Fractional Laser for Atrophic Scar?

Question

Hi, my question is, if a couple of treatments with a palomar fractional laser, suggested by the surgeon (don't know if ablative or not), could improve the appearance of the atrophic scar on upper lip shown in the attachment? sorry for my bad english, i juste moved to the states :-) best greetings

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

R. Brannon Claytor, MD, FACS · Answer

Non-ablative Fractional lasers will most definitely improve the appearance of scars.  Fractional laser is also known as skin resurfacing.  Pulses of energy will be delivered to the damaged skin cells and promote cell renewal which leads to newer, healthy looking skin.  The laser will help produce collagen to smooth out the scar. You most likely would need anywhere from 3-5 treatments.

Matthew Richardson, MD · Answer

Fractional lasers do work well to improve atrophic scars or any scars with stepoffs or contour irregularities. It is important to remember that several treatments may be required, and that the best results might be achieved with a combination of treatments (such as filler injections, laser, and even scar excision in some cases).All the best,

Robert T. Anolik, MD · Answer

Your scar would certainly benefit from fractional laser resurfacing.  Nonablative (in other words non-wounding) options would leave the area pink for about a week after treatment, possibly with some dry skin.  The downside is that your scar would require numerous treatments to achieve a satisfactory benefit.  A better option for you might be an ablative fractional laser.  These treatments leave the treated area very superficially wounded for about a week and then pink for several weeks.  Although local recovery after an ablative fractional treatment is more extended (i.e. pinker in the treatment area for several weeks), I expect you could achieve a better result in the end and certainly require far fewer sessions to achieve your goal.  Fortunately, since the scar is localized to just the lip, you could likely hide the treated area with a bandaid, especially in the first week when it's most noticeable.  Importantly, atrophic scars do very well with this treatment strategy, as shown in a research study published by our group at the Laser & Skin Surgery Center of New York:

	Weiss EW, et al. Successful treatment of atrophic postoperative and traumatic scarring with carbon dioxide ablative fractional resurfacing: quantitative volumetric scar improvement. Arch Dermatol. 2010 Feb;146(2):133-40.

	If you proceed with this strategy, be sure to discuss medication to prevent against cold sores with your physician.  Laser treatments to the lip edge can cause a cold sore breatkout, so prevention is very valuable.  Fillers (like Juvederm and Restylane) might help fill the depression and serve as a nice adjunct in your optimal treatment strategy, but unfortunately filler will not improve skin texture otherwise and also is not permanent.

Emily Altman, MD · Answer

Fractional laser resurfacing can improve atrophic scars, although several treatments may be required.  If there is residual indentation left, it can be corrected with a dermal filler like Juvederm. The surface of the scar can also be treated with a laser peel to smooth away the edges.

	The extension of the scar to the vermilion (red part of the lip) can be corrected with Juvederm.

David V. Martini, MD · Answer

In my practicea series of 3 to 6 fractional laser treatments with the Palomar 1540 has been very successful in reducing the appearance of scars. The depression in the red of the lip at the vermillion border may require a dermal filler like Restylane or Perlane.

Anita Mandal, MD · Answer

On the right scar, fractional laser can work quite well but you may need several treatments. The end result does depend on the scar width and depth. From the photo, your scar appears to cross the border of your lip and I would use the laser to treat the scar that is in the skin only. The depression at the lip border can possibly be filled to make it flush with the surrounding lip edges using restylane along the vermilion border.

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