To minimize scar formation,
intercept facial wounds as early as possible, and treat them
during the four-to-eight-week window after the trauma or
incision, advises Joseph Niamtu III, D.M.D., an
oral/maxillofacial and cosmetic facial surgeon based in
Improvement in a 15-year-old
traumatic scar (top panel). After a single debulking
treatment with a straight handpiece (middle panel).
Followed by treatment using the computer pattern
generator (bottom panel).
"Before four weeks, wounds
lack sufficient tensile strength to withstand laser
treatment," he says, "And, after eight weeks, laser treatment
is not as effective in eliminating the scar. The optimum
treatment window appears to be four to eight weeks after scar
As the scar matures during the
process of wound repair, adnexal appendages often atrophy. The
pilosebaceous units allow the epithelial cells to migrate from
tissue surrounding the scar. This migration of epithelial
cells into the scar may play a role in the improved outcome
following early treatment.
As scars mature, the
adenexal appendages atrophy. Early treatment may take
advantage of these regenerative cells prior to atrophy. With
early CO2 laser treatment, collagen can be
restructured and layered parallel to the lines of tension in
the skin before the molecular bonding of new collagen is
complete. As a consequence, the contour might be smoother when
the scar eventually forms.
interventional treatment of common types of facial scars," Dr.
Niamtu advises. "Early CO2 laser treatment can
result in better cosmetic results."
Excellent results have been
seen following early laser treatment of incision scars from
facial procedures such as facelift surgery. In addition,
younger patients, even those as young as 5 years of age,
respond especially well to early intervention.
Dr. Niamtu generally uses
the Lumenis Encore CO2 laser at a setting of 80 mJ
and a density of 6 — a setting that translates to 300 mJ and
60 watts with the Coherent Ultrapulse 5000c laser. Treatment
typically involves two to three passes at this fluence,
frequently with additional passes at lesser fluence and
density to "feather out the scar" or "shoulder" the raised
Although many scars respond
well to a single treatment, others will require multiple
treatments performed at three-month intervals.
"Most scars I have treated
respond very favorably," Dr. Niamtu says. "We treat many scars
that are decades old and still usually get good results, but
these scars may require multiple procedures."
For hypertrophic scars that
require significant tissue debulking, Dr. Niamtu prefers to
use the straight 2-mm handpiece. At a 12-week follow-up
appointment, he again uses the manual handpiece, this time in
combination with the computer-pattern generator, to smooth and
blend the scar.
For depressed scars
unfavorable to the resting tension lines, Dr. Niamtu sometimes
performs a w-plasty revision to blend the scar better before
"Some deeper scars will
improve significantly but may be left with hypopigmented
areas, and the patient must be cautioned about this. If the
scar is white before treatment, it is not likely to repigment.
Treatment will result in a more aesthetic scar, but it will
still be hypopigmented."
In certain situations
immediate treatment of scars can also be beneficial.