Combination treatment of surgical, post‐traumatic and post‐herpetic scars with ablative lasers followed by fractional laser and non‐ablative laser in Asians

BACKGROUND AND OBJECTIVES: Scars are usually classified into atrophic scars, hypertrophic scars and keloids. This author would classify atrophic scars as a subclass of non-hypertrophic scars. In other words, non-hypertrophic scars encompass atrophic (depressed) scars and flat scars that are literally flat or protrude minimally above the level of adjacent normal skin, because the same treatment protocol can be used for each. It is speculated that ablative lasers can be used to sculpt the contour of scars or to remove a controlled amount of scar tissue, while at the same time, activating a regenerative cascade. On the other hand, fractional and non-ablative lasers stimulate and/or keep a proliferative phase on, together with other unique beneficial effects of each device. PATIENTS AND METHODS: Thirty non-hypertrophic facial scars of 24 Asian patients (Fitzpatrick's skin type III-IV) were treated with ablative lasers (pulsed CO(2) and Er:YAG) followed by fractional (1,550 nm) laser and non-ablative (1,450 nm) laser alternatively every 2-3 weeks. Thirty-one pairs of pre- and post-treatment-photographs were evaluated independently by three dermatologists and two plastic surgeons, on a scale of 0-100% improvement. If there was no interval change, this was rated 0%. If there was no difference between the treated region and adjacent normal skin, it was rated 100%. The scars (20 post-traumatic, 6 surgical, 2 post-herpetic, 2 burn scars) were all over 6 months old. RESULTS: The evaluators rated an average improvement of 86.8% (median 90%). Ten of 31 pairs of photographs were rated 100%, one of which was unanimous. Each evaluator rated 2-5 pairs as having 100% improvement. CONCLUSION: This study shows the possibility that, with appropriate combinations of different lasers, we can expect complete or near-complete resolution of many types of scars. Further research and data accumulation will help to establish better protocols for each class of scars.