When skin is damaged from injury, surgery or illness, scarring often occurs as the wound heals. While many scars disappear or fade to an unnoticeable degree with time, some do not, and need treatment to improve their appearance. Depressed acne scars, discolored chickenpox scars, raised keloid and hypertrophic scars, and scars from accidental and surgical skin lacerations may itch, feel tender, significantly alter appearance, and negatively impact self-esteem. In recent years, ablative (involving surface skin removal) and non-ablative laser treatment techniques have been used to successfully minimize the appearance if not altogether remove the presence of facial scarring.
Resurfacing
Laser skin resurfacing uses a heat-based, intense light energy laser hand-held device to remodel the skin. The laser penetrates the surface of the skin to remove the effects of a scar from the tissue. Performed on an outpatient basis with minimal anesthesia, this relatively bloodless process allows replacement of unsightly skin cells by those that are new and scar-free, either by systematically removing top layers of the epidermis or working beneath the skin surface to heal from inside to out.
Carbon Dioxide
The carbon dioxide laser works in an ablative manner, using high energy to remove layers of the skin, one by one, unveiling the undamaged skin beneath. Quick, intense pulses of light even out and flatten scars as well blend color with the surrounding skin tone. The licensed practitioner performing the procedure controls the laser, which can greatly reduce the incidence of scarring and skin damage from the procedure itself.
Pulsed Dye
The pulsed dye laser delivers bursts of yellow light below the surface of the skin in energy frequencies, managed with computers and customized to skin condition and type. Working beneath the skin layers in a non-ablative capacity promotes growth of collagen to remove scars and improve overall tone. These lasers reduce physical discomfort from some scars and lessen discoloration, while smoothing raised scars such as keloids. Multiple treatments may be necessary to achieve the desired effect; however there is virtually no recovery time needed with this procedure and relatively few side effects.
Risks
There are few side effects from non-ablative forms of treatment; there may be slight discomfort during procedure and tenderness in the first days afterward, yet there is only a small risk of scarring. Ablative treatment can cause swelling, inflammation, crusting on the skin, burning sensations, darkening and/or lightening of the skin that may last for months, and stimulate outbreak of acne and cold sores for those with the herpes virus in their system. Major side effects are rare, and even those that persist generally do go away with time.
Limitations
Laser resurfacing treatment for facial scars may be more effective on certain types of scars than procedures such as dermabrasion or chemical peels, but there are limitations to what can be realistically and permanently achieved. In some cases, all evidence of a scar cannot be removed and, at best, a scar may become less noticeable. Factors include how long the scar has been present; the condition of the scarred skin; the condition of the surrounding area; the amount of discoloration; a patient's age; and whether the scar is raised or pitted.
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