Treatment Of Hypertrophic Scars Research Articles

Application and effect of tension-reducing suture in surgical treatment of hypertrophic scar

PurposeTo investigate the application and effectiveness of tension-reducing suture in the repair of hypertrophic scars.MethodsA retrospective analysis of clinical data was conducted on 82 patients with hypertrophic scars treated at the Department of Burns and Plastic Surgery of Nanjing Drum Tower Hospital from September 2021 to December 2022. Patients were operated with combination of heart-shaped tension-reducing suturing technique and looped, broad, and deep buried (LBD) suturing technique or conventional suture method. Outcomes of surgical treatment were assessed before and 6 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS).ResultsImprovements were achieved on scar quality compared to that preoperatively, with a reduction in scar width (1.7 ± 0.6 cm vs. 0.7 ± 0.2 cm, P < 0.001). Assessment using the POSAS and VSS scales showed significant improvements in each single parameter and total score compared to preoperative values (P < 0.05). The Combination method group achieved better score in total score of VSS scale, in color, stiffness, thickness and overall opinion of PSAS scale, and in vascularity, thickness, pliability and overall opinion of OSAS scale.ConclusionThe amalgamation of the heart-shaped tension-reducing suturing technique and the LBD suturing technique has shown promising outcomes, garnering notably high levels of patient satisfaction in the context of hypertrophic scar repair. Patients have exhibited favorable postoperative recoveries, underscoring the clinical merit and the prospective broader applicability of this approach in the realm of hypertrophic scar management.

527 Combination Treatment for Hypertrophic Burn Scars Utilizing Fractional Ablative and Continuous Wave CO2 Laser

527 Combination Treatment for Hypertrophic Burn Scars Utilizing Fractional Ablative and Continuous Wave CO2 Laser

Layered dissolving microneedle containing a three-drug combination on the treatment of hypertrophic scar

Hypertrophic scars (HS), mainly caused by burns, trauma, and surgery, are associated with erythema, bumps, itching, and pain. The oral administration of Asiaticoside (AS) is a prevalent treatment for HS in clinical settings; however, its effectiveness is constrained due to its low bioavailability, necessitating high dosages for therapeutic impact. To mitigate this issue, we developed a layered dissolving microneedle (DMN) incorporating AS–ginsenoside Rb1–L–carnosine (A–G–C) at the tip for HS treatment. The tip layer of the DMNs comprised sodium carboxymethyl cellulose (CMC), while the base layer consisted of low-viscosity CMC to enhance mechanical strength. We examined its puncture performance, in vitro dissolution ability, and therapeutic effect on a rabbit ear model of HS. Histological analysis was performed by Hematoxylin and Eosin (H&E), Masson staining and Sirius red staining. The results demonstrated that the DMNs exhibited excellent puncture performance and dissolution rates. A-G-C DMNs were found to be effective in reducing scar thickness by measuring scar thickness changes. Histological analysis revealed that the A–G–C DMNs significantly reduced inflammation and collagen fiber deposition in scar tissue. Importantly, the therapeutic effect achieved with A–G–C DMNs was comparable to that of triamcinolone acetonide injection. These findings highlight the potential of DMNs loaded with A–G–C as a promising treatment modality for HS, offering improved bioavailability and therapeutic outcomes.

Preparation of Compound Salvia miltiorrhiza-Blumea balsamifera Nanoemulsion Gel and Its Effect on Hypertrophic Scars in the Rabbit Ear Model.

