Scars come in many forms, from minor acne marks to raised, discolored surgical scars. While some fade over time, prominent or problematic scarring often causes distress and leads individuals to seek treatment.
When it comes to removing or improving scars, patients now have more options than ever before. These include newer laser-based scar revision techniques, as well as traditional methods like surgery and chemical peels. But how do you decide what’s right for your scar type and skin?
This article will explore the pros, cons, and differences between laser therapy and more traditional techniques.
What is laser scar revision?
Laser skin resurfacing harnesses targeted laser energy to improve the appearance of scarred skin. Removing outer layers stimulates new collagen production in the dermis below to smooth and soften scars. Laser scar removal can also minimize redness and meld pigment.
There are two main laser resurfacing techniques:
- Ablative laser resurfacing (CO2 or erbium) – It vaporizes thin layers of skin down to a precise depth, causing controlled damage to prompt collagen regeneration. Moderate to significant downtime.
- Non-ablative fractional laser therapy – This gently targets water molecules in columns of scar tissue without damaging nearby tissue, yielding subtle but measurable improvement with minimal downtime. Multiple sessions are required for best results.
While traditional ablative resurfacing achieves the most dramatic results in fewer sessions, the lengthy recovery has led the non-ablative fractional approach to become quite popular. We’ll mainly focus our comparisons on fractional lasers.
Who is a candidate for laser scar revision?
The ideal laser patient:
- Has minor to moderate scarring from previous acne, surgery, trauma, burns, etc.
- Is bothered by scar appearance, but scars aren’t severely raised or volumetric
- Is in overall good health without active skin infections or conditions
- Has reasonable expectations for improvement but not perfection.
Laser resurfacing can significantly improve many scar types, colors, and textures without surgery when performed by an experienced cosmetic dermatologist. However, severely raised/thick scars may also require surgical scar revision later on.
Pros and cons of laser scar removal
Like any procedure, there are both advantages and disadvantages to using laser therapy for scar reduction.
Potential benefits:
- Less invasive with faster recovery than surgery
- Encourages natural-looking collagen rebuilding from below
- Treats scar color and texture irregularities
- Appropriate for delicate areas like the face
- Requires no sutures or stitches
- Minimal pain—usually just a stinging sensation
- Low risk of permanent pigment changes when performed properly
Potential drawbacks:
- Gradual results that require multiple treatments
- Doesn’t excise or remove thick, raised scarring
- Temporary side effects like redness, swelling, blistering
- Small risk of infection or permanent scarring if settings are aggressive
- More expensive than over-the-counter creams or gels
- Results may continue to improve gradually over several months
Overall, laser scar therapy is considered safe when administered correctly by an expert provider. Healing time can last from five to 21 days, and redness may persist for a few months.
What about traditional scar revision procedures?
Traditional approaches have been used to remove or minimize scarring for decades and can be excellent options depending on the scar and patient goals. From minor office procedures to intricate surgery, traditional techniques include:
- Punch excision – circular scarred skin is removed, edges pulled together with sutures
- W-plasty – zig-zag incisions within a scar that reposition tissue to break up straight lines
- Dermabrasion – mechanical sanding down of surface layers
- Chemical peels – acidic solution is applied to remove damaged outer skin
- Steroid injections – help flatten and soften hypertrophic and keloid scars
- Cryotherapy – carefully freeze scar tissue to erase raised areas
- Radiation – for severe, protruding keloids unresponsive to other approaches
- Topical silicone gel sheeting – minimizes visible scarring as wounds heal when applied early
These methods allow experienced surgeons to target and eliminate problem scar tissue directly in some instances. By closing wounds in intricate ways, scars can be strategically placed increases or other discreet locations. Techniques like dermabrasion, peels, cryotherapy, radiation, and laser therapy also stimulate the skin to rebuild itself in a smoother, more uniform way by causing controlled injury.
However, all come with inherent risks not seen in non-invasive laser treatment. These include permanent pigment irregularity, worse scarring, infection, bleeding, nerve damage, and significant downtime. Procedures like radiation for severe keloids also damage healthy collagen around the scar site. As such, traditional approaches tend to be reserved for prominent scarring highly unlikely to respond to non-invasive techniques alone.
Which is better?
With a solid understanding of laser skin resurfacing versus traditional scar removal methods, which option wins out? The reality is that both techniques play important roles in scar treatment. Rarely is one inherently ‘better’ than the other. The choice depends wholly on the patient’s specific goals, scar morphology, expectations around downtime/discomfort, and budget.
Those with minor acne scars, small surgical scars from mole removal, or superficial injuries causing texture changes may achieve satisfactory improvement with fractional laser alone. The non-invasive nature, lower cost, and recovery measured in days rather than weeks make it an attractive first-line treatment for such scars. Multiple repeat treatments deliver gradual but measurable improvement.
However, laser resurfacing alone can’t give optimal improvement for all scars. Thick, painful keloids or wide surgical scars often require multi-modal treatment plans—a combined approach provides superior outcomes. One example is performing laser therapy first to improve texture, followed by surgical excision to remove remaining excess scar tissue. Aggressive scars failing laser treatment may also need alternate options like steroid shots, cryotherapy, or radiation.
In all cases, be sure to select a board-certified dermatologist or plastic surgeon with proven expertise in the latest laser and traditional scar revision techniques. This ensures all options are on the table to create a customized treatment plan for your unique scar concerns.
Preparing for scar revision treatment
Ready to explore potential scar revision options? Whether considering laser procedures, surgical approaches, or often a strategic combination, following doctor’s orders before and after treatment is critical.
Before scar revision treatment:
- Discontinue retinoids, benzoyl peroxide, bleaching creams, and similar products five days before since they increase skin sensitivity.
- Avoid extended sun exposure on the scar site, which can impede healing.
- Have someone available to drive you home after surgery or initial laser appointments.
- Arrange sufficient downtime for expected side effects and restrictions.
- Take before photos of scars under consistent lighting/angles to compare improvement.
After scar revision treatment:
- Follow all post-procedure wound care instructions diligently.
- Apply prescribed antibiotics, ointments, gels, or silicone sheets as directed.
- Avoid picking at scabs or crusts, which can cause scarring or pigment issues.
- Use sun protection diligently on treated areas for at least one year.
- Keep follow-up appointments to monitor results and determine if additional treatment is needed.
The takeaway
No matter what approach you take to improve your scars, having patience is key. Whether it’s multiple laser sessions, healing after a procedure to remove the scar tissue, or often a combination, time is crucial for collagen to regenerate. Scars can’t be erased in one quick appointment – it’s a process.
It’s important to set realistic expectations upfront around what’s likely to happen, how long results will take, any discomfort you may feel, and downtime needed. Commit to sticking to your dermatology team’s skincare routine even after things start looking better.
