Scar rehabilitation is the restoring of form and function in scar patients. There are multiple therapeutic approaches have been used in scar management, including surgery (z-plasty), physical therapy, compression, silicone sheeting, corticosteroid therapy, and laser therapy. Leading the way in scar treatments are lasers, which are a scientifically precise and effective treatment modality to rehabilitate and improve scars. Lasers can be used as monotherapy or as an adjunct to surgery and other nonsurgical techniques.
Lasers are divided into ablative and nonablative, depending on depth of penetration and based on wavelength and absorption. Both types of lasers play a role in scar management and their use can be used in management of scars. All lasers should be used judiciously in patients with skin types Fitzpatrick IV to VI because of an increased side effect profile, primarily irreversible hypopigmentation. The two most commonly used ablative lasers are the CO2 laser and the Er:YAG laser. The absorbing chromophore for both lasers is water. Both lasers increase thermal energy, which results in vaporization. Ablative lasers are known to yield good results for treating unsightly or hypertrophic scars and keloids. Additionally, the microchannels in the dermis created by lasers allow for Laser-Assisted Delivery (LAD) of drugs that can modify a scar. Through creation of microchannels, nonablative lasers have also been shown to stimulate extracellular matrix deposition, such as collagen, which makes these lasers desirable for depressed or atrophic scars. In addition to alteration of collagen deposition, another component of laser scar management is redness reduction. Redness of skin or scar is more pronounced if more blood vessels containing cells with oxyhemoglobin are present. Oxyhemoglobin is the target of Nd:Yag and Intense Pulse Light (IPL) treatments. Our combined laser modalities can expedite wound healing and make scars much less perceptible.