Preventing pathological scar formation: treatment of surgical scars with mixed technology: fractional CO2 laser plus Er:Glass laser

Preventing pathological scar formation: treatment of surgical scars with mixed technology: fractional CO2 laser plus Er:Glass laser

Authors

  • Francesca Flagiello Private practice, Rome, Naples
  • Kristallia Antoniadou Private practice, Rome
  • Domenico Centofanti Private practice, Rome
  • Emanuele Bartoletti Isola Tiberina- Gemelli Isola Hospital, Rome
  • Loredana Cavalieri Private practice, Rome

Keywords:

Scar Prevention, Laser Therapy, Fractional CO2 Laser, Wound Healing, Hypertrophic Scars

Abstract

Background: Scar treatment is a very challenging field. One of the major challenges in managing scars is their variability, which depends on the patient's etiology, severity, distribution, skin type, comorbidities, genetics, age, changes over time, and patient compliance, to name just a few. Despite best efforts and research over the decades, the quality of analytical studies on scars remains unsatisfactory compared to other fields of clinical and scientific activity. However, doctors and scientists continue to work to implement clinical and scientific strategies aimed at making treatments more effective. Objective: to study the new Mixed technology (MT) laser technology to prevent the formation of pathological scars during the wound healing process. Method: To this end we used a laser YouLaser mixed technology (MT) laser whose characteristic consists in the combination of two different wavelengths: fractional CO2 laser (10600 nm - ablative) and Er:Glass laser (1540 nm - non-ablative). 15 patients were enrolled and 20 surgical scars were selected. The protocol was completed on 7 patients for a total of 13 scars, of which 6 women and 1 man, with ages between 20 and 60 years and phototype according to Fritzpatrick between I and III. The selected scars were the results of surgery performed less than 6 months ago. Results: The severity and characteristics of scars were assessed via photographic images and using the POSAS (The Patient and Observer Scar Assessment Scale) questionnaire, a standardized and internationally recognized tool for scar assessment. The collected data were analyzed and interpreted with the help of a specific Likert scale, allowing a statistical evaluation of the progress of the severity and characteristics of the scars. All the characteristics analyzed showed a significant improvement, with scores that went from an average value of 6 to significantly lower values, between 2 and 4. The results showed significant improvements in terms of texture, color and thickness of the treated scars. Conclusions: According to the results of this study, early intervention on recent scars is effective because it guarantees preventive activity on the lesions, blocking the pathological evolution of the scars themselves. This is confirmed by the fact that one year after the surgery none of them had a pathological course in the hypertrophic or keloid sense.

References

Cohen BE, Geronemus RG, McDaniel DH, Brauer JA. The Role of Elastic Fibers in Scar Formation and Treatment. Dermatol Surg. 2017; 43 Suppl 1:S19-S24.

Arno AI, Gauglitz GG, Barret JP, Jeschke MG. Up-to- date approach to manage keloids and hypertrophic scars: a useful guide. Burns. 2014; 40(7):1255-66.

Zurada JM, Kriegel D, Davis IC. Topical treatments for hypertrophic scars. J Am Acad Dermatol. 2006; 55(6):1024-31.

Khatri KA, Mahoney DL, McCartney MJ. Laser scar revision: a review. J Cosmet Laser Ther. 2011; 13(2):54-62.

Bloemen MC, van der Veer WM, Ulrich MM, van Zuijlen PP, Niessen FB, Middelkoop E. Prevention and curative management of hypertrophic scar formation. Burns. 2009; 35(4):463-75.

Enoch S, Leaper DJ. Basic science of wound healing. Surgery (Oxford). 2008; 26(2):31-37.

Durani P, Bayat A. Level of evidence for the treatment of keloid disease. J Plast Reconstr Aesthet Surg. 2008; 61(1):4-17.

Robles DT, Berg D. Abnormal wound healing: keloids. Clin Dermatol. 2007; 25(1):26-32.

Lee JY, Yang CC, Chao SC, Wong TW. Histopathological differential diagnosis of keloid and hypertrophic scar. Am J Dermatopathol. 2004; 26(5):379-84.

Rippa AL, Kalabusheva EP, Vorotelyak EA. Regeneration of Dermis: Scarring and Cells Involved. Cells. 2019; 8(6):607.

Murray JC, Pollack SV, Pinnell SR. Keloids: a review. J Am Acad Dermatol. 1984; 4(4):461-70.

Murray JC. Keloids and hypertrophic scars. Clin Dermatol. 1994; 12(1):27-37.

Mafong EA, Ashinoff R. Treatment of hypertrophic scars and keloids: a review. Aesthet Surg J. 2000; 20(2):114-121.

Woo SH, Park JH, Kye YC. Resurfacing of different types of facial acne scar with short-pulsed, variable-pulsed, and dual-mode Er: YAG laser. Dermatol Surg. 2004; 30(4 Pt 1):488- 93.

O'Daniel TG. Multimodal management of atrophic acne scarring in the aging face. Aesthetic Plast Surg. 2011; 35(6):1143-50.

Jordan R, Cummins C, Buris A. Laser resurfacing of the skin for the improvement of facial acne scarring: a systematic review of the evidence. Br J Dermatol. 2000; 142(3):413-23.

Monstrey S, Middelkoop E, Vranckx JJ, et al. Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstruct Aesthet Surg. 2014; 67(8):1017-25.

Oliaei S, Nelson JS, Fitzpatrick R, Wong BJ. Laser treatment of scars. Facial Plast Surg. 2012; 28(5):518-24.

Jao J, Champlain A, Weddington C, Moy L, Tung R. Treatment of burn scars in Fitzpatrick phototype III patients with a combination of pulsed dye laser and non-ablative fractional resurfacing 1550 nm erbium:glass/1927 nm thulium laser devices. Scars Burns Heal. 2018; 4:1-6.

Alajlan AM, Alsuwaidan SN. Acne scars in ethnic skin treated with both non-ablative fractional 1,550 m and ablative fractional CO2 lasers: comparative retrospective analysis with recommended guidelines. Lasers Surg Med. 2011; 43(8):787-91.

Bach DQ, Garcia MS, Eisen DB. Hyperpigmented burn scar improved with a fractionated 1550 m non-ablative laser. Dermatol Online J. 2012; 18(7):12.

Ramsdell WM. Fractional carbon dioxide laser resurfacing. Semin Plast Surg. 2012; 26(3):125-30.

Chowdhury B, Kassir M, Salas-Alanis J, et al. Laser in surgical scar clearance: An update review. J Cosmet Dermatol. 2021; 20(12):3808-3811.

You H-J, Kim D-W, Yoon E-S, Park S-H. Comparison of 4 different lasers for acne scars: resurfacing and fractional lasers. J Plast Reconstr Aestehtic Surg. 2016; 69(4):e87-95.

Carrière ME, Mokkink LB, Tyack Z, et al. Development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0: a qualitative study. Qual Life Res. 2023; 32(2):583-592.

Downloads

Published

31-03-2025

How to Cite

1.
Flagiello F, Antoniadou K, Centofanti D, Bartoletti E, Cavalieri L. Preventing pathological scar formation: treatment of surgical scars with mixed technology: fractional CO2 laser plus Er:Glass laser. Aesthetic Medicine [Internet]. 2025 Mar. 31 [cited 2025 Apr. 6];11(1):16569. Available from: https://mail.mattioli1885journals.com/index.php/aestheticmedicine/article/view/16569