Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Dermatology Reports
Published in: Current Dermatology Reports 3/2016

01-09-2016 | Medical Surgery (M Alam, Section Editor)

Treatment of Surgical Scars with Laser Therapy

Authors: Laurel Naversen Geraghty, Zakia Rahman

Published in: Current Dermatology Reports | Issue 3/2016

Login to get access

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.
Literature
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.
2.
3.
4.
Alster TS. Laser treatment of hypertrophic scars, keloids and striae. Dermatol Clin. 1997;15:419–29.CrossRefPubMed
5.
Clark RA. Biology of dermal wound repair. Dermatol Clin. 1993;11:647–66.PubMed
6.
Elsaie ML, Choudhary S. Lasers for scars: a review and evidence-based appraisal. J Drugs Dermatol. 2010;9(11):1355–62.PubMed
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.CrossRefPubMed
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.
9.
Idriss N, Maibach HI. Scar assessment scales: a dermatologic overview. Skin Res Technol. 2009;15(1):1–5.CrossRefPubMed
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.CrossRefPubMed
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.CrossRef
12.
13.
Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet. 1995;345(8959):1198–200.CrossRefPubMed
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.CrossRef
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
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.CrossRefPubMed
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.CrossRefPubMed
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.PubMedPubMedCentral
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.CrossRefPubMed
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.PubMed
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.CrossRefPubMed
23.
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
25.
Kunishige JH, Katz TM, Goldberg LH, et al. Fractional photothermolysis for the treatment of surgical scars. Dermatol Surg. 2010;36(4):538–41.CrossRefPubMed
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
27.
Alster T, Zaulyanov L. Laser scar revision: a review. Dermatol Surg. 2007;33:131–40.PubMed
28.
Alster TS. Cutaneous resurfacing with CO2 and erbium:YAG lasers: preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg. 1999;103:619–32.CrossRefPubMed
29.
Wheeland RG. Revision of full-thickness skin grafts using the carbon dioxide laser. J Dermatol Surg Oncol. 1988;14(2):130–4.CrossRefPubMed
30.
Nanni CA, Alster TA. Complications of carbon dioxide laser resurfacing: an evaluation of 500 patients. Dermatol Surg. 1998;24(3):315–20.CrossRefPubMed
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.CrossRefPubMed
32.
Alter TS. Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous resurfacing. Lasers Surg Med. 1999;24(2):87–92.CrossRef
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
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.
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
39.
Fisher G, Geronemus R. Short-term side effects of fractional photothermolysis. Dermatol Surg. 2005;31:1245–9.CrossRefPubMed
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.PubMed
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.CrossRefPubMed
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.
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.PubMed
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.CrossRefPubMed
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.
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRef
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
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.
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
Metadata
Title
Treatment of Surgical Scars with Laser Therapy
Authors
Laurel Naversen Geraghty
Zakia Rahman
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Dermatology Reports / Issue 3/2016
Electronic ISSN: 2162-4933
DOI
https://doi.org/10.1007/s13671-016-0152-7

Other articles of this Issue 3/2016

Current Dermatology Reports 3/2016 Go to the issue

Medical Surgery (M Alam, Section Editor)

Premedication, Sedation, and Pain Medication in Dermatologic Surgery

Medical Surgery (M Alam, Section Editor)

Surgical Treatment of Cutaneous Extramammary Paget’s Disease

Laser Therapy (J Jagdeo, Section Editor)

Tattoos and Beyond: the Clinical Evolution of Picosecond Laser Technology

Laser Therapy (J Jagdeo, Section Editor)

Accelerating Ablative Fractional Resurfacing Wound Healing Recovery by Photobiomodulation

Laser Therapy (J Jagdeo, Section Editor)

A Combination Approach with Lasers, Light, and Energy-Based Devices for Ultimate Rejuvenation of the Aging Face

Laser Therapy (J Jagdeo, Section Editor)

Laser Revision and Rehabilitation of Mohs Micrographic Surgical Scars