Laser Scar Treatment: All Your Questions Answered Live by a Dermatologist

Hello. Viewers of Beon-D, I am Director Lee Sang-ju of Yonsei Star Dermatology. Today, we will take a closer look at scars, which everyone has one or two of in their lifetime, focusing on laser treatment, a non-surgical scar treatment method.

Scars basically start with an injury to the skin. Scars can occur due to various causes such as deep wounds after surgery, trauma like traffic accidents, scratches or injuries in daily life, self-harm scars, burns or frostbite, viral infections like acne or chickenpox, bacterial/insect/fungal/parasitic infections, and even cosmetic injuries like ear piercing.

The skin can be divided into the outermost epidermal layer and the underlying dermal layer. When only the epidermal layer is damaged, scars generally do not form, but if the dermal layer is also damaged to the extent of bleeding, scars may form.

Medically, wound healing is largely divided into four stages: hemostasis, inflammation, proliferation, and maturation. However, in daily life, it is convenient to remember it in three stages: wound, early scar, and late scar.

• Wound: The epidermis, which is the protective barrier of the skin, is peeled off, and the underlying dermis is exposed. At this time, treatment is needed to quickly fill the wound area.
• Early scar: Refers to a red scar that has formed within about 6 months of the injury. Keloid scars are an exceptional case that remains red even after maturation.
• Late scar: Refers to a state where the scar has matured and turned white.

Here are three key management methods to minimize scars when a wound occurs.

1. Clean thoroughly: Since there may be foreign substances, disinfect with Betadine or quickly wash with saline solution, tap water, or Samdasoo.
2. Apply antibiotic ointment: Apply an antibiotic ointment such as Fucidin or Madecassol to prevent bacterial infection.
3. Moist dressing: Keep the wound area moist to prevent scabs from forming by applying a moist dressing. Scabs can leave more scars.

Burn first aid

In case of a burn, one more step must be added before the three steps above. Cool the burned area under cool running water (not too cold) for about 20 minutes, then proceed with the wound treatment steps 1-3 above.

For red early scars that have formed within 6 months of the injury, the main purpose of treatment is to prevent the scar from worsening. In the past, scars were often left alone, but recently, various prevention methods have been discovered.

• Scar ointments and patches: After the wound has completely healed and no more exudate is coming out, use silicone gel or sheets, or skin tape. Silicone products help reduce scar formation by keeping the skin moist. If the cost is a burden, applying paper tape is also an option.
• Medication: For scars that swell, such as those after surgery, anti-inflammatory injection treatments like Triamcinolone can be used to flatten the scar.
• Early laser treatment: Since 1995, when Dr. Pinnell Star reported that applying laser to early scars resulted in fewer scars, laser treatment has been actively applied. Dermatologists recommend starting treatment after the wound has healed, for example, immediately after removing stitches from a surgical site, or within 2-4 weeks of healing. The earlier the treatment, the fewer scars remain, and domestic studies have reported a scar reduction effect of over 50%.

For early scar laser treatment, vascular lasers such as Pulsed Dye Laser are mainly used. The principle is to control the excessive blood vessel formation in the scar area that causes swelling, helping the scar heal beautifully. The treatment interval is generally repeated every 4 weeks.

Mature scars that have turned completely white require restorative treatment. Depending on the type of scar, a more suitable method can be chosen between surgical methods and laser treatment. Laser treatment is particularly effective for large burn scars that are difficult to operate on, and self-harm scars or keloid scars that frequently recur.

Advantages of laser scar treatment:

• Suitable for large scars that are difficult to operate on or scars that frequently recur.
• Customized treatment is possible according to the height, color, and texture of the scar.
• Less pain compared to surgery, with almost no disruption to daily life.
• Relatively low possibility of side effects.

Lasers that regenerate scars are broadly known as ablative lasers, fractional lasers, and the Pinhole Technique.

• Ablative laser: Mainly used for depressed scars like acne scars, it helps flatten uneven scars by shaving off the skin.
• Fractional laser: Unlike ablative lasers that shave off the entire skin, this method treats only a part of the skin by creating microscopic holes. Reported by Dr. Rox Anderson of Harvard in 2004, this method leaves surrounding healthy skin intact, allowing for faster recovery and achieving desired effects without creating scars. It has minimal impact on daily life but requires repeated treatments.

Pinhole Technique

Pinhole Technique utilizes the principle of fractional laser, creating small holes in the scar tissue with a laser to soften the scar. Through these microscopic holes, the skin regenerates, inducing the scar to change into the desired shape. This method has been actively used in Korea since the early 2000s.

Depending on the type and characteristics of the scar, improvement can be expected through appropriate laser treatment.

• Burn scars: Can improve the shiny texture or color issues, and soften hard scars to alleviate movement restrictions.
• Surgical scars: Laser can conceal linear scars, such as those in front of the ear or on the forehead after a facelift, which are difficult to improve with reoperation.
• Wrist scars: Wrist scars due to self-harm or surgery may have low satisfaction with surgical methods because the skin is thin and soft. Tattoos can actually make scars more prominent, so laser treatment should be considered.
• Keloid scars: Keloids, which are pathological scars that swell due to constitutional factors, can also be improved with laser treatment. In particular, injection treatment for keloids on the body often caused severe pain, but recently, injection treatment methods that reduce pain by about 70% have emerged, allowing patients to receive treatment more comfortably.

Depending on the type of laser, there may be discomfort or exudate for about 2-3 days after the procedure. If exudate occurs, moist dressing may be necessary. After the procedure, it is important to apply sunscreen diligently, and daily activities such as washing and showering are possible. However, scrubbing or excessive irritation should be avoided on the treated area. Pain is generally at a level where treatment can be sufficiently received with only light topical anesthetic cream, not injection anesthesia.

Once a scar forms, it is difficult to completely erase it like with an eraser. However, various non-surgical laser treatments can help improve the size, color, and texture of the scar, making it less noticeable, and improving the quality of life for patients.