Scar resurfacing with high-energy, short-pulsed and flashscanning carbon dioxide lasers

BACKGROUND. Scars have a significant effect on a person's physical and social being. Many treatment modalities for scar improvement such as surgical scar revision, electrosurgical planning, chemical peeling, filler substance implantation, and dermabrasion have been developed. Recently, the resurfacing carbon dioxide (CO2) laser systems have proven to be a useful and safe treatment in the treatment of facial rhytides and acne scarring. OBJECTIVE. The purpose of this study was to evaluate the resurfacing CO2 lasers in the treatment of various surgical, traumatic, acne, and varicella scars. METHODS. Thirty subjects, aging between 14 and 84 years, with surgical, traumatic, acne, or varicella scars were evaluated. Two types of resurfacing laser systems were utilized in this study, a high-energy, short-pulsed CO2 laser and a continuous wave CO2 laser with an optico-mechanical computer flash-scanner. Postsurgical scars were treated with laser resurfacing between 4 and 6 weeks after scar formation. Traumatic, acne, and varicella scars were treated after scar maturation (range, 1-10 years). Scar improvement was evaluated by photographic analysis of before and after images by four independent health care workers using a quartile scale of improvement (<25%, 25-49%, 50-74%, >75%) as well as optical profilometry using silicone surface impressions in 12 scars. RESULTS. Twenty of 24 surgical scars had greater than 75% improvement, and 24 of 24 had greater than 50% improvement by photographic analysis. All six traumatic, acne and varicella scars had greater than 50% improvement. Optical profilometry and surface topography maps reveal a significant flattening of related and depressed scars. CONCLUSION. The high-energy, short-pulsed CO2 laser and the continuous wave CO2 laser with flash-scanning attachment are safe and effective as a treatment modality for scar revision. In general, elevated scars improve more dramatically than depressed scars. (C) 1998 by the American Society for Dermatologic Surgery, Inc.