Pulsed Dye Laser Treatment of Scars

Much of the research relating to the effects of the PDL on scars has been led by Dr Tina Alster in Washington, DC. She noted (Alster et al, 1993) that the PDL was able to alter argon laser-induced scars, which are often erythematous and hypertrophic. By using optical profilometry measurements she demonstrated a trend toward more normal skin texture as well as reduction in observed erythema. This work was extended to the treatment of erythematous and hypertrophic scars (Alster and Williams, 1995) using objective measurements; clinical appearance (colour and height), surface texture, skin pliability and pruritus could all be improved.

It is not known how the PDL improves the appearance of hypertrophic and keloidal scars. Microvascular damage may effect collagen or collagenase activity within the scar. Thermal damage to abnormal collagen within the hypertrophic scar may allow remodelling, and reduction in endothelial cell volume can affect type V collagen, which is increased in hypertrophic scars (Hering et al, 1983). Mast cell alterations after laser irradiation may also be of importance.

Although established hypertrophic scars can respond to treatment, early treatment of scars within the first months might prevent hypertrophy in individuals who are keloid-prone. I have certainly seen the benefits of early PDL treatment of excised recurrent keloids (Smith, Lanigan and Murison, unpublished observations). In a group of 11 patients treated in this way, none had a recurrent keloidal scar. Treatment at 6.5-7.5Jcm2 with a 5mm spot or 6-6.75Jcm2 with a 7mm spot is usually used. Treatment is repeated at 6- to 8- weekly intervals depending on clinical response. Keloidal scars require multiple treatments and the response is unpredictable. There may be additional benefits from using newer PDL with wavelengths of 590 or 595 nm but there is no published work to confirm this.

Alster's work has been confirmed by Dierickx et al (1995), who treated 15 patients with erythematous/hypertrophic scars and obtained an average improvement of 77% after an average of 1.8 treatments. Goldman and Fitzpatrick (1995) also treated 48 patients with similar laser parameters. Scars less than 1 year old did better than those more than 1 year old and facial scars did better there was an 88% average improvements, with total resolution in 20% after 4.4 treatments. Similar results were also seen in erythematous and hypertrophic facial acne scars by Alster and McMeekin (1996). Combinations of CO2­ and PDL treatment of hypertrophic non-erythematous scars have also shown additional benefit of the PDL compared to the CO2 laser alone (Alster et al, 1998).

For persistent scars combinations of intralesional corticosteroid injections, steroid impregnated tapes and laser therapy may be necessary (Sawcer et al, 1998).

More recent work by Manuskiatti et al (2001) showed improvement in scarring following treatment with the pulsed dye laser at varying fluences of 3, 5 and 7 Jcm-2. There was a trend for lower fluences to show most improvement and multiple treatments were required.

Two studies have compared the effects of pulsed dye laser treatment with other treatment modalities, particularly intralesional steroids. Alster (2003) compared pulsed dye laser treatment alone with laser therapy combined with intralesional corticosteroid treatment. Both treatment arms produced improvement in scars and there was no significant difference between the two treatments. Manuskiatti and Fitzpatrick (2002) compared scar treatment with intralesional corticosteroids alone or combined with 5-fluorouracil or 5-fluorouracil alone or the pulsed dye laser using fluences of 5 Jcm-2. All treatment areas were improved compared to baseline, there was no significant difference in treatment outcome compared to method of treatment. The highest risk of adverse sequelae occurred in the corticosteroid intralesional group. They concluded that treatment with intralesional corticosteroid alone or in combination with 5-fluorouracil or 5-fluorouracil alone and pulsed dye laser treatment are comparable.

Other studies however, have failed to demonstrate substantial effects of the pulsed dye laser on scars (Allison et al 2003; Paquet 2001; Whittenberg et al 1999;). Paquet assessed laser treated scars using remittance spectroscopy. Although a discrete decrease in redness of the scars was reported clinically this was not confirmed by objective data. Whittenberg et al, in a prospective single blind randomized controlled study compared laser treatment with silicon gel sheeting and controls. Although there was an overall reduction in blood volume and flow and scar pruritis over time, there were no differences detected between the treatment arms and the control groups. Allison et al, treating old and new scars with the pulsed dye laser with fluences of 5 to 6 Jcm-2 were unable to demonstrate any statistical differences between treatment and control by photographic assessments nor surface profile measurements. However, they did notice a significant improvement in scar pruritis in the active group compared with the controlled group.

