treatment of burn scars. J Burn Care Res. 2016;37(2):106–14. https://doi.org/10.1097/BCR.0000000000000285.

    Article  PubMed  Google Scholar 

  12. Miletta N, Siwy K, Hivnor C, Clark J, Shofner J, David Z, Rox Anderson R, Lee K, Donelan M. Fractional ablative laser therapy is an effective treatment for hypertrophic burn scars: A prospective study of objective and subjective outcomes. Ann Surg. 2019; https://doi.org/10.1097/SLA.0000000000003576. [Epub ahead of print].

  13. Issler-Fisher AC, Fischer OM, Smialkowski AO, Li F, van Schalkwyk CP, Haertsch P, et al. Ablative fractional CO2 laser for burn scar reconstruction: an extensive subjective and objective short-term outcome analysis of a prospective treatment cohort. Burns. 2017;43(3):573–82. https://doi.org/10.1016/j.burns.2016.09.014.

    Article  PubMed  Google Scholar 

  14. Einstein A. On the quantum theory of radiation. Physikal Zeitschr. 1917;18:121.

    CAS  Google Scholar 

  15. Nelson JS. An introduction to lasers and laser-tissue interactions in dermatology. In: Kauvar ANB, Hruza GJ, editors. Principles and practices in cutaneous laser surgery. Boca Raton: Taylor & Francis Group; 2005. p. 59–78.

    Google Scholar 

  16. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220:524–7.

    Article  CAS  PubMed  Google Scholar 

  17. Alster TS. Improvement of erythematous and hypertrophic scars by the 585-nm flashlamp-pumped pulsed dye laser. Ann Plast Surg. 1994;32(2):186–90.25.

    Article  CAS  PubMed  Google Scholar 

  18. Allison KP, Kiernan MN, Waters RA, Clement RM. Pulsed dye laser treatment of burn scars. Alleviation or irritation? Burns. 2003;29:207–13.

    Article  CAS  PubMed  Google Scholar 

  19. Nast A, Eming S, Fluhr J, Fritz K, Gauglitz G, Hohenleutner S, et al. German S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids). J Dtsch Dermatol Ges. 2012;10(10):747–62. https://doi.org/10.1111/j.1610-0387.2012.08012.x.

    Article  PubMed  Google Scholar 

  20. de las Alas JM, Siripunvarapon AH, Dofitas BL. Pulsed dye laser for the treatment of keloid and hypertrophic scars: a systematic review. Expert Rev Med Devices. 2012;9(6):641–50. https://doi.org/10.1586/erd.12.56.

    Article  CAS  PubMed  Google Scholar 

  21. Kuo YR, Wu WS, Jeng SF, Huang HC, Yang KD, Sacks JM, et al. Activation of ERK and p38 kinase mediated keloid fibroblast apoptosis after flashlamp pulsed-dye laser treatment. Lasers Surg Med. 2005;36(1):31–7. https://doi.org/10.1002/lsm.20129.

    Article  PubMed  Google Scholar 

  22. Syneron Candela. VBeam Perfecta system specification. https://syneroncandela.com/int/product/877/system_specifications. Accessed 7 Oct 2018.

  23. Keaney TC, Tanzi E, Alster T. Comparison of 532 nm potassium titanyl phosphate laser and 595 nm pulsed dye laser in the treatment of erythematous surgical scars: a randomized, controlled, open-label study. Dermatol Surg. 2016;42(1):70–6. https://doi.org/10.1097/DSS.0000000000000582.

    Article  CAS  PubMed  Google Scholar 

  24. Lee Y, Kim W. Combination laser treatment for immediate post-surgical scars: a retrospective analysis of 33 immature scars. Lasers Med Sci. 2017;32(5):1111–9. https://doi.org/10.1007/s10103-017-2215-9. Epub 2017 May 2.

    Article  PubMed  Google Scholar 

  25. Raulin C, Weiss RA, Schönermark MP. Treatment of essential telangiectasias with an intense pulsed light source (PhotoDerm VL). Dermatol Surg. 1997;23(10):941–5. discussion 945–6.

