Laser Treatment of Scars

  • Ladan Afifi
    Correspondence
    Corresponding author. Division of Dermatology, University of California Los Angeles, 200 Medical Plaza Suite 450, Los Angeles, CA 90024.
    Affiliations
    Division of Dermatology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite 450, Los Angeles, CA 90024, USA
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  • Sara R. Hogan
    Affiliations
    Division of Dermatology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite 450, Los Angeles, CA 90024, USA

    David Geffen School of Medicine, University of California, 10833 Le Cont Avenue, Los Angeles, CA 90095, USA
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Published:March 16, 2021DOI:https://doi.org/10.1016/j.yacs.2021.01.010
      Scars vary in color, topography, tension, and maturity, and often show several characteristics at once.

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      References

        • Alster T.S.
        • McMeekin T.O.
        Improvement of facial acne scars by the 585 nm flashlamp-pumped pulsed dye laser.
        J Am Acad Dermatol. 1996; 35: 79-81
        • Yoon H.J.
        • Lee D.H.
        • Kim S.O.
        • et al.
        Acne erythema improvement by long-pulsed 595-nm pulsed-dye laser treatment: a pilot study.
        J Dermatolog Treat. 2008; 19: 38-44
        • Glaich A.S.
        • Goldberg L.H.
        • Friedman R.H.
        • et al.
        Fractional photothermolysis for the treatment of postinflammatory erythema resulting from acne vulgaris.
        Dermatol Surg. 2007; 33: 842-846
        • Glaich A.S.
        • Rahman Z.
        • Goldberg L.H.
        • et al.
        Fractional resurfacing for the treatment of hypopigmented scars: a pilot study.
        Dermatol Surg. 2007; 33 ([discussion: 293–4]): 289-294
        • Wand M.
        • Ritch R.
        • Isbey E.K.
        • Jr
        • et al.
        Latanoprost and periocular skin color changes.
        Arch Ophthalmol. 2001; 119: 614-615
        • Massaki A.B.
        • Fabi S.G.
        • Fitzpatrick R.
        Repigmentation of hypopigmented scars using an erbium-doped 1,550-nm fractional laser and topical bimatoprost.
        Dermatol Surg. 2012; 38: 995-1001
        • Siadat A.H.
        • Rezaei R.
        • Asilian A.
        • et al.
        Repigmentation of hypopigmented scars using combination of fractional carbon dioxide laser with topical latanoprost vs. fractional carbon dioxide laser alone.
        Indian J Dermatol. 2015; 60: 364-368
        • Seago M.
        • Shumaker P.R.
        • Spring L.K.
        • et al.
        Laser treatment of traumatic scars and contractures: 2020 international consensus recommendations.
        Lasers Surg Med. 2020; 52: 96-116
        • Bencini P.L.
        • Tourlaki A.
        • Galimberti M.
        • et al.
        Nonablative fractional photothermolysis for acne scars: clinical and in vivo microscopic documentation of treatment efficacy.
        Dermatol Ther. 2012; 25: 463-467
        • Bjørn M.
        • Stausbøl-Grøn B.
        • Braae Olesen A.
        • et al.
        Treatment of acne scars with fractional CO2 laser at 1-month versus 3-month intervals: an intra-individual randomized controlled trial.
        Lasers Surg Med. 2014; 46: 89-93
        • Chapas A.M.
        • Brightman L.
        • Sukal S.
        • et al.
        Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing.
        Lasers Surg Med. 2008; 40: 381-386
        • Cho S.B.
        • Lee S.J.
        • Cho S.
        • et al.
        Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation.
        J Eur Acad Dermatol Venereol. 2010; 24: 921-925
        • Baugh W.P.
        • Kucaba W.D.
        Nonablative phototherapy for acne vulgaris using the KTP 532 nm laser.
        Dermatol Surg. 2005; 31: 1290-1296
        • Asilian A.
        • Salimi E.
