Are scars better if you laser them during surgery?

Here's an interesting idea:  what happens if you laser an incision right at the time of wound closure?  Does it help?  According to a tiny pilot study published in Archives of Dermatology last month, it might help the scar end up looking better.

Ten dermatology patients, who were having some skin lesions excised from their face or arms, were put into this study, where one-half of the wound was treated with a fractional CO2 laser at the time of suture repair.  The incisions were then graded at about 2-3 months post-op by having other dermatologists review the photos.  In this study, 9 out of 10 times, the laser treated side looked better to the patients and to the physicians.  One photo, which was not overwhelming to me personally, showed a slight improvement on the laser side.

So, what do we make of this study?

1)  It's interesting, but needs to be repeated in a larger version with more patients.
2)  The  scars need to be followed for longer than 2-3 months, in order to make a judgement about things.  It may be, for example, that the laser treatment only delays the final appearance of the scar, which could show up later.
3)  Most of these incisions were on the face, where laser resurfacing treatment is better tolerated than any other area of the body.
4)  There was no division of patient results according to skin type - and we know that darker skin types have more side effects from laser resurfacing.  Is this a treatment that only works for Caucasians?

Conclusion:  Too early to say whether we'll end up adopting this concept.  More work needs to be done first.

Scars: Part one - Keloids and Hypertrophic scars

Many people have heard the word "keloid", and think it means "any bad looking scar". This is a common misconception. Scars fall into a couple of categories. Since different types of scars and scar problems are treated differently, it's important to diagnose the scar situation accurately.

A keloidal scar is a scar that continues to enlarge and spreads beyond the borders of the initial wound. They are more common in African-American patients as well as Hispanics, Philipinos and Orientals, but can occur in patients of any race. Keloids often recur after excision, and do not tend to improve with time on their own. They are common on the face, earlobes and the chest. They are more common in women than men.

A hypertrophic scar may be thick, raised or reddish in color - but the key diagnostic difference is that they do not spread beyond the boundaries of the original wound. Most of the "bad scars" that patients show me are in this category. Hypertrophic scars may partially regress over time, becoming more flat and pale. They usually show up during the first few months after a surgical incision. They occur in equal frequency in both men and women.

A third type of scar, called a "wide-spread scar", is also common. These are typically surgical incisions that remain flat, but widen out, like a stretch-mark. They do not have the ropey consistency of a hypertrophic scar. These scars have a normal amount of collagen in them (unlike keloids and hypertrophic scars). They typically have widened out from mechanical tension (pull) across the incision. These usually respond quite well to surgical re-excision.

Commonly used treatments for these abnormal scars can involve scar massage, pressure application, use of topical silicone sheeting or gel, use of steroid injections into the scar, in addition to various surgical excision methods. Since the recurrence rate with surgical excision alone in keloid scars is about 50%, surgical excision is usually combined with one or more of the other listed techniques.

We'll discuss more about surgical scar revision in future chapters of the blog.