Lasers and adjunctive treatments for facial scars: a review

A variety of facial scars--erythematous, pigmented, atrophic and hypertrophic--may occur as a result of trauma, surgery, burns and skin disease such as acne. Surgery with other adjunctive methods including radiotherapy, intralesional steroids and pressure therapy have shown variable results. Laser treatment has been attempted for scar revision since the 1980s. The continuous wave lasers, including continuous wave carbon dioxide (CO2), argon and Nd:YAG achieved some improvement; however, their use was limited by the inherent problems of continuous mode lasers. The pulsed dye laser has been successfully used in erythematous and hypertrophic scars. Pigment-specific Q-switched lasers have shown a good improvement for pigmented scars. Skin resurfacing lasers (both CO2 and erbium-YAG) have been used successfully to improve selected atrophic facial scars. The results may be improved by using lasers together with scar subcision and injectable or implantable fillers.