Cutaneous injuries that result in scar formation are relatively common, leading patients to seek treatment for cosmetic or functional improvement. Treatments that have the potential to improve or eliminate scarring include radiation therapy, surgical excision, and intralesional injections of corticosteroids, 5-flourouracil, or bleomycin. Unfortunately, these methods are associated with high recurrence rates and untoward sequelae such as skin atrophy, dyspigmentation, and pain. Laser scar revision is a safe procedure with clinically demonstrable efficacy and minimal side effects when used alone or in combination with other scar treatments. The specifics of current laser scar revision techniques are addressed in this overview.
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An imbalance in wound-healing homeostasis is at the epicenter of scar formation
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Scars, particularly facial scars, significantly affect the lives of patients
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Physicians can improve the quality of patients’ lives via scar revision
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Numerous scar treatments are available, but lasers have proven to deliver the most reproducibly good results
The psychosocial impact of cutaneous scarring can be profound. Scars inflicted by traumatic incidents, surgical procedures, and severe acne bear a heavy emotional burden on patients, particularly when present on visible areas such as the face. The quality of life of patients may be affected from aesthetic concerns in addition to chronic symptoms such as pruritus and pain. In addition, substantial anxiety and self-consciousness has been noted in men and women when trauma or elective procedures result in even nominal scarring. Cutaneous injuries that result in scar tissue formation are relatively common and lead patients to seek treatment for cosmetic or functional improvement. It is imperative for physicians to recognize that physical improvement of scars can translate into improved psychosocial well-being and behavior of patients.
Scars are the result of a deviation in the orderly pattern of healing and can be caused by a variety of factors, such as excessive wound tension, improper surgical repair, delayed reepithelialization, or a history of radiation to the affected area. The underlying pathophysiologic mechanism appears to be an imbalance of matrix degradation and collagen biosynthesis. An overzealous healing response can create a raised nodule of fibrotic tissue, whereas “pitted” and atrophic scars may result from inadequate replacement of deleted collagen fibers. Although vascular and pigment alterations associated with wound healing are typically transient, the textural changes caused by collagen disruption are often permanent. Histologically, what makes scars unique is the relative absence of skin appendages and elastic fibers—constituents of normal skin that may account for the loss of flexibility seen in scar tissue.
There are several currently available scar-reducing therapies and many other agents that may emerge to have the potential to eliminate scarring. Some of the most commonly used modalities to improve scar appearance include intralesional corticosteroids, 5-fluorouracil, and bleomycin. It is likely that these agents exert their effect on scars by suppressing inflammation and/or collagen production. Combination therapy is often advocated as a means of increasing efficacy and decreasing total medication dosage, thereby decreasing the likelihood of adverse effects. Radiation therapy and surgical intervention, particularly in combination with one another, are sometimes used for refractory and recurrent scars. Unfortunately, each of these methods has been associated with unacceptably high incidences of scar recurrence and other untoward sequelae such as skin atrophy, dyspigmentation, and pain. Laser scar revision is a safe procedure with clinically demonstrable efficacy and minimal side effects that may be used in combination with the aforementioned scar treatments. The remainder of this article addresses the use of lasers for the treatment of scars.
History of laser scar revision
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The principles of selective photothermolysis help guide the laser surgeon in choosing the proper laser wavelength and treatment parameters for scar revision
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Proper scar classification is essential for optimizing treatment results
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