Can I Use Fraxel for New Scars?

Question

I had an indurated, raised, red scar resulted from skin exicison. My plastic surgeon told me that using CO2 ablative laser after 6-8 weeks is recommended. Can I use Fraxel or my surgeon meant the ablative traditional CO2 laser? Does Fraxel work on newly formed scar to make them fade out?

Sanusi Umar, MD · Answer

Fraxel lasers promote the synthesis of new collagen fibers that are present throughout your skin. The difference between these fibers and the scar tissue is simply how they are arranged. These lasers work by allowing your skin to produce the normal collagen fibers that help to "fade out" the scars. There are different Fraxel systems (e.g. Repair, Restore, Dual and Refine). The choice to go with one or another has to do with the issue, and the individual characteristics of your skin (like skin tone etc.) But of course, it is important to discuss this with your doctor.

Robert T. Anolik, MD · Answer

The variety of Fraxel lasers (such as the Re:Store, Dual, and Re:Pair) along with the other fractional resurfacing lasers (such as the Palomar Artisan, ActiveFX and others) are wonderful tools in the strategy to minimize scarring, whether these scars are old or new.

	Although there are treatments for scars of all ages, I believe getting to scars earlier than later can be of benefit in many cases, as I feel we can affect the way new collagen and scars form in a positive way.  In fact, when I perform Mohs micrographic surgery for the treatment of skin cancer, I will often employ a variety of lasers to reduce any scar appearance during the initial routine follow-up visits.  Of course, each situation is different and must be individually evaluated.  However, if scars begin to show evidence of uneven textures (either thickening or thinning), the use of ablative (i.e. superficially wounding) fractional lasers (such as the Fraxel Re:Pair) in the near term (i.e. first 1-2 months) can be very valuable.  When the developing scars show evidence of just slight uneven texture, the non-ablative (non-wounding) fractional resurfacing lasers are often valuable.  If scar redness is prominent, the pulsed dye laser (such as the Candela VBeam laser) can also be integrated at the same time.  When broken blood vessels become evident, other vascular lasers can be employed to augment the pulsed dye laser therapy, such as the Gemini laser.  These lasers, in combination with injecting a variety of medications can also help minimize the appearance of scars.  I will often consider injecting steroids (such as Kenalog) and 5 fluorouracil depending on the situation.

	I realize there is a lot of information out there, but the good news is that scars can be markedly improved and its valuable to consider the entire arsenal of tools out there and even a combination approach.  To summarize the question that prompted this discussion: yes, Fraxel lasers are a very valuable component in the treatment of new scars, but consider all the options and combination therapies that are available.

	Sincerely,

	Robert Anolik, MD

Lori Stetler, MD · Answer

I use two laser systems to optimize the appearance of newly healing scars. For scars that are thick and red, I prefer using the pulsed dye laser possibly in combination with injection of steroids into the scar. This combination reduces the redness and thickness components of the scar. If the scar is relatively flat, I can use the Fraxel laser system to improve the texture and overall appearance of the scar. In some instances, I may ultimately use both systems.

Edward Szachowicz, MD, PhD · Answer

I have had the Fraxel re:store laser since 2006, and I have experience in treating both surgical and traumatic scarring.

	I begin Fraxel laser resurfacing to any incision I put on my patient's face starting at six weeks after the surgery, as part of the post-operative healing program. Fraxel helps to flatten the scars, reduce redness and smooth any contour irregularities. I plan for a minimum of 3-4 treatment sessions, one month apart.

	Although six weeks has been shown to be a good time to begin Fraxel for scar improvement, I have seen good results on mature old scars where healing is not optimal.

Lori A. Brightman, MD · Answer

Scars can be inproved with laser treatment. The appropriate laser will depend on the type of scar you have.

	Fractional lasers, with usually multiple treatments, can improve the appearance of flat scars. For thickened or pink scars, generally one may need a pulsed dye laser or fractional ablative along with injections of steriods (in some cases)

	Best to be evaluated first by a physician well skilled in laser procedures

Can I Use Fraxel for New Scars?

Answers (5)