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Comparative Effectiveness of Fractional CO2 Laser and Topical Silicone Gel for Postcesarean Scars
Yi Wang1,2, Minjian Chen1,2, Zhenni Wei1,2
1Department of Plastic Surgery, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350000, People's Republic of China.
Background:
Postcesarean scars are common and may cause persistent symptoms and dissatisfaction. Topical silicone gel is widely used as first-line therapy, but its effects are mainly limited to surface hydration and barrier support. Fractional CO2 laser, by contrast, induces controlled dermal microinjury and collagen remodeling. Comparative evidence for postcesarean scars remains limited. This study compared the effectiveness of fractional CO2 laser versus topical silicone gel for improving scar quality, symptoms, and patient satisfaction.
Methods:
In this retrospective cohort study, 220 women with postcesarean scars were included (112 treated with fractional CO2 laser and 108 with topical silicone gel). Both groups received standard postoperative scar care according to routine clinical practice. The primary outcome was scar quality at 6 months assessed by the Vancouver Scar Scale (VSS). Secondary outcomes included pain, pruritus, tightness, satisfaction, and safety. Between-group differences were analyzed using unadjusted comparisons and analysis of covariance adjusting for baseline VSS and time from surgery to treatment. Sensitivity analyses included additional covariate adjustment and propensity score-adjusted models.
Results:
At 6 months, the laser group was associated with better scar quality compared with the silicone group (VSS total 4.185 ± 1.064 vs 4.619 ± 1.085; unadjusted difference -0.435, P = 0.003). After adjustment, fractional CO2 laser remained associated with a lower VSS total score (adjusted mean difference -0.643; 95% CI -0.891 to -0.395; P < 0.001). Significant improvements were also observed in vascularity, pigmentation, and height/thickness. Laser treatment further reduced pain, pruritus, and tightness, and produced higher patient satisfaction (all P < 0.001). Adverse events were infrequent and comparable between groups.
Conclusion:
Fractional CO2 laser was associated with greater improvements in postcesarean scar quality and related symptoms at 6 months compared with topical silicone gel, with a comparable safety profile.