In conclusion, there are now multiple studies assessing the effects of the pulsed dye laser in the treatment of scars. Although results are conflicting, particularly when controlled studies are performed, it would appear that in some cases laser therapy can be beneficial in the treatment for scars. It is likely that redness and pruritis are the two parameters that are most likely to significantly improve with this treatment.

source: ezinearticles.com

Laser Scar Removal

The wound-healing process begins with inflammation, progresses to tissue formation and ends with modifying specific factors in the anatomy – such as collagen, the main protein found in connective tissue that supports the skin, bone, cartilage and blood vessels. Scarring occurs when the wound-healing process is disrupted by certain factors such as too much or too little collagen. For example, a keloid scar is a mass of collagen.

Today's laser scar removal techniques can reduce the appearance of several types of scars, including Keloid Scarring, Hypertrophic Scarring and Atrophic Scarring. like pockets in the skin that can result from skin conditions or diseases such as acne. Not everyone is a candidate for laser scar removal. People with skin disorders such as psoriasis, cystic acne and dermatitis may not be ideal candidates. Those using certain medications such as isotretinoin for acne must stop using the medication for six months prior to the procedure.

During laser scar removal, the laser is moved along the scar. This can vaporize or remove a layer of skin and expose a more natural-looking skin layer, which heals over time to minimize scar appearance. Other lasers may target lower layers of the skin, stimulating new collagen growth and correcting scars from the inside out. The laser scar removal procedure is often performed under local anesthesia in an outpatient surgery center, surgeon's office or hospital. Sometimes, general anesthesia is used. The surgery takes anywhere from a few minutes to an hour and a half.

Many types of lasers are available, each of which has unique benefits for scar removal. The CO2 and Er:YAG lasers are best suited for acne scarring. The CO2 is an ablative laser that basically sandblasts the skin away; resulting in some substantial downtime. The Er:Yag is also ablative, but less so than the CO2; meaning that it is less damaging. Many different companies manufacture CO2 and Er:YAG lasers.

Fractionated CO2 and Er:YAG lasers including the Fraxel and fractionated radiofrequency treatments also are very helpful for acne scarring, but they require multiple treatments. Fractionated lasers work by treating a fraction of the skin's surface. These lasers create tiny wounds in the deeper layer of the skin. Each wound is surrounded by untreated skin, helping to repair the treated area via a controlled wound-healing process. Both CO2 and Erbium YAG lasers as well as radiofrequency treatments can be fractionated.

Until recently, African-Americans were not considered ideal candidates for laser scar removal, but times are changing. Certain lasers (such as fractionated infrared lasers) and radiofrequency devices such as Thermage may be helpful in treating acne scars among African-Americans. There is still little that lasers can do to treat keloid scars affecting this population.

Laser Treatment for Scar Removal

Almost everyone would had experienced mild to severe acne during their high school and college days. Acne can't be cured completely but can be controlled. Treatments are very important not only to keep acne and inflammation under control, but also to remove scars that would had formed as a result of acne. Scar removal is not an easy process as one can think of. This needs to be done very carefully as it may cause adverse permanent side effects.

Most of the treatments work by removing scars either mechanically or chemically. Mechanical removal treatments are quite unsafe. These type of treatments if not administered properly may cause more harmful effects. Chemical treatments work by dissolving dead cells along with scars. Laser scar treatment is quite a new method to remove scars. In these methods neither mechanical brushes or used or alpha hydroxy chemicals or used. But a high precise laser beam would be made to fall on scars.

The laser beam can effectively and precisely remove the bonding between dead cells and living skin cells. In effect the scars are burned out leaving mild wounds or redness on skin. Skin cells repair themselves after certain period of time which would be acne free. Laser treatments if not administered in right intensity levels can damage active living skin cells. This is quite an undesirable effect and can result in skin rashes and hyper pigmentation. One should undergo these treatments only with an experienced dermatologist in specialty clinics.

Dermabrasion Scar Treatment

Dermabrasion is considered as one of the best surgical options for those in search of effective scar removal treatments. This age-old treatment has been used for ages to remove damaged layers of skin and give way to rejuvenated and healthy looking skin. There are several types of skin treatments that are used to remove scars. They vary in their procedure, but strive for a common goal - scar removal.

Laser dermabrasion: This type of treatment is a laser resurfacing treatment that involves different types of laser impulses to remove damaged skin. This laser skin resurfacing treatment is used on patients with inactive acne and disfiguring scars as an alternative to dermabrasion. Dermabrasion stretch marks: Dermabrasion is used on all types of scars as a scar removal treatment. This includes stretch marks and acne scars. However, dermabrasion isn't always effective on stretch marks because it doesn't reach deep enough into the skin to make a difference.