Hypertrophic scars (HS) still remain an urgent challenge in the medical community. Traditional Chinese medicine (TCM) has unique advantages in the treatment of HS. However, due to the natural barrier of the skin, it is difficult for the natural active components of TCM to more effectively penetrate the skin and exert therapeutic effects. Therefore, the development of an efficient drug delivery system to facilitate enhanced transdermal absorption of TCM becomes imperative for its clinical application. In this study, we designed a compound Salvia miltiorrhiza-Blumea balsamifera nanoemulsion gel (CSB-NEG) and investigated its therapeutic effects on rabbit HS models. The prescription of CSB-NEG was optimized by single-factor, pseudoternary phase diagram, and central composite design experiments. The results showed that the average particle size and PDI of the optimized CSB-NE were 46.0 ± 0.2 nm and 0.222 ± 0.004, respectively, and the encapsulation efficiency of total phenolic acid was 93.37 ± 2.56%. CSB-NEG demonstrated excellent stability and skin permeation in vitro and displayed a significantly enhanced ability to inhibit scar formation compared to the CSB physical mixture in vivo. After 3 weeks of CSB-NEG treatment, the scar appeared to be flat, pink, and flexible. Furthermore, this treatment also resulted in a decrease in the levels of the collagen I/III ratio and TGF-β1 and Smad2 proteins while simultaneously promoting the growth and remodeling of microvessels. These findings suggest that CSB-NEG has the potential to effectively address the barrier properties of the skin and provide therapeutic benefits for HS, offering a new perspective for the prevention and treatment of HS.

COMPARISON OF THE EFFICACY OF INTRALESIONAL 5% FU VERSUS INTRALESIONAL TRIAMCINOLONE IN PATIENTS PRESENTING WITH KELOID AND HYPERTROPHIC SCAR AT TERTIARY CARE HOSPITAL, KARACHI

Despite the fact that keloids and hypertrophic scars are frequent benign hyper-proliferative growths of dermal fibroblasts, the clinical concerns, such as physical and psychological issues, are serious and impairing, and there are few effective therapies. Although 5-fluorouracil (5-FU) and intralesional triamcinolone acetonide (TAC) are widely used to manage both scars, their effectiveness is still debatable. To compare the efficacy of intralesional 5% FU versus intralesional triamcinolone in patients presenting with keloid and hypertrophic scar at Tertiary Care Hospital, Karachi. This RCT study was conducted on patients presenting with keloid and hypertrophic scars at the Outpatient Department of Dermatology, JPMC, Karachi, meeting inclusion criteria. A brief history of demographic information and written informed consent were taken from each patient. A total of 158 patients were enrolled in the study and were randomly allocated to Group A, Intralesional triamcinolone group, and B: Intralesional 5% FU group twice weekly for a total of 4 sessions. During each visit, the keloid height was measured, photographed again, and documented. Efficacy was labeled if patients with keloid and hypertrophic scar in either group showed ≥ 50% reduction in height. Comparison of efficacy between groups showed a significant difference as the efficacy rate was higher in patients treated with 5-FU 45mg as compared to the patients administrated with TAC 10mg (70.9% vs. 50.6%; P-value=0.009). This analysis revealed that irrespective of the patient's age, sex, illness duration, or lesion site, intra-lesional 5-fluorouracil (5-FU) offered the significant benefit of a faster and more effective response than triamcinolone (TAC) in the treatment of keloids and hypertrophic scars.

Cucumber‐Derived Extracellular Vesicle‐Functionalized Metal‐Organic Frameworks for Enhanced Photodynamic Therapy of Hypertrophic Scars

AbstractPhotodynamic therapy (PDT) with noninvasiveness and high safety has emerged as a promising therapeutic approach for the management of hypertrophic scars (HS). However, the low transdermal delivery and overexpressed levels of intracellular glutathione (GSH) severely hinder its therapeutic effectiveness. Herein, a multifunctional biomimetic nanoplatform (NDs@EV‐RGD) composed of arginine‐glycine‐aspartic acid (RGD)‐modified cucumber‐derived extracellular vesicles (EVs) and copper‐based metal‐organic framework nanodots (Cu‐MOF NDs) is designed for PDT‐mediated HS treatment. The EVs with low Young's modulus exhibit excellent deformability which endow NDs@EV‐RGD with the capacity to overcome the compact stratum corneum barrier, thereby significantly improving their transdermal delivery efficiency. Notably, the RGD targeting peptide displays specific binding to α1β1 integrin on the fibroblast membranes within HS, leading to the high accumulation efficiency of NDs@EV‐RGD at the HS site. Under near‐infrared laser irradiation, NDs@EV‐RGD efficiently generates abundant reactive oxygen species, inducing the apoptosis of excessively proliferated fibroblasts. Moreover, Cu‐MOF NDs interact with the local GSH, leading to GSH depletion and a significant enhancement in PDT efficacy. Furthermore, NDs@EV‐RGD demonstrates a remarkable therapeutic effect in improving the appearance of HS in a rabbit ear HS model, promoting the apoptosis and remodeling of collagen fibers. Therefore, this work provides a promising biomimetic platform for HS treatment.

