Laser Scar Removal: What You Need to Know

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

• Average Cost:
• $750

• Range:
• $250 - $6,000

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.

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.

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.

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.

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.”