Chemical peel: A chemical Peel is a process that is done with a chemical substance that peels away the outer skin layer. It is considered to be one of the safest and most effective cosmetic treatments available, but is not recommended for dark skin. Microdermabrasion: Any type of microdermabrasion treatment will be more affordable and less invasive than another type of dermabrasion such as laser dermabrasion. Since this treatment doesn't require professional supervision it can be found over-the-counter, an added benefit to those too busy to find time for a professional treatment.

Dermabrasion is an aggressive procedure that goes deep into the skin and may, at times, result in bleeding. It is performed by a physician and is used to manage superficial scars and contour scar irregularities. A microdermabrasion treatment exfoliates the skin by virtually sand-blasting the uppermost skin layer. It is not as aggressive as dermabrasion and should not produce bleeding. Microdermabrasion treatments are performed by an aesthetician.

Acne scars fractional erbium laser

Treatment with a fixed array fractional 1540-nm erbium laser was effective for improving acne scars. Treatments were given using the 10-mm, 100-microbeam per pulse handpiece for a minimum of three passes per treatment site at 10-millisecond pulse duration. Fluence was set at 50-70 mJ/microbeam.

Self-assessed treatment results indicated that the patients were pleased with the outcomes, with 85% rating their skin as improved. Patient self-assessment indicated that pain was minimal, with a reported average pain score of 2.75 out of 10. Side effects were minimal and included mild erythema and edema, which resolved in all patients within 24 hours. The findings suggest that a minimal fluence of 50 mJ/microbeam with three passes is required to achieve improvement in acne scars with this laser, Dr. Weiss noted.

Fractional laser for scars

Second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed. All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement. Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types.

We found that the best results were achieved with scars, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III. The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, noting that there were no permanent side effects.

Laser tattoo removal & modification

Since 1993 Melbourne dermatology clinic Laser Dermatology has provided Melbourne's only specialist tattoo removal service. Thousands of people have benefitted from tattoo removal treatment with the Q-Switched YAG laser and are happily rid of their tattoos. Laser Dermatology now offers the newest Medlite C6™ tattoo removal laser as well as the Wavelength Sinon™ Ruby and Cynosure HT10™ Alexandrite tattoo removal lasers to address those colours of tattoo ink which are more difficult to remove. These lasers are also used for removal of cosmetic tattooing (eyebrows, eyeliner, lip liner) and traumatic tattooing following injury.

These pigment specific tattoo removal lasers fade or remove tattoo ink with the energy of light. The laser removes the ink by using a specific colour of light that passes through normal skin and is absorbed by the tattoo ink without damaging surrounding tissue. Rapid absorption of laser light energy causes the tattoo pigment to break into smaller granules so it can be removed by the body's natural filtering systems.

There is no safe method of removing a tattoo in one treatment. All single treatment methods such as infrared coagulation, surgical excision, dermabrasion and acid de-tattooing will damage the skin and leave a scar. The laser light pulses produced by the tattoo removal lasers feel similar to being flicked by a rubber band. Most people do not require anaesthesia, but local anaestheic is available for those who find laser tattoo removal treatment uncomfortable.

The number of laser tattoo removal treatments will depend on the amount, colour and type of tattoo ink, the depth of tattoo ink into the skin and the method of tattoo application. Professional tattoos may require ten or more laser treatments, while self-applied tattoos may fade after four laser tattoo removal treatments. Tattoo removal treatments are conducted at six weekly intervals.

Yes. Dark blue, black and red tattoo inks usually respond very well to the Q-Switched YAG tattoo removal laser. Green, aqua and yellow inks have been the most difficult tattoo colours to remove but may now respond to the Q-Switched Alexandrite laser or Q-Switched Ruby tattoo removal lasers. In many cases, greater than 95% fading of the tattoo may be achieved with laser tattoo removal treatment. However, it is very important to know that over 100 tattoo inks are in use worldwide today. Not knowing which tattoo ink, how deep or how much was used, makes it impossible to predict the extent of laser removal treatment in any given tattoo.

The vast majority of patients treated by laser tattoo removal have not developed any scarring. It is, however, impossible to guarantee that no scarring will occur given the enormous differences between individuals. Some people may experience minor textural change on areas treated by tattoo removal lasers. If you have any evidence that your healing capacity makes you especially prone to bad scarring, please bring this to our attention so a test laser treatment can be carried out on your tattoo.