Keloid and Hypertrophic Scars Treatment.

Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen. To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600nm and a non-Ablative 1570nm Hybrid Laser Device. Treatment parameters with the ProScan Hybrid Mode were 40W/1.3-1.5ms for the CO2 and 12W/4ms for the 1570nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded. A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics. The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Endogenous stimuli-responsive separating microneedles to inhibit hypertrophic scar through remodeling the pathological microenvironment

Hypertrophic scar (HS) considerably affects the appearance and causes tissue dysfunction in patients. The low bioavailability of 5-fluorouracil poses a challenge for HS treatment. Here we show a separating microneedle (MN) consisting of photo-crosslinked GelMA and 5-FuA-Pep-MA prodrug in response to high reactive oxygen species (ROS) levels and overexpression of matrix metalloproteinases (MMPs) in the HS pathological microenvironment. In vivo experiments in female mice demonstrate that the retention of MN tips in the tissue provides a slowly sustained drug release manner. Importantly, drug-loaded MNs could remodel the pathological microenvironment of female rabbit ear HS tissues by ROS scavenging and MMPs consumption. Bulk and single cell RNA sequencing analyses confirm that drug-loaded MNs could reverse skin fibrosis through down-regulation of BCL-2-associated death promoter (BAD), insulin-like growth factor 1 receptor (IGF1R) pathways, simultaneously regulate inflammatory response and keratinocyte differentiation via up-regulation of toll-like receptors (TOLL), interleukin-1 receptor (IL1R) and keratinocyte pathways, and promote the interactions between fibroblasts and keratinocytes via ligand-receptor pair of proteoglycans 2 (HSPG2)-dystroglycan 1(DAG1). This study reveals the potential therapeutic mechanism of drug-loaded MNs in HS treatment and presents a broad prospect for clinical application.

Efficacy and safety of 1064-nm fractional picosecond laser for the treatment of postmastectomy scars in transgender men: A randomized controlled trial.

Subcutaneous mastectomy is a crucial component of gender affirmation therapy for transgender men (TM), but the scars that result from this procedure can frequently impair their quality of life. This study aimed to assess the efficacy and safety of 1064-nm fractional picosecond laser (FxPico) treatment for hypertrophic and atrophic postmastectomy scars in TM. Twenty-two patients with a total of 35 pairs of bilateral symmetric mastectomy scars were enrolled. One of each pair of symmetric scars was randomly assigned to receive four FxPico treatments at 4-week intervals. All scars were evaluated using the modified Vancouver Scar Scale (mVSS) and three-dimensional imaging for scar roughness, melanin index, and hemoglobin index before each treatment session and at 1, 3, and 6 months following the last treatment. Additionally, participant-rated scar satisfaction (PSS) and scar improvement (Global Assessment Score, GAS), as well as adverse events were recorded. During the 6-month follow-up period after the end of laser treatment sessions, the treated scars showed significant reductions in the mVSS compared to the untreated controls (p < 0.001), whereas the melanin index and hemoglobin index were not significantly different. Subgroup analysis of hypertrophic scars demonstrated statistically significant reductions in mVSS at 1 (p = 0.003) and 3 months (p = 0.041) after the end of laser treatments. PSS was significantly higher on the laser-treated scars than the controls (p = 0.008), and a participant-rated GAS of 2.95 ± 0.65 was found. There were no serious adverse events reported. 1064-nm FxPico could be utilized to treat mastectomy scars among TM, particularly the hypertrophic type.

Effects of botulinum toxin type A in the prevention and treatment of facial hypertrophic scars: A meta-analysis.