        • Faghihi G.
        • et al.
        Comparison of Q-Switched 1064-nm Nd: YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar.
        J Res Med Sci. 2011; 16: 1189-1195
        • Friedman P.M.
        • Jih M.H.
        • Skover G.R.
        • et al.
        Treatment of atrophic facial acne scars with the 1064-nm Q-switched Nd:YAG laser: six-month follow-up study.
        Arch Dermatol. 2004; 140: 1337-1341
        • Lipper G.M.
        • Perez M.
        Nonablative acne scar reduction after a series of treatments with a short-pulsed 1,064-nm neodymium:YAG laser.
        Dermatol Surg. 2006; 32: 998-1006
        • Wada T.
        • Kawada A.
        • Hirao A.
        • et al.
        Efficacy and safety of a low-energy double-pass 1450-nm diode laser for the treatment of acne scars.
        Photomed Laser Surg. 2012; 30: 107-111
        • Wang B.
        • Wu Y.
        • Luo Y.J.
        • et al.
        Combination of intense pulsed light and fractional CO(2) laser treatments for patients with acne with inflammatory and scarring lesions.
        Clin Exp Dermatol. 2013; 38: 344-351
        • Rkein A.
        • Ozog D.
        • Waibel J.S.
        Treatment of atrophic scars with fractional CO2 laser facilitating delivery of topically applied poly-L-lactic acid.
        Dermatol Surg. 2014; 40: 624-631
        • Gold M.H.
        • McGuire M.
        • Mustoe T.A.
        • et al.
        Updated international clinical recommendations on scar management: part 2–algorithms for scar prevention and treatment.
        Dermatol Surg. 2014; 40: 825-831
        • Ouyang H.W.
        • Li G.F.
        • Lei Y.
        • et al.
        Comparison of the effectiveness of pulsed dye laser vs pulsed dye laser combined with ultrapulse fractional CO(2) laser in the treatment of immature red hypertrophic scars.
        J Cosmet Dermatol. 2018; 17: 54-60
        • Al-Mohamady Ael S.
        • Ibrahim S.M.
        • Muhammad M.M.
        Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: a comparative randomized split-scar trial.
        J Cosmet Laser Ther. 2016; 18: 208-212
        • Kuo Y.R.
        • Jeng S.F.
        • Wang F.S.
        • et al.
        Flashlamp pulsed dye laser (PDL) suppression of keloid proliferation through down-regulation of TGF-beta1 expression and extracellular matrix expression.
        Lasers Surg Med. 2004; 34: 104-108
        • Bellew S.G.
        • Weiss M.A.
        • Weiss R.A.
        Comparison of intense pulsed light to 595-nm long-pulsed pulsed dye laser for treatment of hypertrophic surgical scars: a pilot study.
        J Drugs Dermatol. 2005; 4: 448-452
        • Erol O.O.
        • Gurlek A.
        • Agaoglu G.
        • et al.
        Treatment of hypertrophic scars and keloids using intense pulsed light (IPL).
        Aesthet Plast Surg. 2008; 32: 902-909
        • Kim H.S.
        • Lee J.H.
        • Park Y.M.
        • et al.
        Comparison of the effectiveness of nonablative fractional laser versus ablative fractional laser in thyroidectomy scar prevention: a pilot study.
        J Cosmet Laser Ther. 2012; 14: 89-93
        • Oh B.H.
        • Hwang Y.J.
        • Lee Y.W.
        • et al.
        Skin characteristics after fractional photothermolysis.
        Ann Dermatol. 2011; 23: 448-454
        • Anderson R.R.
        • Donelan M.B.
        • Hivnor C.
        • et al.
        Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report.
        JAMA Dermatol. 2014; 150: 187-193
        • Sardana K.
        • Manjhi M.
        • Garg V.K.
        • et al.
        Which type of atrophic acne scar (ice-pick, boxcar, or rolling) responds to nonablative fractional laser therapy?.
