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Fractional ablative lasers a ‘mainstay’ for scar treatment


AT CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY


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DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.

"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."

She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."

The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.

For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."

Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.

Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."

Continued...