    Article  CAS  PubMed  Google Scholar 

  26. Hultman CS, Edkins RE, Lee CN, Calvert CT, Cairns BA. Shine on: review of laser- and light-based therapies for the treatment of burn scars. Dermatol Res Pract. 2012;2012:243,651. https://doi.org/10.1155/2012/243651.

    Article  Google Scholar 

  27. Kim DY, Park HS, Yoon HS, Cho S. Efficacy of IPL device combined with intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with regards to the recovery of skin barrier function: a pilot study. J Dermatolog Treat. 2015;26(5):481–4. https://doi.org/10.3109/09546634.2015.1024598. Epub 2015 Sep 4.

    Article  PubMed  Google Scholar 

  28. Quarato D, Pascali M, Carinci F. Traumatic and surgical scars: successful treatment with a 1,565nm erbium-glass NAFL combined with IPL. J Biol Regul Homeost Agents. 2018;32(2 Suppl. 1):159–65.

    CAS  PubMed  Google Scholar 

  29. Peng L, Tang S, Li Q. Intense pulsed light and laser treatment regimen improves scar evolution after cleft lip repair surgery. J Cosmet Dermatol. 2018; https://doi.org/10.1111/jocd.12684. [Epub ahead of print].

    Article  PubMed  Google Scholar 

  30. Wanner M, Sakamoto FH, Avram MM, Chan HH, Alam M, Tannous Z, et al. Immediate skin responses to laser and light treatments. Therapeutic endpoints: how to obtain efficacy. J Am Acad Dermatol. 2016;74(5):821–33. https://doi.org/10.1016/j.jaad.2015.06.026.

    Article  PubMed  Google Scholar 

  31. Iyer S, Fitzpatrick RE. Long-pulsed dye laser treatment for facial telangiectasias and erythema: evolution of a single purpuric pass versus multiple subpurpuric passes. Dermatol Surg. 2005;31(8 Pt 1):898–903. https://doi.org/10.1111/j.1524-4725.2005.31802.

    Article  CAS  PubMed  Google Scholar 

  32. Srinivas CR, Kumaresan M. Lasers for vascular lesions: standard guidelines of care. Indian J Dermatol Venereol Leprol. 2011;77(3):349–68. https://doi.org/10.4103/0378-6323.79728.

    Article  CAS  PubMed  Google Scholar 

  33. Cheng W, Saing H, Zhou H, Han Y, Peh W, Tam PK. Ultrasound assessment of scald scars in Asian children receiving pressure garment therapy. J Pediatr Surg. 2001;36(3):466–9.

    Article  CAS  PubMed  Google Scholar 

  34. Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. Burns Trauma. 2016;4:14. https://doi.org/10.1186/s41038-016-0036-x. eCollection 2016.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  36. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426–38. https://doi.org/10.1002/lsm.20048.

    Article  PubMed  Google Scholar 

  37. Miletta NR, Beachkofsky TM, Donelan MB, Kaiser SE, Hivnor CM. Lasers for burns and trauma. In: Kantor J, editor. Dermatologic surgery. New York: McGraw Hill Education; 2018. p. 1065–90.

    Google Scholar 

  38. Laubach HJ, Tannous Z, Anderson RR, Manstein D. Skin responses to fractional photothermolysis. Lasers Surg Med. 2006;38(2):142–9. https://doi.org/10.1002/lsm.20254.

    Article  PubMed  Google Scholar 

  39. Azzam OA, Bassiouny DA, El-Hawary MS, El Maadawi ZM, Sobhi RM, El-Mesidy MS. Treatment of hypertrophic scars and keloids by fractional carbon dioxide laser: a clinical, histological, and immunohistochemical study. Lasers Med Sci. 2015;31(1):9–18. https://doi.org/10.1007/s10103-015-1824-4.

    Article  Google Scholar 

  40. Qu L, Liu A, Zhou L, He C, Grossman PH, Moy RL, et al. Clinical and molecular effects on mature burn scars after treatment with a fractional CO(2) laser. Lasers Surg Med. 2012;44(7):517–24. https://doi.org/10.1002/lsm.22055.

