Introduction

Laser therapy is a non-invasive procedure that uses focused light on scar tissue, stimulating the healing and growth of new, healthy skin. In this article, we will break down what kinds of scars laser therapy can treat, the different kinds of lasers used, what to expect from the procedure, and the potential risks and benefits. Laser therapy is versatile and can treat a multitude of scar types; each has a different response to treatment. Knowing your scar type will be important in choosing the right approach to treatment.

Types of scars

Atrophic scars are sunken or depressed scars that develop usually from acne chicken pox or other disorders which result in the loss of skin damage, similar to collagen. The reason such types of scars occur is that there is not enough production of collagen in the skin after healing to elevate the skin where it has been damaged. A depressed mark is left. Laser therapy can help build up collagen and therefore assist in filling depressions, and smoothing out the skin. 

Hypertrophic scars are raised thick scars. They remain within the boundaries of the original wound. They are common after surgery or injury. Laser therapy helps in softening the tissue, and breaking down excess collagen, hence reducing the height and redness of the hypertrophic scars. 

Keloids result in a person's body producing too much collagen during healing and make a scar grow bigger than the original wound. These raised scars are hard to treat; however, laser therapy combined with other treatments, like injections of corticosteroid, may help these types of scars flatten and shrink over time. 

Contracture scars are caused by burns, which might tighten the skin, constricting movement. This type of scarring can be softened and improved in its flexibility through laser therapy, becoming less restrictive toward movement.

Types of laser therapy for scars

Ablative lasers, such as CO₂ and Erbium lasers, remove the outer layer of skin to induce new tissue growth. These types of lasers are very effective for deep scars but take more time off from work because the strength of the treatment is intense. The skin surface is being resurfaced, hence smoothing the area that had the scar, and it encourages collagen production. However, ablative lasers do carry associated risks of redness, swelling, and possible changes in skin pigmentation. 

Non-ablative lasers, on the other hand, including fractional lasers and pulsed dye lasers, are non-destructive to the superficial layers of the skin. They instead go deeper into the skin to stimulate the production of collagen with much less significant surface trauma. These lasers are minimally invasive and have shorter recovery times, hence are ideal for people who want a finer improvement with minimal downtime. Non-ablative lasers are also especially good for more superficial scars and those of generally darker skin tones. 

Fractional lasers are a hybrid of both ablative and non-ablative technologies. They target a fraction of the skin at one time, leaving surrounding tissues untouched to promote faster healing. These lasers treat both deep and shallow scars, thus providing a kind of balance in the treatment of scars.

Procedure overview

If one is considering laser therapy, then it is paramount that one knows what to expect before, during, and after the treatment. First and foremost, one should undertake an initial consultation with a dermatologist or laser specialist. During this session, your scar type, skin type, and overall skin health are assessed. A practitioner will also explain what to expect in terms of the results and how many sessions might be needed for optimal results. This may include avoiding sun exposure and the application of specific skincare products, such as moisturizers or retinoids, to make the results of the treatment better. In the process of laser treatment itself, the practitioner takes a hand-held device and applies focused light to scar tissue. Depending on the type of laser that may be used, you might either feel a snapping sensation or heat. 

Generally, pain is minimal, and topical anaesthesia is applied to numb the area. For deeper treatments, local anaesthesia can be employed to make you comfortable. Immediately post-procedure, your skin may look red or swollen, kind of like having mild sunburn. The right amount of after-care is critical to the best healing. The dermatologist will recommend products used on your skin for after-care. Gentle cleansers and moisturizers may soothe the treated area, while proper protection from sun exposure using a high SPF sunscreen is required thereafter. Recovery can vary depending on the type of laser used. In general, one may expect some mild redness and flakiness for days to one week.

Risks and side effects

As with any medical treatment, the risk with laser therapy in general is minimal. The more common adverse events are transient erythema and edema that usually settle within days. Some patients may be prone to skin pigmentation changes, usually hyperpigmentation or hypopigmentation of the skin, which may be exacerbated in dark-skinned patients or those not adhering to appropriate aftercare. 

Less common is the very slight possibility of scarring or infection, particularly if the treatment has been too aggressive or post-procedure care is not followed correctly. Although laser therapy is very effective for scar treatment, it is not the only option. 

Other alternatives include microneedling, chemical peels, and excision. Microneedling involves making controlled injury to the skin with the aid of tiny needles, while the production of collagen by one's body will smooth out your scar. Chemical peels involve applying some solution to the topmost layers of the skin, which exfoliates it and allows new skin growth to take its place. Sometimes, large or problematic scarring needs to be removed or revised surgically. Each one of these methods has certain advantages and disadvantages compared to the others. For example, microneedling and chemical peels are less invasive than laser therapy but may also have less effect on deeper scars. Surgical removal provides results a bit more immediately but usually takes longer in recovery.

Conclusion

Laser treatment is a state-of-the-art therapy focused on light to reduce the presence of atrophic, hypertrophic, keloid, and contracture scars, among others. There are also several laser types: ablative, non-ablative, and fractional; each is better suited for a specific scar concern. Generally safe, it may require multiple sessions and post-care routines for the best results. However, although there are risks involved, such as redness and changes in pigmentation, laser therapy is one of the best scar treatments. Other treatments include microneedling and chemical peels but often do not have the dramatic results seen with laser therapy. Laser therapy is promising in trying to decrease the appearance of their scars from acne, surgery, or injury. The right laser therapy, matched for your skin type and scar type, will work toward making your skin smoother and even. The opinion of a dermatologist might be sought to discuss options before a final decision is made. While laser treatment probably would not remove all scarring, it greatly reduces the appearance and can work to bring one's confidence back.