A meta-analysis was conducted to comprehensively evaluate the prophylactic and therapeutic efficacy of botulinum toxin type A (BTX-A) in the treatment of facial hypertrophic scars. Computerised searches were performed in databases, from their inception to November 2023, including Embase, Google Scholar, Cochrane Library, Wanfang, PubMed and China National Knowledge Infrastructure databases, focusing on randomised controlled trials (RCTs) that investigated the use of BTX-A for treating facial hypertrophic scars. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Seventeen RCTs were ultimately included, involving 1605 patients who underwent facial cosmetic surgery. The analysis revealed that compared with conventional treatments, BTX-A significantly reduced visual analogue scale (VAS) scores (standardized mean difference [SMD]: -3.50, 95% confidence interval [CI]: -5.16 to -1.84, p < 0.001) and Vancouver scar scale (VSS) scores (SMD: -2.86, 95% CI: -4.03 to -1.68, p < 0.001), and narrowed scar width (SMD: -1.80, 95% CI: -2.48 to -1.13, p < 0.001), while also enhancing the overall effectiveness of the treatment. This study indicates that BTX-A is an effective modality in the prophylaxis and treatment of facial hypertrophic scars, significantly alleviating scar-related pain and preventing scar widening, and is thus worthy of broader clinical application.

Photo-crosslinkable polyester microneedles as sustained drug release systems toward hypertrophic scar treatment

Burn injuries can result in a significant inflammatory response, often leading to hypertrophic scarring (HTS). Local drug therapies e.g. corticoid injections are advised to treat HTS, although they are invasive, operator-dependent, extremely painful and do not permit extended drug release. Polymer-based microneedle (MN) arrays can offer a viable alternative to standard care, while allowing for direct, painless dermal drug delivery with tailorable drug release profile. In the current study, we synthesized photo-crosslinkable, acrylate-endcapped urethane-based poly(ε-caprolactone) (AUP-PCL) toward the fabrication of MNs. Physico-chemical characterization (1H-NMR, evaluation of swelling, gel fraction) of the developed polymer was performed and confirmed successful acrylation of PCL-diol. Subsequently, AUP-PCL, and commercially available PCL-based microneedle arrays were fabricated for comparative evaluation of the constructs. Hydrocortisone was chosen as model drug. To enhance the drug release efficiency of the MNs, Brij®35, a nonionic surfactant was exploited. The thermal properties of the MNs were evaluated via differential scanning calorimetry. Compression testing of the arrays confirmed that the MNs stay intact upon applying a load of 7 N, which correlates to the standard dermal insertion force of MNs. The drug release profile of the arrays was evaluated, suggesting that the developed PCL arrays can offer efficient drug delivery for up to two days, while the AUP-PCL arrays can provide a release up to three weeks. Finally, the insertion of MN arrays into skin samples was performed, followed by histological analysis demonstrating the AUP-PCL MNs outperforming the PCL arrays upon providing pyramidical-shaped perforations through the epidermal layer of the skin.

Laser-Assisted Drug Delivery in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review.

Hypertrophic scars and keloids are the result of an exaggerated healing process and often associated with significant patient morbidity. Fractional ablative lasers create microchannels in the skin and penetrate into the substance of the scar, inducing a normal healing response in zones of created damage. Focal delivery of scar modulating agents into the scar through these microchannels - a process termed Laser-Assisted Drug Delivery (LADD) - is a promising and developing treatment modality. In this systematic review, we aim to critically examine the evidence of LADD in the treatment of hypertrophic scars and keloids. The evidence suggests that LADD improves outcomes in hypertrophic scars and keloids. LADD is a more effective treatment modality than topical application of agents in hypertrophic scars and equally effective as intralesional injection of agents in keloids. There were few reports of adverse events. Evidence supports the use of LADD as an adjunct to non-surgical measures or a treatment modality to be used before more invasive measures such as surgical excision. However, the quality of evidence supporting this conclusion is inconsistent and lacks power. Additional studies are required to optimize dosages, laser settings, and agent choice for the treatment of these lesions.