    Article  PubMed  Google Scholar 

  41. Ozog DM, Liu A, Chaffins ML, Ormsby AH, Fincher EF, Chipps LK, et al. Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser. JAMA Dermatol. 2013;149(1):50–7. https://doi.org/10.1001/2013.jamadermatol.668.

    Article  PubMed  Google Scholar 

  42. Hultman CS, Friedstat JS, Edkins RE, Cairns BA, Meyer AA. Laser resurfacing and remodeling of hypertrophic burn scars: results of a large prospective, before-after cohort study with long term follow-up. Ann Surg. 2014;260(3):519–29. https://doi.org/10.1097/SLA.0000000000000893.

    Article  PubMed  Google Scholar 

  43. Waibel J, Beer K. Ablative fractional laser resurfacing for the treatment of a third-degree burn. J Drugs Dermatol. 2009;8(3):294–7.

    PubMed  Google Scholar 

  44. Kimura U, Kinoshita A, Osawa A, Negi O, Haruna K, Mizuno Y, et al. Biophysical evaluation of fractional laser skin resurfacing with an Er:YSGG laser device in Japanese skin. J Drugs Dermatol. 2012;11(5):637–42.

    PubMed  Google Scholar 

  45. Weiss ET, Chapas A, Brightman L, Hunzeker C, Hale EK, Karen JK, et al. Successful treatment of atrophic postoperative and traumatic scarring with carbon dioxide ablative fractional resurfacing: quantitative volumetric scar improvement. Arch Dermatol. 2010;146(2):133–40. https://doi.org/10.1001/archdermatol.2009.358.

    Article  PubMed  Google Scholar 

  46. Bhargava S, Cunha PR, Lee J, Kroumpouzos G. Acne scarring management: systematic review and evaluation of the evidence. Am J Clin Dermatol. 2018;19(4):459–77. https://doi.org/10.1007/s40257-018-0358-5.

    Article  PubMed  Google Scholar 

  47. Zuccaro J, Ziolkowski N, Fish J. A systematic review of the effectiveness of laser therapy for hypertrophic burn scars. Clin Plast Surg. 2017;44(4):767–79. https://doi.org/10.1016/j.cps.2017.05.008. Epub 2017 Jul 10.

    Article  PubMed  Google Scholar 

  48. Bass LS. Rejuvenation of the aging face using Fraxel laser treatment. Aesthet Surg J. 2005;25(3):307–9. https://doi.org/10.1016/j.asj.2005.03.003.

    Article  CAS  PubMed  Google Scholar 

  49. 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 

  50. de Sica RC, Rodrigues CJ, Maria DA, Cuce LC. Study of 1550-nm Erbium glass laser fractional non-ablative treatment of photoaging: comparative clinical effects, histopathology, electron microscopy, and immunohistochemistry. J Cosmet Laser Ther. 2016;18(4):193–203. https://doi.org/10.3109/14764172.2015.1114645. Epub 2016 Mar 8.

    Article  PubMed  Google Scholar 

  51. Min S, Park SY, Moon J, Kwon HH, Yoon JY, Suh DH. Comparison between Er:YAG laser and bipolar radiofrequency combined with infrared diode laser for the treatment of acne scars: differential expression of fibrogenetic biomolecules may be associated with differences in efficacy between ablative and non-ablative laser treatment. Lasers Surg Med. 2017;49(4):341–7. https://doi.org/10.1002/lsm.22607. Epub 2016 Nov 2.

    Article  PubMed  Google Scholar 

  52. Taudorf EH, Danielsen PL, Paulsen IF, Togsverd-Bo K, Dierickx C, Paasch U, et al. Non-ablative fractional laser provides long-term improvement of mature burn scars—a randomized controlled trial with histological assessment. Lasers Surg Med. 2015;47(2):141–7. https://doi.org/10.1002/lsm.22289. Epub 2014 Aug 22.

    Article  PubMed  Google Scholar 

  53. Omi T, Numano K. The role of the CO2 laser and fractional CO2 laser in dermatology. Laser Ther. 2014;23(1):49–60. https://doi.org/10.5978/islsm.14-RE-01.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Lumenis. UltraPulse. https://lumenis.com/wp-content/uploads/2018/07/UltraPulse-Brochure-for-web_PB-1124760_RevD_A4_250117_web.pdf. Accessed 8 Oct 2018.

