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Preventing scars: Early involvement after surgery key to better cosmesis
Early intervention will prevent the development of visible, linear scars. One of the increasingly common treatment modalities to prevent scar development is the use of lasers. Laser therapy is virtually painless and does not burn the skin.
Key Points
"What we are starting to realize is that early intervention for scars is better for final outcome," says Suzan Obagi, M.D., assistant clinical professor of dermatology at UPMC.
Lasers
"It turns out that there are lasers that are out there that you can use that are giving a very good clinical outcome that you don't have to use at high settings.
"It took a leap of faith on our part to see if they work," Dr. Obagi tells Dermatology Times.
Case study
In a case study published in 2004, Dr. Obagi used an Nd:YAG laser of 1,320 nm with needle subcision to treat acne scars. The combination treatment was found to be well-tolerated and effective to improve acne scars on the face compared to subcision alone.
Goal
"You want to intervene before scars are mature and in a linear band," Dr. Obagi explains, noting that the ideal time to intervene with a laser is at the time of suture removal.
The lasers that can be used early on to prevent visible scar formation include light-emitting diodes, pulse-dye lasers and microsecond Nd:YAG. Most recently, fractionated lasers, Dr. Obagi says, can be helpful in mature scars.
"There may be a scar that forms, but if it is not in a linear band, it is not visible to the human eye," Dr. Obagi says.
The lasers can be used for potentially large scars following major surgeries like abdominoplasty, or more minor surgeries on the lower leg related to diabetic wounds, she says.
Considering factors
Clinicians need to consider factors involved with wound healing, Dr. Obagi says.
"Younger patients heal faster than older patients, and that applies to bones as well as the skin," she says.
"We need to be more cautious with older patients."
Also, there is an elevated risk of poor wound healing and scar development in patients who are deficient in protein and certain vitamins, Dr. Obagi says. Ethnicity also plays a role in the risk of scar development.
The laser therapy is well-tolerated and virtually painless, and there is no risk of burning to the skin if the energy is delivered at low levels, Dr. Obagi explains.
Disclosure: Dr. Obagi reports no relevant financial conflicts.
