Question 1

What is laser scar removal?

Accepted Answer

Laser scar removal treatments use a focused beam of light to make a scar look less noticeable and (in some cases) help it disappear altogether—without surgery. They can also reduce the pain, itching, and sensitivity of scar tissue.

A scar is a natural response to the formation of a wound, be it from an injury, surgery, illness (like chicken pox), or a skin condition like acne. The body forms new collagen fibers to mend the skin damage, creating a different texture and quality than the surrounding tissue.

Most wounds, except very minor ones, result in some degree of scarring. “Sometimes your body is able to heal an area nicely and the scar looks fine,” says Dr. Ariel Ostad, a dermatologic surgeon in New York City. “Other times it’s red, raised, or depressed, and doesn’t blend in with the rest of the skin.”

While many scars fade and become less noticeable over time, they’re still permanent and may be an unhappy reminder of a painful experience.“ Scars are benign, but they can have a profoundly negative effect on a person’s confidence level,” says Dr. Ostad. “In their mind, they see that scar all the time.”

Depending on the type of scar and its location, laser skin resurfacing can be very effective in reducing the appearance of scars by blending them into the surrounding skin.

A variety of lasers can help improve a scar, but these two are most commonly used.

Pulsed-dye lasers

Vbeam, Excel V, and other Pulsed-dye laser (PDL) treatments target excess blood vessels and redness in the skin.
This type of laser treatment is often used on red or pink scars (those that are early on in the healing phase, on relatively light skin types), or scars that may remain pink or red because the new blood vessels that developed to help heal the wound never receded.
“At a specific wavelength, the energy of the laser is absorbed by the hemoglobin in red vessels, causing them to close and the pink or red color to fade [over time],” Dr. Ostad explains.
PDLs can also flatten raised (hypertrophic) scars, likely by reducing the blood flow that helps promote collagen production.

Fractionated laser resurfacing

Fractionated lasers like Fraxel Re:store work by causing micro-injuries to a fraction of the skin’s surface, stimulating new collagen growth. This wounds the skin in a controlled manner, so new skin grows more uniformly.
This technology is favored for atrophic (indented) scars, such as mild to moderate acne scars and some surgical scars. “By delivering a precise amount of energy, these lasers can induce collagen formation and raise the scar to a level that’s adjacent to surrounding skin,” says Dr. Ostad.
More powerful fractionated CO2 lasers, such as Fraxel Re:pair or UltraPulse CO2, are often used to treat deeper scars, including icepick acne scars. The heat provided by these lasers gets absorbed by water in the scars and vaporizes the tissue within it, removing (ablating) a thin layer of skin before stimulating new collagen production to help even out the skin.
Though more aggressive fractionated lasers come with more downtime and risk (in the hands of an inexpert provider), they can be a very effective treatment option.

An experienced dermatologist who offers a range of laser skin resurfacing options will be able to recommend the best laser treatment option for your specific type of scar.

Some acne scars may even respond well to IPL (intense pulsed light) phototherapy, which uses more broad, visible light (unlike the focused light of a laser).

Ablative lasers carry more risk and require more downtime, but they can produce a much greater degree of improvement.

RealSelf Tip: If used early enough, the pulsed dye laser can significantly improve and slow the progression of stretch marks, which are a type of scar. This laser only treats newer stretch marks that are red or purple. The sooner it’s used after stretch marks form, the more effective the treatment. Older (silver or white) stretch marks can be treated by skin resurfacing lasers like Fraxel.

Question 2

What are the pros and cons of laser scar removal?

Accepted Answer

Pros

Lasers can improve scars with minimal downtime. “We can dramatically change the color and shape of a scar and make it much less noticeable,” says Dr. Ostad.
Laser scar treatment can be done anywhere on the body.
This in-office treatment is fast (around an hour, depending on the scar) and—depending on the type of laser—may not even require anesthesia.
Lasers can treat even deep scars precisely, without damaging the surrounding skin. They can also treat a specific or broad area.
Depending on the laser and treatment intensity, you may have little to no downtime. Recovery time after fractional laser treatment, the go-to treatment for acne scars, is usually 3–5 days.
The results are permanent. “Once a scar is improved, it’s not coming back,” says Dr. Ostad.

Cons

Laser scar treatment doesn’t make a scar disappear; it can only make it less noticeable.
Not all scars are suitable for laser therapy. In some cases, scar removal surgery is a better choice. For raised or keloid scars, corticosteroid injections directly into the scar can help significantly.
People with deep skin tones (Fitzpatrick skin types IV–VI) are at risk for increased pigmentation from laser therapy.
Most patients need a series of laser treatments, usually spaced a month apart, to achieve optimal results.
You may also require more than one type of treatment. For example, to treat deep acne scars, a provider may combine laser therapy with a dermal filler like Sculptra.
“If it’s not treated properly, there’s the potential for making a scar worse,” says Dr. Ostad. In unskilled hands, laser scar treatment can result in burns and pigmentation changes. Be sure to see a board-certified dermatologist or plastic surgeon who specializes in laser scar removal.

RealSelf Tip: Laser scar treatment costs can be high, and because it’s considered cosmetic, health insurance generally doesn’t cover it. There are exceptions, though. Your provider may be able to help you get coverage from your health insurer if:

your scar impairs you or interferes with function—for instance, it doesn’t allow you to open your mouth or close your eyes
it causes pain and itching

Question 3

How much does laser scar removal cost? Will insurance cover it?

