Laser Revision Can Help with Serious Scarring

Whatever the cause—burns, trauma or surgery—scars can have a negative impact on a patient’s quality of life. In decades past, treatment of symptomatic scarring (scars that result in discomfort, itch, pain or reduced range of motion) was limited and often complicated.

That has changed dramatically. Today, high-powered lasers shrink and relax symptomatic scar tissue, giving it flexibility closer to that of uninjured skin. Measurable improvements are possible in just a few months’ time, helping patients resume a happier, more normal lifestyle.

Why Lasers Help

Scarring is the body’s natural way to repair damaged tissue. But all scars are not alike. Depending on the individual and extent of the injury, some scars can critically limit the patient’s functional capability.

For example, consider a burn survivor with scarring near a joint. Scar tissue is naturally tighter, denser and stiffer than uninjured skin, and scars around elbows, shoulders, hips, knees or fingers might significantly limit that patient’s functionality and range of motion in that portion of their body. Laser treatment gradually makes such problematic scars thinner and suppler, so they behave more like normal tissue, improving movement. The treatment can also improve scars that feel continuously itchy, painful or “foreign” to the body.

In some cases, tight scars around a wound may prevent it from fully closing. But laser treatment can loosen these scars so they’re less of an obstacle to healing.

And while no scar can be 100 percent removed, laser scar revision can reduce thickness and improve discoloration. The lasers we use at MedStar Washington Hospital Center are powerful and effective against thicker, stiffer scar tissue.

How Scars Form

When the body is injure, it repairs itself by laying down collagen, the protein that makes up connective tissue. But the process isn’t necessarily neat—the collagen can be deposited in random layers and bundles, which is why scars tend to look, feel and behave differently than the damaged tissue they replace.

Severe injuries generally produce severe scars. But everyone scars differently, for reasons we don’t completely understand—an injury in one person might result in completely different scarring characteristics than in another person. We do know that people with darker skin, particularly those with African American and East Asian lineage, are more at risk of severe scarring.

How the Laser Works

Our lasers are able to target this scar collagen very accurately. The laser creates scores of small, barely visible holes in the scar tissue, making incremental improvements by releasing tension in the tissue. Over time and subsequent treatments, more tension is released as we slowly and carefully destroy the thickest collagen bundles. This stimulates a sort of remodeling, as the flexibility of the scar improves with each treatment.

The most fascinating aspect of this process is that we know that it is successful—but we’re not sure exactly why it works at the cellular level. Existing research is largely incomplete. We are working diligently to fill the gaps via multiple studies, including some with patients who volunteer to participate here at the Hospital Center. With time, we will unlock the secrets of the laser’s efficacy.

Impressive Results

Laser techniques have replaced many types of scar revision surgery, which were often uncomfortable and psychologically disheartening, as patients with large scars often had to start over with scar excision and the need for repeat skin grafting.

Today’s laser scar revision is very gratifying because we can deliver dramatic improvements to the patient with no significant side effects or down time. After just one session, 96.5 percent of patients treated at the Burn Center report improvement in their scarring in the form of increased range of motion or reduction of pain, itch or other discomfort.

On average, problem scarring can reduce range of motion to as little as 70 percent of normal. After one or two treatments, we can see that number improve to 76 percent. After the third treatment, patients may approach as much as 90 percent of normal capacity. Such improvement frequently enables patients whose scarring had rendered them unable to work to return to their jobs.

Getting Started

Most patients with thick and problematic scarring are great candidates for laser treatment.

The patient meets with our burn rehabilitation therapists, who take photographs and careful measurements to assess range of motion, functionality and other symptoms. The next meeting is with the surgeon, who determines with the patient the best course of action and duration of treatment.

Before treatment, we submit a report to the patient’s insurance company, detailing how laser treatment will help the patient’s specific symptoms. Getting each protocol preapproved paves the way for a treatment schedule without interruptions that can slow progress.

Most patients with serious scars benefit from an average of six treatments, each four weeks apart. If we delay longer between treatments, we sometimes see symptoms return, so an interval of about a month is optimum.

Laser treatment at the Hospital Center is a same-day procedure that takes 45 minutes or less. Patients are sedated during the procedure; general anesthesia is usually not needed unless we are treating very large areas or the neck or face.

After the procedure, patients may experience a feeling like sunburn, easily managed with over-the-counter ibuprofen (Motrin®/Advil®) or acetaminophen (Tylenol®). Most patients can return to bathing, wearing regular clothing and the normal activities of work and school the following day.

Why MedStar Washington Hospital Center

The Hospital Center is the only adult medical facility in the Washington, D.C., area to own and operate this particular specialized laser equipment. We generally perform around 200 treatment sessions each year.

And while the laser is a superb tool for the treatment of serious scars, it’s not the only one in the Hospital Center tool kit. The Burn Center is at the leading edge of treating scars from injury or surgical incision with a wide array of other treatment options such as compression garments, massage and topical silicone. While the days of being limited to large-scar revision surgery are happily behind us, we often perform smaller, less traumatic surgical procedures that will help improve effectiveness of the laser and other strategies.

Careful rehabilitation also contributes to a patient’s good results. Experienced in scar management, our rehabilitation therapists carefully assess and evaluate patients’ functionality and help them take full advantage of the new flexibility delivered by the laser. Their work is further supported by our excellent team of advanced practice providers, social workers, psychologists and other specialists.

In years past, physicians waited at least a year before surgical scar revision. Today, we know that laser care can begin as soon as the patient’s injury heals. It can even improve and relieve older scarring that has been problematic for decades. And during COVID-19, we are following all virus guidelines carefully and consistently, with treatments that are quick and minimally invasive.

If scars are making life difficult for you or a loved one, we encourage you to reach out to the Burn Center team to discuss your needs with our specialists. Laser revision can help improve your quality of life significantly.

Click here to learn more about our laser scar revision program.