How to Prevent Scars or Scarring from a Laser Treatment?

Question

the one fear I have about laser treatment like Fraxel is the danger/risk/side effect of scarring. are laser scars avoidable?

James R. Gordon, MD, FACS, FAAO · Answer

Choosing the right physician is key in preventing a scar following laser skin resurfacing. A very experienced doctor/surgeon will be able to determine the proper treatment plan and individualize it for each patient. The skin color, amount of sun damage, texture, wrinkles and degree of irregular pigmentation are some of the important unique issues that must be considered. A physician who only uses one type of laser does not have the "armament" to treat all skin conditions. It is important to consider the physician's years in practice, his volume of patients and his reputation. A great physician will also know how to handle any complications that may occur. Proper preparations prior to Fraxel laser treatment and post-laser skin care will greatly help to diminish the risk of scarring. I hope you find this helpful. Good luck!

Matthew Richardson, MD · Answer

The key to scar prevention with resurfacing treatments is choosing the right provider. Be sure to find someone who specializes in facial aesthetic procedures and can show you expected results of any skin resurfacing treatment. Any procedure (surgical and non-surgical) has risks, but these risks can be minimized through proper patient selection, technique, and experience.Luckily, most of the lasers on the market today are designed to reduce the risk of adverse events and are generally very safe and highly effective when used properly.All the best,

Sonia Badreshia-Bansal, MD · Answer

Scarring from lasers are rare in capable hands. Pigment irregularity is the more common problem, especially in ethnic patients, but it is usually temporary and can be avoided with pre-care and after-care with bleaching creams and sunscreen.*

Scott Trimas, MD · Answer

Whether you use a Fraxel type of CO2 laser or traditional CO2 laser, the risk of scarring always exists. Any laser treatment that ablates the skin can result in scarring although the risks are small. Certain areas like the neck and bony prominences of the face are more prone to scarring. Even in careful experienced hands this unfortunate occurrence can occur. To tell you otherwise would be not true. The reason why Fraxel has been touted as causing less scarring is because normal skin bridges are left intact between treated areas. However, if you are the type of person prone to scarring, this can still occur despite your surgeon's best efforts. That being said in 16 years of practice, the occurrence of scarring is still very rare and can usually be treated if noted early. A more common occurrence is skin lightening over the period of years.

Stephen Prendiville, MD · Answer

Obviously, every procedure carries with it the risk of complications. However, the beautiful thing about fractionated lasers is the consistency of depth achieved with the settings used. So when used properly by a Physician experienced in the cosmetic use of lasers, the risk of scarring is very low. Lasers are a resurfacing tool, but the tool will only be as good as the practitioner using it.

William Ting, MD · Answer

During your initial consultation with the laser surgeon, detailed discussion of potential complication of laser resurfacing and proactive steps to minimize them should be shared with you. If no discussion of potential adverse events took place, you should seek a second opinion. Ideally, your laser surgeon is a board-certified dermatologist or plastic surgeon who has performed at least 50 cases of laser resurfacing of your specific skin type. Strict sun protection, prophylactic medication to prevent infection, frequent emollient application, no picking, and pretreatment of bleaching cream or retinoid for ethnic skin are critical to minimize complication from laser resurfacing.

Harold J. Kaplan, MD · Answer

The risk for scarring from laser resurfacing treatments can be minimized by focusing on a few issues:
1.  Make sure that you independently verify that the laser being suggested for your treatment is appropriate for your skin type. For example if you are African American and your physician suggest CO2 resurfacing, I would be worried.  There are lots of lasers available but many should be limited to certain skin types.
2.  Choose a physician that has done hundreds if not thousands of the procedures being proposed. Preferably one that has a specialty in lasers.
3.  Ask lots of questions. Has the laser been used with your skin type commonly?  What is the incidence of side effects? What are the most serious side effects that have been encountered?  What is being done to minimize unintended side effects in the treatment?

Raffy Karamanoukian, MD, FACS · Answer

Laser is simply a monophasic beam of light.  The theory is that each laser wavelength targets a specific part of the tissue. In hair removal, the wavelength chosen is absorbed greatest by black color in the follicles, whereas wrinkle reducing lasers target the water chromophore and cause energy absorption and tightening.
Experience with your skin complexion is most important in seeking a physician to perform laser treatments. I see patients regularly with laser complications. When you delve into their history, time and time again, the patients report going to an inexperienced or non-credentialled practitioner.

Sam Naficy, MD, FACS · Answer

Lasers treatments are the most unregulated medical procedure performed today. Many medi-spas and skin clinics that offer laser treatments do not have an experienced medical doctor on site to evaluate the patient before the procedure and to be present to deal with any potential complications.

	Ideally, laser treatments should be performed in a medical setting (not in the so-called medi-spas or skin clinics), such as the offices of a dermatologist or a plastic surgeon.

	The nurses and aestheticians who actually perform the laser procedures should be under the supervision of a plastic surgeon or dermatologist who is physically present on site. Presently, less than 20% of laser treatments are performed in such a manner.

Jean M. Casello, MD · Answer

It is absolutely possible to reduce the risk of scarring after laser resurfacing.  It is important that your provider is adequately trained to operate such a device.  Laser resurfacing is a medical procedure and should only be performed by a medical doctor or under very  close supervision by a physician. You want to make sure that it is the appropriate laser to treat your condition and your particular skin type.  It is also important that you follow the pre/post instructions and allow enough time for adequate healing.