        Dermatol Surg. 2014; 40: 288-300
        • Yoo K.H.
        • Ahn J.Y.
        • Kim J.Y.
        • et al.
        The use of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin: a pilot study.
        Photodermatol Photoimmunol Photomed. 2009; 25: 138-142
        • Waibel J.S.
        • Wulkan A.J.
        • Shumaker P.R.
        Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery.
        Lasers Surg Med. 2013; 45: 135-140
        • Azzam O.A.
        • Bassiouny D.A.
        • El-Hawary M.S.
        • et al.
        Treatment of hypertrophic scars and keloids by fractional carbon dioxide laser: a clinical, histological, and immunohistochemical study.
        Lasers Med Sci. 2016; 31: 9-18
        • Poetschke J.
        • Dornseifer U.
        • Clementoni M.T.
        • et al.
        Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach.
        Lasers Med Sci. 2017; 32: 1031-1040
        • Huang C.
        • Ogawa R.
        Roles of lipid metabolism in keloid development.
        Lipids Health Dis. 2013; 12: 60
        • Van De Water L.
        • Varney S.
        • Tomasek J.J.
        Mechanoregulation of the myofibroblast in wound contraction, scarring, and fibrosis: opportunities for new therapeutic intervention.
        Adv Wound Care (New Rochelle). 2013; 2: 122-141
        • Shumaker P.R.
        • Kwan J.M.
        • Landers J.T.
        • et al.
        Functional improvements in traumatic scars and scar contractures using an ablative fractional laser protocol.
        J Trauma Acute Care Surg. 2012; 73: S116-S121
        • Kauvar A.N.B.
        • Kubicki S.L.
        • Suggs A.K.
        • et al.
        Laser therapy of traumatic and surgical scars and an algorithm for their treatment.
        Lasers Surg Med. 2020; 52: 125-136
        • Boen M.
        • Jacob C.
        A review and update of treatment options using the acne scar classification system.
        Dermatol Surg. 2019; 45: 411-422
        • Gan S.D.
        • Graber E.M.
        Papular scars: an addition to the acne scar classification scheme.
        J Clin Aesthet Dermatol. 2015; 8: 19-20
        • Jacob C.I.
        • Dover J.S.
        • Kaminer M.S.
        Acne scarring: a classification system and review of treatment options.
        J Am Acad Dermatol. 2001; 45: 109-117
        • Jeong J.T.
        • Kye Y.C.
        Resurfacing of pitted facial acne scars with a long-pulsed Er:YAG laser.
        Dermatol Surg. 2001; 27: 107-110
        • Walia S.
        • Alster T.S.
        Prolonged clinical and histologic effects from CO2 laser resurfacing of atrophic acne scars.
        Dermatol Surg. 1999; 25: 926-930
        • Woo S.H.
        • Park J.H.
        • Kye Y.C.
        Resurfacing of different types of facial acne scar with short-pulsed, variable-pulsed, and dual-mode Er:YAG laser.
        Dermatol Surg. 2004; 30: 488-493
        • Alexis A.F.
        • Coley M.K.
        • Nijhawan R.I.
        • et al.
        Nonablative fractional laser resurfacing for acne scarring in patients with fitzpatrick skin phototypes IV-VI.
        Dermatol Surg. 2016; 42: 392-402
        • Chan N.P.
        • Ho S.G.
        • Yeung C.K.
        • et al.
        The use of non-ablative fractional resurfacing in Asian acne scar patients.
        Lasers Surg Med. 2010; 42: 710-715
        • Cohen B.E.
        • Brauer J.A.
        • Geronemus R.G.
        Acne scarring: a review of available therapeutic lasers.
        Lasers Surg Med. 2016; 48: 95-115
        • Alster T.S.
        • Tanzi E.L.
        • Lazarus M.
        The use of fractional laser photothermolysis for the treatment of atrophic scars.
