Laser Scar Removal

Lasers in the field of resurfacing have been of limited utility in the brown skin
Downtime, and post-inflammatory pigmentation, have been the major problems

Resurfacing in India

Resurfacing lasers have traditionally been used for wrinkles in the west in India, more important indications are acne scarring, chicken pox scarring, pigmentation and it they can work.

Ablative Skin Resurfacing

treatment graph

Existing treatments were either too mild (such as MDA/sup chemical peels) or too aggressive (such as dermabrasion/CO2 resurfacing).

Fractional photothermolysis

In 2003, Manstein and colleagues introduced the concept of fractional photo-thermolysis to bridge the gap between ablative and non-ablative resurfacing. Manstein D, Herron GS, Sink RK, et al.

Fractional photothermolysis: A new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med2004;34:426–38.

2940nm Er: YAG Pixel2940nm ER-YAG Pixel

Skin is treated in fractions (hence the name fractional photothermolysis) or pixels (skin is divided in to zones or pixels,just like a digital camera), thereby removing tissue by scattered ablation( destruction), in contrast to the total ablation done by previous lasers.

Pixel Fractional Laser Resurfacing

effect of multiple passesThe total collateral microdamage depends on the number of passes, matrix, size and the level of energy used.

Pixel laser imageThe Pixel thus treats only a small fraction of the skin (about 25-35%), and leaves the rest of skin unaffected. This generates a pattern of microscopic noncontiguous collumns of thermal injury within the dermis.

Our experience

  • Our patient population is mostly acne scars
  • Some patients of ageing changes, other scars, pigmentation conditions- melasma, lichen planus pigmentosus, frictional melanosis
  • Others: Keratosis pilaris, Becker’s nevus.

Our methods

  • Informed consent after viewing a brochure and computer presentation
  • The informed consent form mentions that multiple sessions are needed
  • That some erythema may occur which may persist fro 2-5 days
  • All patients are usually treated with prior bleaching agents and sunscreens.

Methods n=67

  • All acne scars are graded: grade 1-4( modified Goodman scale); type also noted
  • Discomfort during treatment is graded as comfortable/ slightly uncomfortable/ very uncomfortable
  • Post procedure reaction graded by patient as mild( erythema of one day) , moderate( erythema(1-5 days), severe( more than 5 days)
  • Improvement graded as mild( <25%), moderate(25-50%), very good(50-75%) , excellent(more than 75%).

Patient feedback on treatment

  • Most patients comfortable during treatment
  • Describe it as mild tingling
  • Some patients wanted a break during treatment due to feeling of heat
  • 5 patients demanded EMLA
  • Icepacks needed for all, particularly when multiple passes are used.

Pixel laser (n=67)

  • Ten patients were not available for follow up
  • Of the 57 patients: Male – 31 (18–48yrs); Female – 26 (17–48 yrs)
  • Out of 10 who had dropped out, 4 said they were happy with one just pass; 3 were unhappy because of the erythema ; 3 felt the cost was too high.

All patients became fairer

  • Clinical improvement was atleast 51% to 75% in 80% of the patients after 4 sessions.
  • Most patients with superficial and medium depth scars responded very well
  • Deep scars did not respond in terms of depth, but had a textural improvement and change in colour.

Postoperative changes

  • At low dosage( 700-800 mj) erythema lasts only a day
  • Erythema lasts longer when multiple passes are used and when higher dosages( 1200-1400 ) are used
  • At 1400 mj, erythema lasted almost a week; two patients also had mild crusting and pigmentation