Efficacy and safety of fractional 1064‐nm picosecond laser for atrophic traumatic and surgical scars: A randomized, single‐blinded, split‐scar‐controlled study

Abstract

Objective: A fractional 1064-nm picosecond laser is an efficient and safe treatment for atrophic acne scars. However, evidence of using a picosecond laser for atrophic posttraumatic and surgical scar therapy is lacking. This study aimed to evaluate the efficacy and safety of using a 1064-nm picosecond laser with a microlens array (MLA) for the treatment of atrophic posttraumatic and surgical scars. Methods: This was a prospective, intraindividual, single-blinded, randomized split-lesion-controlled trial. Twenty-five subjects with atrophic traumatic or surgical scars that existed for more than 1 year were enrolled. All atrophic scars were divided at the midline into two halves and randomly assigned to a treatment or control side. The treatment group was treated with a 1064-nm picosecond laser with an MLA handpiece (spot size: 6-8 mm, fluence: 1.0-1.2 J/cm 2 , repetition rate: 5 Hz, three passes) for 3 monthly sessions. The scar volumes were objectively measured using a three-dimensional (3D) photograph at baseline, 1 month after the first and second treatments, and 3 and 6 months after the final treatment. Subjective assessments were conducted by a blinded dermatologist and patients' self-assessment to evaluate improvements at 3 months after the final treatment. Results: The treated sides exhibited a significant volume reduction, with statistically significant improvements over the control group at 1 month after the first and second treatments and at 3 months after the final treatment (p = 0.024, 0.005, and 0.019, respectively). At 3 months after the final treatment, a blinded dermatologist correctly identified the treated side in 24 of 25 patients (96%). The patients rated the improvements as excellent (>75%) and marked (50%-75%) in 36% and 48% of patients, respectively. Conclusion: At 3 months, the 1064-nm picosecond laser with a fractionated MLA can significantly reduce the posttraumatic and postsurgical atrophic scar volume in patients with Fitzpatrick skin types III-V. Insufficient data preclude inferences regarding efficacy at 6 months.

Fractional picosecond laser treatment of non‐acne atrophic scars and scar erythema in Chinese patients

“…This result is consistent with the previous study, which found that 91.7% of patients with atrophic traumatic and surgical scars obtained mild to excellent improvement in 1064 nm FPL treated side assessed by blinded dermatologists in Thailand. 4 Due to the lack of a 3-dimensional camera and reflectance confocal microscopy, it is unfortunate that this study cannot provide accurate data on volume changes in atrophic scars. However, based on mMSS scores, the total score and scores of three parameters (color, distortion, and texture) have statistically significant reductions after FPL treatment.…”

“…Three recent studies have presented the effectiveness and safety of 1064 nm FPL treatment for posttraumatic and postsurgical atrophic scars in Italy and Thailand. 4,16,17 Lee et al reported that 755 nm FPL treatment was effective and safe for linear atrophic scars caused by trauma in Korea. 18 In this retrospective case series, we provided the first report on the effectiveness and safety of FPL treatment for non-acne atrophic scars in Chinese patients.…”

“…According to their morphology, scars may be categorized into atrophic scars, flat scars, hypertrophic scars, and keloids 3 . Atrophic scars result from the loss of dermal collagen and/or adipose tissue after injury, from inversion of the wound edge during wound healing, or from adhesion of the dermis with the underlying tissue after surgery 4 . The common causes of atrophic scars may be trauma, surgery, burns, chemical injury, acne, and varicella 5 .…”

“…dermis with the underlying tissue after surgery. 4 The common causes of atrophic scars may be trauma, surgery, burns, chemical injury, acne, and varicella. 5 In addition to physical disfigurement, atrophic scars can also lead to psychological morbidities and social difficulties.…”

“…[13][14][15] There is, however, limited evidence regarding the effectiveness of FPL treatment for non-acne atrophic scars. 1,4,[16][17][18][19] As far as we know, it is unknown whether FPL treatment is effective and safe for Chinese patients with non-acne atrophic scars. Furthermore, there is little evidence regarding the effectiveness of FPL treatment for scar erythema associated with non-acne atrophic scars.…”