Differential Photosensitivity of Fibroblasts Obtained from Normal Skin and Hypertrophic Scar Tissues.

It is unclear whether normal human skin tissue or abnormal scarring are photoreceptive. Therefore, this study investigated photosensitivity in normal skin tissue and hypertrophic scars. The expression of opsins, which are photoreceptor proteins, in normal dermal fibroblasts (NDFs) and hypertrophic scar fibroblasts (HSFs) was examined. After exposure to blue light (BL), changes in the expression levels of αSMA and clock-related genes, specifically PER2 and BMAL1, were examined in both fibroblast types. Opsins were expressed in both fibroblast types, with OPN3 exhibiting the highest expression levels. After peripheral circadian rhythm disruption, BL induced rhythm formation in NDFs. In contrast, although HSFs showed changes in clock-related gene expression levels, no distinct rhythm formation was observed. The expression level of αSMA was significantly higher in HSFs and decreased to the same level as that in NDFs upon BL exposure. When OPN3 knocked-down HSFs were exposed to BL, the reduction in αSMA expression was inhibited. This study showed that BL exposure directly triggers peripheral circadian synchronization in NDFs but not in HSFs. OPN3-mediated BL exposure inhibited HSFs. Although the current results did not elucidate the relationship between peripheral circadian rhythms and hypertrophic scars, they show that BL can be applied for the prevention and treatment of hypertrophic scars and keloids.

MiR‐141‐3p‐Functionalized Exosomes Loaded in Dissolvable Microneedle Arrays for Hypertrophic Scar Treatment (Small 8/2024)

MiR‐141‐3p‐Functionalized Exosomes Loaded in Dissolvable Microneedle Arrays for Hypertrophic Scar Treatment (Small 8/2024)

Microneedling in the Treatment of Post-burn Hypertrophic Scars.

Post-burn hypertrophic scars are an important cause of physical discomfort, limitation of movements, psychological disorders, low self-esteem and reduced quality of life. Treatment for this condition is complex and involves several options. Microneedling, also known as minimally invasive percutaneous collagen induction,is an affordable minimally invasive option that can be combined with other treatments, including ablative ones. The goal of this study was to present our microneedling approach for the treatment of hypertrophic scars after burns. A prospective study of 15 patients with post-burn hypertrophic scars was conducted between October 2016 and June 2022. All patients were treated with microneedling and drug delivery of triamcinolone. Scars were evaluated using Vancouver Scar Scale (VSS), Burn Scar Assessment Scale (BSAS) and angle measurement for amplitude of movement evaluation of joints. A significant improvement in the VSS score was obtained after microneedling (8.8 ± 0.44 to 4.1 ± 0.98; p = 0.012), especially in the acute group (less than 1 year after burns): 9.3 ± 0.49 to 3.5 ± 1.36; p = 0.041. There was a significant and progressive improvement of the scars throughout the treatment sessions in all criteria evaluated and in the ranges of joint movement (p = 0.012). Our microneedling protocol promoted a significant improvement of post-burn scars, especially in acute hypertrophic scars, and in the amplitude of joint motion. Sequential treatments provided progressive improvement. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of hypopigmented burn hypertrophic scars with short-term topical tacrolimus does not lead to repigmentation.