Accepted Answer

Your laser scar removal cost will depend on:

your provider's credentials and level of experience
their practice location
the size of your scar; small scars can cost as little as $200 remove, while larger scars can cost thousands, according to patient reviews and doctors on RealSelf
how difficult it is to remove—for example, keloid scar treatment can be especially difficult and time-consuming
how many treatment sessions you need for your desired result
whether you have any complementary treatments, such as microneedling or chemical peels

During an initial consultation with an experienced provider, they should recommend the best scar revision option for your skin tone, scar type, and budget. Don't be afraid to ask for a detailed, personalized price quote. It may even be worth your time to consult with more than one provider, so you can compare their treatment plans and cost estimates.

Most insurance policies don’t cover cosmetic scar treatments like this one, but they may offer partial coverage to treat a scar from an injury. That's especially true for thick scar tissue that impacts your quality of life and limits your movement.

Question 4

Who’s a good candidate for laser scar removal?

Accepted Answer

Skin tone is an overriding consideration for laser scar removal treatment. “The scars on dark skin types are a challenge to treat, as the skin contains more melanin (pigment) than lighter skin,” explains Dr. Stephen Mulholland, a plastic surgeon in Toronto.

The pigment in the skin reacts to the heat of the laser by producing more pigment, sometimes causing permanent changes in skin tone. Burns are also more of a risk with deep skin tones because lasers

However, that doesn’t mean that there are no safe options for people with tan, brown, or deep skin tones: it’s a matter of finding a doctor who’s experienced with lasers and has multiple laser and light systems to choose from.

The Aerolase LightPod Neo is an Nd:YAG laser that can safely treat acne scars on most skin tones. Pico lasers like PicoSure, which releases energy in ultrashort pulses (one trillionth of a second or a picosecond), are safe for all skin types.

Pre-treatment with pigment-suppressor creams may also be recommended to reduce the risk of hyperpigmentation.

When consulting with your doctor, they’ll examine your scars and the condition of your skin to provide you with a customized treatment plan.

While a laser may be a good treatment option for your scar, it may not be the right first treatment.

For instance, the dense tissue of an inflamed hypertrophic (or raised) scar or keloid scar should be initially treated with a steroid injection. This helps flatten the scar, soften the tissue, and reduces inflammation, says Dr. Harold Kaplan, a facial plastic surgeon in Los Angeles. “After the scar has been softened and flattened, then laser options may be a good idea for redness and texture,” he explains.

Question 5

What happens during laser scar removal?

Accepted Answer

Laser scar removal is an outpatient treatment, and you can return home immediately afterward.

Treatment with the pulsed dye laser doesn’t usually require anesthesia. It can sting like the snap of a rubber band, but unless treatment is near a particularly sensitive area, most people manage without a numbing cream.

Skin resurfacing lasers like Fraxel, on the other hand, are more painful. To make you comfortable during treatment, your provider will apply a topical anesthetic or administer a local anesthetic (with or without IV sedation) if you’re having an ablative procedure. Most lasers also blow cold air on the treatment area, to cool the skin as they work.

Prior to the treatment, you’ll be given goggles or special shields to protect your eyes.

During treatment with a pulsed dye laser, your doctor will hold a wand-like instrument against the area being treated and “pulse” the laser on and off, as if turning a flashlight on and off, at a selected frequency.

During a Fraxel treatment, your provider passes a handpiece over the targeted area. It’s important to work with a qualified provider who will know how to blend the treated area into the untreated areas of your skin, so the border is undetectable.

Laser treatment settings depend on the number of passes and the energy (or joules) that are used. Typically at least four passes—and often as many as eight—are made.

For best results, scarring often requires a higher treatment intensity than procedures to improve sun damage or fine lines.

To avoid the potential negative side effects of the higher settings, be sure to seek out a physician who’s experienced in laser scar revision.

Question 6

How long does recovery take after laser scar removal?

Accepted Answer

Recovery time depends on the intensity of your laser scar treatment.

With the pulsed dye laser, “it’s as simple as being red for a few hours to a couple of days,” says Dr. Ostad. Ice packs can help minimize redness, as well as any swelling or bruising that may occur.

With Fraxel Re:store, you may have mild sunburn-like redness for a day, and then skin will feel dry and tight for about a week. A few days of peeling and flaking is also normal; this is the treated skin sloughing off as new fresh skin is generated. Apply bland moisturizer or petroleum jelly as needed. Skin may feel warm after laser treatment, so store your moisturizer in the refrigerator—the coolness against your skin will feel soothing.

After treatment with a more heavy-duty CO2 laser, skin will peel and tiny scabs due to pinpoint bleeding during the procedure will develop. You’ll want to plan for a few days of at-home recovery and 10–12 days or more before you’re fully healed.

Your doctor will provide detailed instructions for aftercare. To ensure proper healing, be sure to follow their advice. One must-do is protecting your skin from the sun until it heals. This includes broad-spectrum sunscreen with an SPF 30+, sunglasses, hats, and sun-protective clothing. Skin will be sun-sensitive following laser treatment, and if the ultraviolet rays hit your treated skin, you can develop another scar.

Question 7

When will you see the results of laser scar removal?

Accepted Answer

It can take weeks to see the full outcome of a laser scar treatment. For best results, a series of 3–5 monthly treatments are usually necessary. The exception is treatment with an ablative laser, which—because it’s more aggressive—usually only requires a single treatment.

Initially, you may not notice much improvement. For instance, when treating acne scars with a pulsed dye laser, “it would be unusual to see significant improvement immediately after your first treatment,” says Dr. William Groff, a dermatologist in San Diego. “I would give yourself four to six weeks after that session to see how much improvement you might achieve.”

The same is true for acne scars treated with a fractionated laser. “A single session of Fraxel is likely inadequate for treating acne scars,” says Dr. Michele Green, a dermatologist in New York City. “I’ve found in my own practice that several treatments spaced about a month apart have the most effective results on acne scars.”

Question 8

How long will results last?

Accepted Answer

Once your treatment is completed, the results are considered very long-lasting, if not permanent.

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Karyn Repinski

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