  55. Solta Medical. Fraxel. https://www.fraxel.com/hcp#the-fraxel-system. Accessed 8 Oct 2018.

  56. Tierney EP, Hanke CW. Review of the literature: treatment of dyspigmentation with fractionated resurfacing. Dermatol Surg. 2010;36(10):1499–508. https://doi.org/10.1111/j.1524-4725.2010.01672.x.

    Article  CAS  PubMed  Google Scholar 

  57. Tao J, Champlain A, Weddington C, Moy L, Tung R. Treatment of burn scars in Fitzpatrick phototype III patients with a combination of pulsed dye laser and non-ablative fractional resurfacing 1550 nm erbium:glass/1927 nm thulium laser devices. Scars Burn Heal. 2018;4:2059513118758510. https://doi.org/10.1177/2059513118758510. eCollection 2018 Jan–Dec.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Royston S, Tiernan E, Wright P. Post-burn non-emergent hair in the male moustache area. Burns. 2012;38(4):615–6. https://doi.org/10.1016/j.burns.2011.12.024. Epub 2012 Feb 22.

    Article  PubMed  Google Scholar 

  59. Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med. 2013;45(3):135–40. https://doi.org/10.1002/lsm.22120. Epub 2013 Mar 4.

    Article  PubMed  Google Scholar 

  60. Greywal T, Krakowski AC. Pediatric dermatology procedures and pearls: multimodal revision of earlobe keloids. Pediatr Dermatol. 2018;35(2):268–70. https://doi.org/10.1111/pde.13374. Epub 2017 Dec 20.

    Article  PubMed  Google Scholar 

  61. Park J, Chun J, Lee JH. Laser-assisted topical corticosteroid delivery for the treatment of keloids. Lasers Med Sci. 2017;32(3):601–8. https://doi.org/10.1007/s10103-017-2154-5. Epub 2017 Jan 26.

    Article  PubMed  Google Scholar 

  62. Prince GT, Cameron MC, Fathi R, Alkousakis T. Intralesional and laser-assisted 5-fluorouracil in dermatologic disease: a systematic review. J Drugs Dermatol. 2018;17(3):274–80.

    PubMed  Google Scholar 

  63. Lee BW, Levitt AE, Erickson BP, Ko AC, Nikpoor N, Ezuddin N, et al. Ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil for the treatment of cicatricial ectropion and periocular scarring. Ophthal Plast Reconstr Surg. 2018;34(3):274–9. https://doi.org/10.1097/IOP.0000000000000948.

    Article  PubMed  Google Scholar 

  64. Rkein A, Ozog D, Waibel JS. Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid. Dermatol Surg. 2014;40(6):624–31. https://doi.org/10.1111/dsu.0000000000000010.

    Article  CAS  PubMed  Google Scholar 

  65. Carney BC, McKesey JP, Rosenthal DS, Shupp JW. Treatment strategies for hypopigmentation in the context of burn hypertrophic scars. Plast Reconstr Surg Glob Open. 2018;6(1):e1642. https://doi.org/10.1097/GOX.0000000000001642. eCollection 2018 Jan.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Occupational Safety & Health Administration. Surgical Suite Use of Medical Lasers. https://www.osha.gov/SLTC/etools/hospital/surgical/lasers.html. Accessed 8 Oct 2018.

  67. American National Standards Institute. ANSI Z136.1: American National Standard for Safe Use of Lasers; 2014. http://webstore.ansi.org/RecordDetail.aspx?sku=ANSI+Z136.1-2014&source=blog. Accessed 8 Oct 2018.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthias B. Donelan .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Durso, T.A., Miletta, N.R., Iddins, B.O., Donelan, M.B. (2020). Laser Therapy for Scars. In: Ogawa, R. (eds) Total Scar Management. Springer, Singapore. https://doi.org/10.1007/978-981-32-9791-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-981-32-9791-3_14

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-32-9790-6

  • Online ISBN: 978-981-32-9791-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics