Fraxel Laser for Breast Augmentation Scars?

Question

I had breast augmentation surgery 18 months ago (submuscular), and am not happy with the scars. They were supposed to be in breast fold, but one is now half inch below fold, thus quite visible.  I spoke to a dermatologist, who is willing to use Fraxel Laser to reduce it. Actually, I would prefer to treat both scars since the other one is also visible (although less, being in the fold).  Could laser heat damage the implants, in particular if I treat the other scar, in the fold, too? And generally, do you believe the procedure would make sense?

Lewis Albert Andres, MD · Answer

Hello! Thank you for the question! It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.   Laser treatment may give you the results that you are hoping for and improve the appearance. Hope that this helps! Best wishes!

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Ron Shelton, MD · Answer

The depth of effectiveness of the Fraxel laser can not penetrate to the plane in which the implant is located. The scars will remain, not disappear, after all the Fraxel treatments are done. There is a chance that there will be considerable improvement in the scars, both in texture and appearance, but this can not be guaranteed. Some scars continue to improve for many months after the last laser treatment. Further sessions may be desired in the future to continue improvement. Your scars are relatively mature that it is worth an attempt to improve them if they bother you. The improvement may be very minimal or substantial. If there has been widening of the scars, this will not change. If the scars are raised and red, then V-beam laser treatment may be a preferred first therapy to consider. This laser might help reduce the red color and flatten the raised texture.

William Groff, DO · Answer

Hey Amy-- At our practice, we are using the Fraxel repair and restore with very nice results. There is no risk of damaging the implants. I will often combine the Fraxel with the Vbeam perfecta if there is redness or purple discoloration of the scar. I will add some photos to my RealSelf profile so that you can see some results. Take care. Dr. Groff

Michael A. Persky, MD · Answer

Hi Amy,
Surgical scars respond well to both Fraxel restore and repair laser treatments.  It does take a series of treatments.  The heat from the laser does not travel deep enough to damage the implants.  If the skin is injected with local anesthesia, make sure that your physician keeps the injection needle superficial.
The breast scars that we have treated have improved nicely. 
Good luck and be well.
Dr. P

Terrence Keaney, MD · Answer

Not all scars are created equal.  Some scars are flat/red and others are skin colored/raised/depressed. The distinction is important because different lasers have different targets in the skin. If your scar is still red, I would recommend a vascular laser treatment (PDL or KTP).  If the scar is also raised and depressed, I would then initiate laser skin resurfacing (ablative or nonablative - depending on the downtime you could tolerate). The two laser systems can be used on the same day if needed.- Dr. Keaney

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