Dyschromia is an understudied aspect of hypertrophic scar (HTS). The use of topical tacrolimus has successfully shown repigmentation in vitiligo patients through promotion of melanogenesis and melanocyte proliferation. It was hypothesized that HTSs treated with topical tacrolimus would have increased repigmentation compared to controls. Full-thickness burns in red Duroc pigs were either treated with excision and meshed split-thickness skin grafting or excision and no grafting, and these wounds formed hypopigmented HTSs (n = 8). Half of the scars had 0.1% tacrolimus ointment applied to the scar twice a day for 21 days, while controls had no treatment. Further, each scar was bisected with half incurring fractional ablative CO2 laser treatment before topical tacrolimus application to induce laser-assisted drug delivery (LADD). Pigmentation was evaluated using a noninvasive probe to measure melanin index (MI) at Days 0 (pretreatment), 7, 14, and 21. At each timepoint, punch biopsies were obtained and fixed in formalin or were incubated in dispase. The formalin-fixed biopsies were used to evaluate melanin levels by H&E staining. The biopsies incubated in dispase were used to obtain epidermal sheets. The ESs were then flash frozen and RNA was isolated from them and used in quantitative reverse transcription polymerase chain reaction for melanogenesis-related genes: Tyrosinase (TYR), TYR-related protein-1 (TYRP1), and dopachrome tautomerase (DCT). Analysis of variance test with Šídák's multiple comparisons test was used to compare groups. Over time, within the grafted HTS and the NS group, there were no significant changes in MI, except for Week 3 in the -Tacro group. (+Tacro HTS= pre = 685.1 ± 42.0, w1 = 741.0 ± 54.16, w2 = 750.8 ± 59.0, w3 = 760.9 ± 49.8) (-Tacro HTS= pre = 700.4 ± 54.3, w1 = 722.3 ± 50.7, w2 = 739.6 ± 53.2, w3 = 722.7 ± 50.5). Over time, within the ungrafted HTS and the NS group, there were no significant changes in MI. (+Tacro HTS= pre = 644.9 ± 6.9, w1 = 661.6 ± 3.3, w2 = 650.3 ± 6.2, w3 = 636.3 ± 7.4) (-Tacro HTS= pre = 696.8 ± 8.0, w1 = 695.8 ± 12.3, w2 = 678.9 ± 14.0, w3 = 731.2 ± 50.3). LADD did not lead to any differential change in pigmentation compared to the non-LADD group. There was no evidence of increased melanogenesis within the tissue punch biopsies at any timepoint. There were no changes in TYR, TYRP1, or DCT gene expression after treatment. Hypopigmented HTSs treated with 0.1% tacrolimus ointment with or without LADD did not show significantly increased repigmentation. This study was limited by a shorter treatment interval than what is known to be required in vitiligo patients for repigmentation. The use of noninvasive, topical treatments to promote repigmentation are an appealing strategy to relieve morbidity associated with dyschromic burn scars and requires further investigation.

Effect and mechanism of action of botulinum toxin type A on hypertrophic scar &lt;i&gt;in vitro&lt;/i&gt;

Purpose: To examine the effect of botulinum toxin type A (BTXA) on the formation of hypertrophic scar and to unravel its mechanism of action.&#x0D; Methods: HSF cells were isolated from hypertrophic scars and cultured. Immunohistochemistry (IHC) assays were performed to determine TGF-β1, FN, and Col1 expressions in hypertrophic scar and normal tissues while the expressions and phosphorylation of p38, ERK, JNK, as well as the expressions of α-SMA, Col1 and FN1 in HSF cells were evaluated by immunoblot techniques. CCK-8 and Transwell assays were used to assess the effect of BTXA on the viability and motility of HSF cells.&#x0D; Results: BTXA suppressed MAPK pathway in hypertrophic scar fibroblasts (p &lt; 0.01). It also suppressed excessive collagen deposits in hypertrophic scar through MAPK pathway (p &lt; 0.01), and restrained HSF growth and motility via MAPK pathway (p &lt; 0.01).&#x0D; Conclusion: BTXA suppresses hypertrophic scarring via MAPK pathway and thus, can potentially be developed as a drug for the treatment of hypertrophic scarring.

Effect of fractional CO2 laser combined with 5-Fluorouracil injection in the treatment of Hypertrophic Scars and Keloids..

Effect of fractional CO2 laser combined with 5-Fluorouracil injection in the treatment of Hypertrophic Scars and Keloids..

Intense pulsed light therapy for the treatment of facial erythema and hypertrophic scar after phenol peeling

Intense pulsed light therapy for the treatment of facial erythema and hypertrophic scar after phenol peeling

Combined fractional carbon dioxide laser with long pulsed Nd:YAG laser for treatment of immature hypertrophic scar

Combined fractional carbon dioxide laser with long pulsed Nd:YAG laser for treatment of immature hypertrophic scar