There may be some pinpoint bleeding with scab or blister formation. An antibiotic dressing must be applied daily until the area is healed. You may bathe normally but we do suggest you minimise vigorous activity for a few days to optimise healing after your laser tattoo removal treatment.

Once you have decided on laser tattoo removal treatment, remember the most important things about our clinic - the expertise of the laser operators and our "state of the art" laser tattoo removal equipment. All our laser therapists are registered nurses who are trained by our resident dermatologist. You may be aware that many "laser" and "IPL" centres are offering tattoo removal, amongst other treatments. Unfortunately, no matter how good the equipment, it will only be as good as its operator. Scarring and changes to skin pigment can result from improperly applied light treatments for tattoo removal treatments.

Acne scar treatment tips

Acne scar treatment tips

1. Using tretinoin speeds up the skin's remodeling process and helps heal post-inflammatory changes.
2. Surgical removal (or excision) of acne scars is especially effective for ice pick and boxcar scars.

3. Accutanea may be prescribed for severe cases.
4. Acne staining can be treated with exfoliating creams and facials.
5. Skin grafting may be necessary under certain conditions.
6. Lasers of various wavelength and intensity may be used to recontour scar tissue and reduce the redness of skin around healed acne lesions.
7. Hippocrates serum for treatment of acne scarring is a high potency resurfacing serum to retexturize your skin.
8.Cellex-C is yet another acne scar removal cream that is recommended by many.
9.Elicina cream is a natural day and night protein cream for all ages and skin colours.
10. Mederma is a type of acne scar removal cream. It is actually a gel based medication and has been very helpful in many situations.

New techniques scar improved

While most skin cancer patients would like nothing more than to put their experience behind them, the majority carry constant reminders of their battle with cancer in the form of surgical scars. In some cases, skin cancer surgical scars can cause serious disfigurement, particularly on facial areas that are hard to hide or camouflage. Now, thanks to pioneering research, dermatologists can offer patients more effective facial reconstruction options to reduce the appearance of scars following skin cancer surgery.

Dermatologists are improving patient satisfaction by using the newest innovations and techniques to minimize surgical scars from facial skin cancers. For years, dermatologists have used a number of tried-and-true healing options for wounds resulting from skin cancer surgery - from effectively allowing Mother Nature to heal wounds without medical or surgical intervention to various closure techniques, surgical flaps and skin grafts. While these methods have proven quite effective in minimizing surgical scars, dermatologists are drawing on their expertise in how the skin heals to expand the current treatment options and further enhance results.

Dermatologic surgeon threads a running "baseball stitch" through the wound - or a continuous stitch that weaves in and out similar to the stitching on a baseball - causing the barbs to catch onto the connective tissue of the wound. In essence, the barbs on the stitches anchor themselves to the deep tissue of the wound and gradually close the wound together without tying knots. The barbed stitch technique was recently introduced and, in my experience, the technique has proven successful in closing complicated wounds very quickly and efficiently. Since the patient's operation time is greatly reduced because multiple stitch knots are avoided, their risk of surgical complications is theoretically less - as longer surgeries are associated with greater risk of infection and other complications.

Since the barbed stitch is thick, it works best for large wounds in areas of thicker skin and with high resistance that are hard to stretch - such as the rigid scalp area. This procedure is not recommended in areas where the skin is thin, for instance on the nose or eyelids. He added that patients with thick skin on their cheeks may also be good candidates for the technique.

All surgeries will leave scars and a "scar less" surgery is unrealistic. One approach that comes close is immediate sanding (dermabrasion) of the incision line. In this method, which was developed by dermatologists, a wound is closed with deep stitches first to bring the skin edges together. Sanding is then performed with either a mechanical abrasive device or a laser (intense beam of light energy) to remove the epidermis (the skin's outer layer) all along the entire incision line. This sanding is done at the time of surgery rather than several months afterwards, which is when traditional dermabrasion is completed. Once the epidermis is sanded down, the dermatologist places the top stitches and seals the wound.

Over the course of about seven to 10 days, the cells in the area where the skin was sanded down or stripped migrate over the upper stitch line and effectively hide that line. The migrating cells effectively seal the scar and blend it in with the surrounding skin. Both of dermabrasion and lasers can be used immediately after surgery on almost any area of the face except the eyelids or lips. The best candidates for these procedures are fair-skinned patients and those without an abundance of oil glands along the stitch line itself.

In general, the smoother the skin and the fairer the patient, the better dermabrasion or lasers work together with traditional closure techniques to minimize a scar's visibility. In many cases, adding these methods into the mix can result in an almost scar-less outcome. In fact, these technologies can hide the stitches so well that even under magnification you cannot detect them.