        Dermatol Surg. 2007; 33: 295-299
        • Lee S.J.
        • Kim J.M.
        • Kim Y.K.
        • et al.
        The pinhole method using an erbium: YAG laser for the treatment of papular acne scars.
        Dermatol Ther. 2017; : 30
        • Waldman A.
        • Bolotin D.
        • Arndt K.A.
        • et al.
        ASDS guidelines task force: consensus recommendations regarding the safety of lasers, dermabrasion, chemical peels, energy devices, and skin surgery during and after isotretinoin use.
        Dermatol Surg. 2017; 43: 1249-1262
        • Eilers R.E.
        • J r.
        • Ross E.V.
        • Cohen J.L.
        • et al.
        A combination approach to surgical scars.
        Dermatol Surg. 2016; 42: S150-S156
        • Wainwright D.J.
        Burn reconstruction: the problems, the techniques, and the applications.
        Clin Plast Surg. 2009; 36: 687-700
        • Conologue T.D.
        • Norwood C.
        Treatment of surgical scars with the cryogen-cooled 595 nm pulsed dye laser starting on the day of suture removal.
        Dermatol Surg. 2006; 32: 13-20
        • Nouri K.
        • Elsaie M.L.
        • Vejjabhinanta V.
        • et al.
        Comparison of the effects of short- and long-pulse durations when using a 585-nm pulsed dye laser in the treatment of new surgical scars.
        Lasers Med Sci. 2010; 25: 121-126
        • Nouri K.
        • Jimenez G.P.
        • Harrison-Balestra C.
        • et al.
        585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day.
        Dermatol Surg. 2003; 29 ([discussion: 73]): 65-73
        • Jin R.
        • Huang X.
        • Li H.
        • et al.
        Laser therapy for prevention and treatment of pathologic excessive scars.
        Plast Reconstr Surg. 2013; 132: 1747-1758
        • Choe J.H.
        • Park Y.L.
        • Kim B.J.
        • et al.
        Prevention of thyroidectomy scar using a new 1,550-nm fractional erbium-glass laser.
        Dermatol Surg. 2009; 35: 1199-1205
        • Friedman O.
        • Gofstein D.
        • Arad E.
        • et al.
        Laser pretreatment for the attenuation of planned surgical scars: a randomized self-controlled hemi-scar pilot study.
        J Plast Reconstr Aesthet Surg. 2020; 73: 893-898
        • Karmisholt K.E.
        • Banzhaf C.A.
        • Glud M.
        • et al.
        Laser treatments in early wound healing improve scar appearance: a randomized split-wound trial with nonablative fractional laser exposures vs. untreated controls.
        Br J Dermatol. 2018; 179: 1307-1314
        • Park K.Y.
        • Oh I.Y.
        • Seo S.J.
        • et al.
        Appropriate timing for thyroidectomy scar treatment using a 1,550-nm fractional erbium-glass laser.
        Dermatol Surg. 2013; 39: 1827-1834
        • Tierney E.P.
        • Kouba D.J.
        • Hanke C.W.
        Review of fractional photothermolysis: treatment indications and efficacy.
        Dermatol Surg. 2009; 35: 1445-1461
        • Jung J.Y.
        • Jeong J.J.
        • Roh H.J.
        • et al.
        Early postoperative treatment of thyroidectomy scars using a fractional carbon dioxide laser.
        Dermatol Surg. 2011; 37: 217-223
        • Zhang Y.
        • Liu Y.
        • Cai B.
        • et al.
        Improvement of surgical scars by early intervention with carbon dioxide fractional laser.
        Lasers Surg Med. 2020; 52: 137-148
        • Waibel J.S.
        • Rudnick A.
        Comprehensive treatment of scars and other abnormalities of wound healing.
        Advances in Cosmetic Surgery. 2018; 1: 151-162
        • Deitch E.A.
        • Wheelahan T.M.
        • Rose M.P.
        • et al.
