Scar Revision

Laser Scar Revision: Are You a Candidate?

Reviewed by Steven H. Dayan, MD

Laser scar removal is now the gold standard for removing many types of scars. This "bloodless" scar removal technology may reduce the appearance of scars by as much 80 percent, and can help prevent certain scars from recurring.

A Scar Is Born

A scar can occur any time the skin is cut, abraded or burned. Here's how: The body's wound-healing process begins with inflammation. Scarring occurs when the wound-healing process is disrupted by factors such as too much or too little collagen (the main structural protein found in your skin). Exactly how a scar forms depends on several factors, including your age, the part of your body that has been injured as well as your skin color, texture and tone. The more significant the injury and the longer the healing period, the greater the chance of developing a noticeable scar.

Courtesy of AAFPRS

There are several types of scars. Lasers can help remove or lessen the appearance of many of them, including:

Keloid Scars. These are raised, red scars that often spread outside the borders of your injury. Keloids often appear dark and "ropey" and may form months after your initial injury.

Hypertrophic Scars. These scars are firm, raised and pink. They stay within the borders of your wound and tend to develop soon after your injury.

Atrophic Scars. These acne scars are depressed and pin-like.

Laser Scar Removal: Are You a Candidate?

Laser scar removal is not an option for certain people, including:

  • Individuals with skin disorders such as psoriasis, cystic acne and dermatitis
  • Individuals using certain medications such as isotretinoin for acne

Laser Scar Removal: What to Expect

The process starts with a consultation with a board-certified plastic surgeons or facial plastic surgeon. These are the physicians who are most well-suited to evaluate your skin and perform scar revision, if you are deemed an appropriate candidate.

Finding the right doctor can be overwhelming and anxiety-provoking, but All About Facial Rejuvenation is here to make your search easier. Our directory only lists surgeons who are highly skilled and have extensive experience in a range of cosmetic facial procedures. Choosing one of our listed surgeons for your scar removal procedure will help to ensure that you receive proper care and excellent results.

The consultation process starts with a candid discussion of your goals and your relevant medical history. Disclose all information regarding your health, including whether or not you smoke and what medications or vitamins you presently take.

After examining your skin and the scar you want removed or diminished, your surgeon will explain the technique he or she thinks is best suited for you as well as the risks, costs and recovery associated with this procedure. Your doctor will likely stress the fact that no scar can be removed completely. Your treatment may only slightly improve the appearance of your scar. Expectation management is important when it comes to scar removal.

You should be given a preoperative information packet that explains everything you should do and know before your scar revision procedure. The packet should include a list of all the medications you should stop taking in advance. These medications will include, but are not limited to, aspirin-containing products, which can increase your risk of bleeding. Some doctors may recommend that you start taking supplements of Arnica Montana or Bromelain to minimize any swelling or bruising.

Laser scar removal may take anywhere from a few minutes to a few hours. This depends on the size of the scar or scars. Most of the time, it is done using local anesthesia, but general anesthesia may be an option in some extreme cases.

During the procedure, the laser is moved along your scar, vaporizing or removing a layer of skin. This exposes a more natural-looking skin layer that, over time, heals and minimizes your scar's appearance. Some lasers actually stimulate the production of new collagen, basically correcting scars from the inside out.

Types of Lasers for Scar Removal

Many types of lasers can help remove scars. For example, two of the most commonly-used lasers for scar removal are the CO2 and Er:YAG lasers. Several companies manufacture CO2 and Er:YAG lasers. For more information on how these lasers work and what type of downtime is involved with their use, read our article on laser skin resurfacing.

Fractionated CO2 and Er:YAG lasers, including the Fraxel and fractionated radiofrequency treatments, also help treat acne scars. Fractionated lasers zap a fraction of the skin's surface, creating tiny wounds in the deeper layer of your skin. This triggers a controlled wound healing process in which untreated skin surrounds the wound, helping to repair it. Both CO2 and Erbium YAG lasers as well as radiofrequency treatments can be fractionated.

In addition, the 585-595-nm pulsed dye laser technology, which includes Cynosure and Candela lasers, may help treat hypertrophic and keloid scars. Sometimes, your doctor will suggest using adjunctive treatments such as steroid injections with these lasers to help flatten raised hypertrophic and keloid scars.

Laser Scar Removal Recovery

Your doctor will go over any and all aftercare instructions with you. These may include washing the treated area with mild soap, patting it dry and then applying an antibiotic ointment.

There may be some pain after your laser scar removal treatment. This varies based on your pain tolerance as well as the type of laser used. For example, ablative lasers tend to have more significant recovery times attached to them. There will likely be a follow-up visit or two so your doctor can evaluate how well you are healing and make sure there are no complications such as an infection. Your skin may begin to regenerate within four days after your laser scar removal treatment.

Laser Scar Removal Risks

Risks of laser scar removal may include:

  • Pigment abnormalities such as hyperpigmentation or hypopigmentation
  • Infection
  • Allergic reactions
  • Dissatisfaction with the results

Laser Scar Revision: Are There Any Alternatives?

There are many options for scar removal or scar revision, but laser scar removal has emerged as the gold standard. Still, there is no one-size-fits-all scar removal treatment just as there is no one-size-fits-all scar.

Silicone sheeting or gels can be placed on your scar for several weeks or months to help it fade and flatten. These products can also be used preventively after a cut or skin trauma if you are prone to unfavorable scarring.

Steroid injections can help break up collagen and reduce the appearance of certain scars. Surgical excision or removal of the scar is also an option, but it could result in a worse scar.

Punch grafts are another scar removal option. During this procedure, your surgeon uses a small piece of normal skin to replace the scarred skin. He or she uses a tiny circular "cookie cutter" to cut a hole in the skin and remove your scar. The graft is typically taken from the skin behind your ear. There is a risk of scarring with punch grafts, but these scars are usually smoother than the ones they are replacing.

Chemical peels and dermabrasion also play a role in scar removal.

Z-plasty is a plastic surgery scar removal technique. Your surgeon basically redirects or repositions a scar so it is in better alignment with a natural skin fold. This way, your scar heals in accordance with these folds. Z-plasty can help camouflage facial scars.

Laser Scar Removal Cost

The cost of laser scar removal varies based on the type of laser used, the size of the scar and how many treatments are required. A good ballpark estimate for laser scar removal on an area of your face is about $1,500. If the cost is prohibitive, ask your doctor about payment plans or financing options.

If your doctor suggests an alternative scar revision treatment, make sure he or she gives you the necessary cost information so you can factor it into your decision. If the scar revision is considered reconstructive, insurance may cover the costs. Make sure to clear this with your insurer in advance so there are no surprises down the road.

About the Reviewer of this Article

Steven H. Dayan, MD, is a facial plastic surgeon based in Chicago, where he founded and serves as a medical director for a skin care center (True Skin Care), a state-accredited educational center for estheticians. He also is founder and medical director for a DeNova Research. Dr. Dayan is board certified in otolaryngology and a member of the American Academy of Facial Plastic and Reconstructive Surgery. He is also a clinical assistant professor at the University of Illinois, and participates in laboratory and clinical research in minimally invasive medical procedures and plastic surgery. He serves on the editorial board of the Facial Plastic Surgery Journal and has written and published extensively in the field. A graduate of Washington University in St. Louis, Dr. Dayan attended the University of Illinois Medical School. He completed a residency at the University of Illinois and a facial plastic surgery fellowship.