Laser scar removal - Selection of patients

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Laser scar removal - selection of patients

Thinking of laser scar removal? Consult a doctor to see if you are a good candidate for acne scar removal. A proper consultation with the cosmetic surgeon is of paramount importance for the success of any laser procedure or for laser scar removal.

It is important to assess very carefully the problematic area in the initial consultation, and select patients who are positive about the outcomes and are the ones who will respond well to laser scar removal. The potential for acne scar removal in a patient can on be determined only after a through assessment of his/her medical history.

The patient's skin type is also an important issue to be considered before the laser scar removal. Dark skin types are more prone to complications from skin pigmentation after laser treatment. The choice of the type of lasers can also help the issue of laser scar removal, as the short pulsed Er:YAG lasers are so far the best for laser acne scar removal.

Skin conditions that can be treated

A full-face laser resurfacing may produce a dramatic result, especially in aged, sun-damaged skin where actinic and seborrheic keratosis, lentigines, and telangiectasias are common. In addition, CO2 laser surgery seems to give good results for all scar types, but laser scar removal is better for saucer-shaped distensible areas, rather than pitted scars where dermabrasion is a better option.

Laser scar removal is also suitable for atrophic facial scars, hypertrophic scars and traumatic scars, which can also be ablated with considerable improvement of their appearance. Laser scar removal helps considerably in blending the scar with the texture and color of the patient's skin. The technique of treating rhytides and scars consists of laser ablation of a particular anatomical unit.

Skin conditions which cannot be treated

As it is important to be optimistic about the outcome, it is essential for the patient to know about the limitations of the treatment. Although the laser procedure is suitable for facial rhytides, perioral and periorbital areas, the nasolabial folds do not seem to improve significantly.

For skin defects which are not very deep, such as surface irregularities (fine wrinkles, superficial scars), Er YG lasers should be used. These lasers are so far the are best laser scar treatments because of less thermal damage and faster recovery time as compared to the use of other types of laser.

Starting the consultation

The consultation can begin with a discussion of the patient's concerns and expectations, with the laser scar removal followed by a thorough explanation of the options available to address those concerns.

It is essential for the patients to have a thorough knowledge about the procedures of laser scar removal as it helps them to have realistic expectations about it. To be knowledgeable about the exact procedures of laser scar removal also helps them to understand and cope with the potential side effects of the procedures including hyperpigmentation (excessive color), hypopigmentation (a lack of color), temporary or permanent textural change, and scarring.

Looking at the before and after photographs of patients helps in a making a decision. The laser surgeon can also show pictures of patients with average results so that the patients are well-aware of the range of possible outcomes.

The proposed area to be treated for laser scar removal should be carefully examined during the consultation and diagrammed, with particular attention to patient desires and expectations.

Medical history of the patient

  • A thorough discussion on the patient's pertinent medical history is essential, particularly if it has something to do with one's ability to heal such as diabetes, use of isotretinoin, etc. Discussion on diet, anemia, immunodeficiency, collagen, vascular, or connective tissue disorders, is also helpful.
  • General health, current medications, drug allergies, anxiety disorders, tendency to form hypertrophic scars or keloids, tendency to hypopigment or hyperpigment also need due consideration.
  • Response to injury, history of vitiligo, cold sores, and pregnancy medications are also important topics of discussion. Such patients can have de-pigmentation patches after the surgery.
  • Patients with koebnerizing conditions such as psoriasis should also be approached cautiously, as they are susceptible to the development of new lesions due to the injury caused by lasers.
  • Patients who have undergone radiation therapy are not suitable candidates for their decreased tendency to heal due to the reduction of adnexal structures caused by radiation. As reepithelialization occurs from the adnexal structures, their absence may greatly reduce one's ability to heal.
  • Since the laser resurfacing procedures make use of a topical anesthesia protocol, consideration should also be given to the patient's pain threshold and degree of anxiety.
Patients who have unrealistic expectations or show an inability or unwillingness to perform the rigorous wound care during the recovery period should be considered an absolute contraindication to any procedure of laser skin resurfacing or laser scar removal.

Laser scar removal is surely for those who are positive about the laser resurfacing modality and are optimistic about its benefits.

1.E. Papadavid,and A. Katsambas, "Lasers for facial rejuvenation: a review", 2003, The International Society of Dermatology, 42, 480-487
2.D. Railan, and S. Kimlmer, "Ablative treatment of photoaging", Dermatologic Therapy, Vol. 18, 2005, 227-241