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Scars can be a very upsetting reminder of previous injury to the skin, and until recently there was not much that could be done to help them. However, in the last few years there have been advances in lasers which can now be used to significantly improve the appearance of scars.
At Dermatology Consulting, Dr Farrell has a particular interest in the treatment of scars and has attended some of the foremost conferences on scars and visited overseas centres of excellence in scar treatment.
Every scar has individual properties and the treatment plan will depend on the individual aspects of that scar.
The redness of scars can be reduced by the pulse dye laser or KTP laser. Gentle settings are used (gentler than those used to treat birthmarks in babies) to heat up and reduce the dilated blood vessels which are causing the redness. It has also been shown that the earlier the pulse dye laser or KTP laser is used on a scar (ideally when it is a few days old) the less noticeable the scar will be and the less likely that it will grow into a hypertrophic or thickened scar.
Usually, one or two sessions are needed at intervals of 3-4 weeks. The scar may look slightly pinker or slightly bruised afterwards for a few days.
If scars have excess pigment this can be reduced by the Picoway laser or the Fraxel Restore laser with 1927nm wavelength. The Picoway has very little recovery time. The Fraxel Restore with 1927nm wavelength causes very slight pinkness and swelling of the scar and over the next few days the pigment is pushed out of the scar as darker speckles.
The Picoway laser is so superfast that it generates pulses of laser to create tiny bubbles of gas which create tiny gaps in the skin. These tiny gaps stimulate the production of new collagen to replace the old scared collagen.
It does not require local anaesthetic and feels like warm sparkles on the skin. There is no recovery time and it can be done in skin of all colour. This makes it suitable for patients of all ages and skin types.
Approximately four sessions of Picoway laser is equivalent to one session of Fraxel Restore.
The Fraxel Restore using the 1550nm wavelength puts tiny beams of heat less than the diameter of a hair into the skin to heat tiny columns of skin. These columns of skin are pushed out over the next few days by the skin’s natural healing process and replaced by new fresh collagen, replacing parts of the scarred collagen.
The skin is pink and swollen for 7-10 days afterwards but the skin is not broken or bleeding. Makeup can be worn afterwards.
In patients with darker skin there may be slight darkening of the skin afterwards but this settles after a couple of weeks.
Local anaesthetic cream is usually applied beforehand. As it treats a fraction of the skin, several sessions will be needed, which can be done at intervals of two weeks (or more if desired).
CO2 lasers remove the tissue that they heat. When used in a fractionated way (i.e. to make tiny holes into the skin less than the diameter of a hair) they remove the old scarred collagen and replace it with new fresh collagen. This allows remodelling of the scar. It also reduces the tension on the scar.
At Dermatology Consulting we have two Fractionated CO2 Lasers – the Ultrapulse Alpha by Lumenis and Fraxel Repair.
The Ultrapulse Alpha is widely regarded as the most versatile and powerful CO2 laser. It also goes the deepest of any CO2 laser so able to treat very thick scars. It has a variable spot size and beam shape so it can be used easily on scars of all shapes.
There may be mild pin-point bleeding for a few hours afterwards and pinkness for a couple of weeks.
At least three sessions are usually needed.
The Fraxel Repair is another brand of fractionated CO2 laser. It can be used for large areas such as the entire face.
The fractionated CO2 lasers give more rapid improvement than the other forms of laser but there is more recovery time.
One advantage of the fractionated CO2 lasers is that it can be used to deliver chosen drugs into the scar to provide additional benefit.
In particular, steroid and /or 5 Fluorouracil cma be delivered into the skin through the holes created by the CO2 laser. These can flatten and soften an elevated or thickened scar.
Sculptra can be applied into the holes to stimulate collagen production in indented scars.
Bimatoprost can be applied to white scars to help restore pigmentation.
If the scars have more than one feature, the laser treatments can be combined e.g. pulse dye or KTP lasers for redness, Picoway laser for pigmentation, fractionated lasers for texture and laser assisted drug delivery.
Subcision can also be performed before the laser treatment if scars are tethered down.
Sometimes surgical revision to take the tension off the scar needs to be performed beforehand.
A bespoke treatment plan can be drawn up at the initial consultation depending on the appearance of the scar.
Interested in learning more about scar treatments? Contact Dermatology Consulting today to schedule an appointment with one of our providers.