While traditional skin grafts in which a person's own skin is removed from another part of the body and is then stitched over the wound are commonly used in skin cancer reconstruction surgery, a newer application of this technique involves using a skin substitute instead of a person's own skin to close the wound. The skin substitutes currently being used contain an animal protein matrix that the body integrates into the scar.

Skin substitutes are a good option for patients who don't have a lot of healthy skin to use for a graft, such as those with widespread sun damage. Another benefit is that skin substitutes eliminate the need for a second surgery site, and for very deep wounds skin substitutes can be used underneath the skin to plump and shape depressed areas. In the future of facial reconstruction looks bright, with more promising research on the horizon to minimize scarring following skin cancer surgery. Two frontiers in wound reconstruction will involve determining how to modify bad or abnormal scars that sometimes heal poorly and developing products - such as creams or injectables - that promote wound healing based on a greater understanding of how healing occurs at a cellular or biological level.

Remove scars and acne scars

Scars are fibrous tissue which replace normal skin after the dermis, which gets deteriorated following a wound or sore. A skin usually appears in the brownish, blackish or pinkish color. Scars though ugly looking are a natural way of the skin to repair itself from injury. The word scar owes its origin to the Greek word eschara' which means fireplace. An injury becomes a scar only after the sore or wound is completely healed. Let us see how you can treat and remove scars and acne scars from your body:

Apply vitamin E oil directly on the healing tissue two or three times a day. Vitamin E is used to help the skin regenerate, and the gentle massage that you do will help the tissue grow smoothly. You can even use Vitamin E capsules. Break the capsule and smear the oil of these capsule in the area which has scars. - Aloe vera paste can be combined with the oil of vitamin E capsules to remove the scars effectively.

Massage scars with water and little baking soda to gently shed off the dead issue on the top layer of the skin. Massage the scat with baking soda for atleaset one minute, twice daily. Rinse with warm water and apply some olive oil to revitalize the tissue. An expensive yet permanent form of scar removal is by using laser scar removal. The cost of the treatment will depend on the size and the area where the scar exists. Sandalwood paste can effectively get rid of scars. Soak sandalwood in night overnight. The next morning apply the paste on scar affected areas and you will find improvements in your skin tone.

Olive oil or aloe vera gel can also reduce the scar from intensifying. Apply lemon juice on the area where scars are present. Otherwise you can also trying rubbing lemon on the affected skin areas, by cutting the lemon into two halves. The citric quality of lemon helps in not only cleansing the pores but also removing the scars. Apply fresh tomato juice on the affected areas of skin to remove the scars. Rub your skin with ice-cubes to pale the scar. This is the simplest way to reduce scars on the face or other areas of skin. Fuller’s earth can also be used well to remove scars. Take two tablespoons of fuller’s earth and mix it with lemon juice. Mix them well, add rose water to the mixture. Apply the paste on the scars and the scars will reduce considerably. Allow it dry for 15 minutes before washing the area with cool water. If you do this twice a day, the scar will be completely cured.

Gently massage almond oil on the affected skin area to remove scars effectively. Fenugreek seeds are also useful in scar removal treatments in a herbal manner. Take fenugreek seeds and dissolve them in a glass of water. Let it boil for about 5 minutes or so. Then let the solution cool and wash the affected area of scar with this solution. Washing the face with fenugreek water solution can also work wonders to add glow to your face. Mash a ripe banana and apply the resultant paste on the scar. Leave on for ten minutes and then was the skin with cold water. You will be able to remove scars naturally this way. Apply an extract of cucumber on the scar affected area and leave it like that for 15 minutes. Rinse your skin with cool water after 20 minutes. This method can remove the darkest of scars.

Applying honey directly on the scar area can also completely remove the scar. You must apply honey regularly on the scar affected area, till it goes away. Dab some green tea on a cotton and massage it on the scar affected area. Oils like olive oil, coconut oil and the aforementioned almond oil , if regularly applied on the skin several times a day can reduce scars effectively. If the scar is due to an acne or pimple, do this: Mix a tablespoon of yoghurt, sour cream , a tablespoon of ground oatmeal and a some drops of lemon juice and mix together thoroughly. Apply this paste onto the face for ten minutes. Then rinse off with cold water. Do this several times a day. Se low fat sour cream if you have an oily skin. Cut a clove of garlic into two parts and massage it on the acne or pimple area. This helps to cure the scar and its traces effectively.