Scar Treatments using “Lasers”

It’s funny today. No matter what the condition, everyone thinks that a “laser” is available and is best. In most cases, this is not so, but in many cases, laser treatments are available.

There are many different types and causes of scars: traumatic, post-surgical, and acne scars to name a few. Well, there is not one treatment that is best for all types of scars. So, when it comes to scars, you need to have a lot of tools at your disposal in order to get the best result. For example, here is a list of treatments that I perform regularly for scars:

• CO2 laser ablation
• Dermabrasion (not to be confused with microdermabrasion)
• TCA peels
• IPL (intensed pulsed light)
• Topical treatments (i.e. silicone gel sheets, 5-FU), which can be combined with other treatment modalities
• Surgical scar revision
• Electrodesiccation
• Dermal and/or subdermal fillers
• Subcision

What is not on the list:

• Microdermabrasion – studies have shown that there is virtually no benefit unless one reaches the dermis( pinpoint bleeding), at which point it is a dermabrasion and not microdermabrasion. This modality can be combined with chemical peels, which does offer benefit.
• Microneedling – although there may be some benefit, the cost-benefit ratio is poor (high cost for minimal, if any, benefit). This is frequently recommended as there is minimal risk.

In short, the treatment of scars requires experience and skill. More and more frequently, I perform post-operative treatments to reduce the appearance of scars before they fully form (i.e. 10-14 days after facial surgery). But, most scars that are treated are from acne and/or trauma.

New “Laser” to treat skin cancer

Every day a patient contacts me as a nearby Dermatology group is running a television advertisement of a new treatment for skin cancer that does not require surgery. Interestingly, every patient says it is a laser.  Well, this is not the case. This “new” treatment is not new at all. It is electron beam treatment, a form of radiation. This has been used for decades for the treatment of skin cancer at most radiation oncology centers in the United States. Well, what’s new? A smaller, in-office version of this machine is available and is being sold to Dermatologists, all of whom prior to having this machine had no training in treating skin cancers with radiation. Why is this practice advertising on Television? Simple. The average reimbursement for treating one cancer is in the tens of thousands of dollars, versus under $1,000 to have the average cancer on the face treated by other modalities and those not on the face costing $600 or less in most cases.

This treatment requires patients to come to the office 4-5 times per week for up to 24 treatment sessions.

Single treatment tattoo removal: It is now possible to remove tattoos in a single treatment session

Tattoo removal is costly and requires 4-6 laser treatment sessions. A recent study has shown that if one has 4 Alexandrite laser treatments performed 20 minutes apart in a single session, 61% can expect complete clearing of their black, green, and blue tattoos with no increased risk for scarring. Although relatively new, this treatment protocol is very promising and may reduce the time and expense required to remove unwanted tattoos.