Scar Treatment with Fractional Laser

Abstract

Sir:FigureSeveral nonablative lasers have been developed in an effort to improve scars without compromising the skin and thus to eliminate the majority of risks associated with its use.1–3 Those types of lasers have a greater effect on the skin because they are able to heat the dermis and spare the epidermis. This prospective, analytical, clinical study, type series of cases included 42 patients, 30 female patients (71.4 percent) and 12 male patients (28.6 percent), aged 16 to 75 years (average, 32.43 ± 2.05 years; 95 percent confidence interval, 28.29 to 36.57 years). This research has been approved by the Ethics Committee for Research Involving Humans of Multiplastic Clinic with the support of the Federal University of Pernambuco (no. 409-403). For 17 patients (40.5 percent), the scars were sequelae of accidents, and 25 patients (59.5 percent) had plastic surgery scars. The procedures were performed in three to 12 steps per session, with an average of 9 ± 1 sessions (95 percent confidence interval, 7 to 10) and 89 ± 8 spots (95 percent confidence interval, 72 to 105 spots). The modification of the Vancouver Scar Scale4 consisted of hardening and texture corresponding to pliability; and color representing pigmentation and vascularity. Comparisons of results 90 and 180 days after surgery were performed with chi-square test, and compared using the Wilcoxon test at a significance level of 0.05. At 90 days after surgery, there was a predominance of tough hardening (42.9 percent), thick surface (42.9 percent), and brown pigmentation (38.1 percent) (Table 1). These alterations together were interpreted as bad surgical results for 26 patients (62.0 percent). At 180 days after surgery, 21 patients (50.0 percent) were evaluated as having excellent results, 15 (35.7 percent) had good results, and six (14.3 percent) had bad results because of complications such as keloid (four cases) or scar enlargement (two cases). Regarding surgical results, we identified 26 patients (62.0 percent) with dark, irregular scars and eight cases (19.0 percent) with good or excellent results 90 days after surgery. These results changed at 180 days after surgery to a predominance of excellent scars for 50.0 percent of patients; the remaining six patients (14.3 percent) had bad results, represented by keloid formation or scar enlargement (Fig. 1).Table 1: Intensity of Alterations Obtained in the 42 Patients TreatedFig. 1: Result of necrosis of nasal tip showing sequelae of open rhinoplasty (left, preoperative view; right, postoperative view).The literature considers that this type of laser (fractional) has shortened recovery from 2 to 4 months to 24 to 48 hours, always with the skin/epidermis preserved. It is important to point out the use of the modified Vancouver Scar Scale we adopted in this study, as other authors did.3,4 The fractional laser is a great technical evolution for plastic surgery and yields excellent results in scar treatment. It is safe, simple, and efficient in different face and body regions; in addition, it does not require topical or other anesthetic, which makes it well tolerated in all cases. Moisés Wolfenson, M.D. Clínica Multiplástica do Recife, Recife, Pernambuco, Brazil Fernando Cerqueira Norberto dos Santos Filho Federal University of Pernambuco, Clínica Multiplástica do Recife, Recife, Pernambuco, Brazil DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. PATIENT CONSENT The patient provided written consent for use of the patient's images.