        Hypertrophic burn scars: analysis of variables.
        J Trauma. 1983; 23: 895-898
        • Waibel J.S.
        • Gianatasio C.
        • Rudnick A.
        Randomized, controlled early intervention of dynamic mode fractional ablative CO(2) laser on acute burn injuries for prevention of pathological scarring.
        Lasers Surg Med. 2020; 52: 117-124
        • Keen A.
        • Sheikh G.
        • Hassan I.
        • et al.
        Treatment of post-burn and post-traumatic atrophic scars with fractional CO(2) laser: experience at a tertiary care centre.
        Lasers Med Sci. 2018; 33: 1039-1046
        • Mahar P.D.
        • Spinks A.B.
        • Cleland H.
        • et al.
        Improvement of burn scars treated with fractional ablative CO2 lasers - a systematic review and meta-analysis using the Vancouver Scar Scale.
        J Burn Care Res. 2020; ([Epub ahead of print])
        • Ozog D.M.
        • Moy R.L.
        Discussing fractional carbon dioxide laser and other physical treatments for scar prevention with patients.
        JAMA Dermatol. 2015; 151: 815-816
        • Qu L.
        • Liu A.
        • Zhou L.
        • et al.
        Clinical and molecular effects on mature burn scars after treatment with a fractional CO(2) laser.
        Lasers Surg Med. 2012; 44: 517-524
        • Willows B.M.
        • Ilyas M.
        • Sharma A.
        Laser in the management of burn scars.
        Burns. 2017; 43: 1379-1389
        • Yang Y.J.
        • Lee G.Y.
        Treatment of striae distensae with nonablative fractional laser versus ablative CO(2) fractional laser: a randomized controlled trial.
        Ann Dermatol. 2011; 23: 481-489
        • Douglas H.
        • Lynch J.
        • Harms K.A.
        • et al.
        Carbon dioxide laser treatment in burn-related scarring: a prospective randomised controlled trial.
        J Plast Reconstr Aesthet Surg. 2019; 72: 863-870
        • Issler-Fisher A.C.
        • Fisher O.M.
        • Clayton N.A.
        • et al.
        Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures, hospital admission patterns as well as length of stay.
        Burns. 2020; 46: 65-74
        • Fearmonti R.
        • Bond J.
        • Erdmann D.
        • et al.
        A review of scar scales and scar measuring devices.
        Eplasty. 2010; 10: e43
        • Dobbs E.R.
        • Curreri P.W.
        Burns: analysis of results of physical therapy in 681 patients.
        J Trauma. 1972; 12: 242-248
        • Huang T.T.
        • Blackwell S.J.
        • Lewis S.R.
        Ten years of experience in managing patients with burn contractures of axilla, elbow, wrist, and knee joints.
        Plast Reconstr Surg. 1978; 61: 70-76
        • Schneider J.C.
        • Holavanahalli R.
        • Helm P.
        • et al.
        Contractures in burn injury: defining the problem.
        J Burn Care Res. 2006; 27: 508-514
        • Bartoszek G.
        • Fischer U.
        • Grill E.
        • et al.
        Impact of joint contracture on older persons in a geriatric setting: a cross-sectional study.
        Z Gerontol Geriatr. 2015; 48: 625-632
        • Paasch U.
        • Haedersdal M.
        Laser systems for ablative fractional resurfacing.
        Expert Rev Med Devices. 2011; 8: 67-83
        • Yuan X.H.
        • Zhong S.X.
        • Li S.S.
        Comparison study of fractional carbon dioxide laser resurfacing using different fluences and densities for acne scars in Asians: a randomized split-face trial.
        Dermatol Surg. 2014; 40: 545-552
        • Chrastil B.
        • Glaich A.S.
        • Goldberg L.H.
        • et al.
        Second-generation 1,550-nm fractional photothermolysis for the treatment of acne scars.
        Dermatol Surg. 2008; 34: 1327-1332