Years ago, lasers were a thing of science fiction. They lived in our imaginations, and appeared in movies and cartoons. After watching them in fantasy life for so long, we began to believe that they indeed had secret powers, and that they could do anything. Now that lasers are everywhere from operating rooms to beauty salons to car factories, there is nothing to prevent us from continuing to think that they can do anything after all. This becomes especially exciting, if true, in the space of scar treatment.
When I consult patients for surgery, we have a very transparent discussion about what to expect from their scars. There are many controllable and uncontrollable factors when it comes to how a scar will turn out, even though any cut in the skin will lead to a permanent scar. Some patients will ask about laser treatments before they even have their surgery, just to make sure that whatever the outcome, they know that they have the option of dissolving the scar with a laser if they don’t love it. So what can lasers actually do?
The first thing to know is that lasers are a huge category of devices. When it comes to most cosmetic lasers, they are basically burning or breaking apart target elements in the skin. The lasers can be set to target a specific depth, and depending on the laser, either target water, tissue, blood vessels, or pigment. In scar care in particular, there are usually two issues with scars that people do not like. One is the texture, and one is the color. Lumps and bumps are a different problem from dark lines, and need to be treated differently.
For the most part, laser scar treatment either falls into the category of resurfacing, in which a thin layer of skin is burned off to allow the area to flatten out a bit, or a deeper layer is targeted to try to smooth the overlying tissue. Other types of lasers target the color itself, breaking apart the clumps of dark pigment to let the scar blend better with the surrounding skin. Scar-specific lasers sometimes target tiny blood vessels in the skin to help soften the appearance of many types of unsightly marks.
While the technology is amazing, and ever advancing, there are limits to what even lasers can do. They cannot, in effect, completely remove a scar. Even the most successful treatment is only improving the appearance of an existing scar. There are also situations where lasers will be rather ineffective. For dark marks for example, lasers work by targeting the darker pigment compared to the surrounding skin. Even if the mark seems very visible, if those two colors are not that different, then the laser treatment will not be very successful. In other cases, beware of practitioners who do not know their lasers well, or who use too strong a setting. Lasers are powerful machines, and they have the potential to do damage when used incorrectly or too aggressively.
Laser therapy is a wonderful option for the right scar on the right patient, and when administered by the right practitioner. As a surgeon, I will also say that there are instances when the best treatment for a scar is to revise it, or cut it out and start over. Consult with an experienced plastic surgeon to determine what might work best for your case, and keep perspective on what can practically be done. There is a magical wand out there that may be able to do something for you, but it is not a cosmic eraser with limitless potential. It is, as is everything, just another tool in the medical shed.
