Researchers found that both observer- and patient-rated POSAS scores had greatly improved following multiple laser treatments, specifically with regard to pigment, thickness, relief, pliability, surface area and pigment density of scars.
These researchers evaluated objective and subjective changes in mature hypertrophic burn scars following treatment with high, medium, and low density fractional CO2 laser.
What is CO2 Laser Surgery?
Laser therapy may help improve the appearance of hypertrophic scars and relieve symptoms, using local anesthesia at either a dermatology office or outpatient surgery center and generally painless. The procedure usually lasts 2 1/2-3 hours depending on its complexity; CO2 laser is then used to cut under tunneling scars to expose fat underneath. Not only can it improve cosmesis but it may help decrease inflammation and eschar as well.
Multiple laser therapies have been utilized to treat hypersomnia (HS), including long-pulsed Nd:YAG and pulsed dye lasers; however, only a limited number of patients were studied and most studies were not randomized or controlled.
Studies have demonstrated that laser therapy can assist in improving the appearance of hypertrophic scars by reducing erythema and hyperpigmentation, while also serving to prevent future flare-ups of disease.
Scars depend on vascularity for their appearance. Fractional carbon dioxide lasers have been demonstrated to improve scar texture and decrease erythema in burn scars; yet, the exact mechanisms causing such improvements remain unknown.
Robinson and colleagues reported in their case study of a 57-year old female with biopsy-proven elephantiasis nostras verrucosa (ENV) and lymphocutaneous fistula, who responded well to three treatments of an ablative CO2 laser for cosmetic, symptomatic, and functional improvement.
Salvatore and colleagues conducted a pilot study evaluating the efficacy of fractional carbon dioxide lasers for treating VVA/GSM symptoms among postmenopausal women dissatisfied with local estrogen therapy, using subjective and objective scales before and after three laser treatments. Their researchers discovered that VVA symptoms significantly improved and quality of life was increased among 74% of participants after three treatments; additionally histological evaluation demonstrated an increase in dermis thickness as well as decreases in both fibroblast density and collagen bundle thickness – histological evaluation further confirmed improvement as histological evaluation demonstrated improvement as well.
How Does CO2 Laser Surgery Work?
Carbon dioxide lasers operate by emitting a beam of light energy that ionizes gas molecules in their resonator tube, freeing electrons that eventually return to their regular states and release photons of energy that allow the laser to precisely remove thin layers of skin.
CO2 lasers can penetrate deeper than other lasers, providing tightening action on sagging skin, smoothing deep wrinkles and acne scars, lightening brown spots caused by sun damage, as well as stimulating collagen production, leading to firmer, younger-looking skin.
Dr. Shah employs cutting-edge fractional CO2 laser technology to rejuvenate sun-damaged skin, improving both its texture and complexion. Her years of experience allow her to effectively diminish brown spots, shrink pores and blemishes while eliminating scars of all sizes.
CO2 laser treatment can address many cosmetic concerns, such as fine lines and wrinkles, discoloration, blotchiness, age spots, uneven skin tone and rosacea. Furthermore, stretch marks and cellulite may also be reduced significantly using this laser technology.
CO2 lasers can be used to treat many skin conditions, from cancerous lesions such as melanomas to cysts, psoriasis and fibromas. Resurfacing the skin using CO2 lasers instead of traditional scalpels offers immediate cauterizing of blood vessels in treated tissue which reduces bleeding, swelling and infection risk; they may also be used for precancerous lesions or keloids removal and pre-cancerous lesions removal as well. They’re even effective against hidradenitis Suppurativa with complete removal of affected skin, subcutaneous fat and deep fascia helping prevent future flareups recurrence of this condition.
What Are the Side Effects of CO2 Laser Surgery?
CO2 laser treatment can be performed in the office using local anesthesia, typically lasting two to three hours on average and sometimes necessitating sedation depending on severity of disease and other factors. The goal of CO2 laser therapy is to clear away tissue that creates blockages or tunneling; for patients suffering from severe hidradenitis suppurativa this will significantly improve both symptoms and quality of life resulting in significant improvements for symptoms and quality of life improvement. It may be used on both infected and non-infected areas of skin.
Robinson and colleagues (2018) reported on a 57-year old female patient with biopsy-proven elephantiasis nostras verrucosa (ENV), responding well to three monthly treatments of her right thigh with a fractional carbon dioxide laser device, including resolution of lymphocutaneous fistulae and 90% improvement of ENV lesions at one month post treatment follow-up visit; no long-term side effects were noted.
Cloitre and colleagues (2011) conducted an in-depth investigation on the effectiveness of CO2 laser ablation for treating orally potentially malignant disorders (OPMDs). Thirty-five adult patients underwent treatment using an acetic acid mapping procedure followed by Lumenis Shaplan machine CO2 laser ablation; 21 underwent regular rebiopsies while no patient went on to develop G1 pT1 cancer; therefore the authors concluded that using CO2 laser ablation as an effective modality against PeIN and other OMPDs among adults.
Krakowski et al (2014) reported that teenage HS can have profound psychosocial ramifications, both during active disease as well as with residual scarring. A fractionated 10600-nm carbon dioxide laser significantly enhanced objective measures of scarring such as elastic stretch, extensibility, thickness and extensibility compared with control groups. Furthermore, investigators discovered it helped reduce subjective measures of pain/pruritus while improving patient and physician reported scar appearance ratings. According to these researchers the laser may improve short and long-term psychosocial outcomes as well as promote physical scar remodeling or potentially alter disease processes altogether.
How Long Does CO2 Laser Surgery Take?
CO2 laser treatment is typically an outpatient process. Before beginning treatment, your physician will conduct an in-depth medical history analysis and physical exam of your skin, discussing areas of concern and desired results with you to help determine if CO2 laser is indeed the appropriate option for you.
Once the area is numbed with topical anesthesia, your physician will use laser technology to treat your skin. The exact number of sessions will depend on your individual needs and condition.
CO2 laser treatment uses ultrasonic energy to vaporize the top layers of skin, enabling new, firmer tissue to grow underneath. While most people find the procedure pain-free, you may experience slight burning sensations during the procedure. For any discomfort experienced during or following treatment, OTC pain relievers such as acetaminophen or ibuprofen may help.
Initial healing times range between two to four weeks. Your skin may appear red and flaky during this period; to minimize hyperpigmentation from occurring, avoid sun exposure altogether; however if exposed, always wear broad spectrum sunscreen daily!
Mild itching may occur; this typically subsides within 24 hours and can be reduced with hydrocortisone cream available from your physician.
After CO2 laser treatment, your skin may experience slightly increased discomfort due to inflammation. However, this should subside within one week and disappear entirely within days or so of recovery period completion. After this point, wrinkles should begin reducing while other signs of aging will fade; improvement will continue for months or even years after receiving therapy.
What Can I Expect from CO2 Laser Surgery?
Recurring abscesses and fistulas that form in the groin, gluteal folds, axillae and vulvae of those suffering from hidradenitis suppurativa have a tremendously negative impact on their quality of life. Their symptoms can be both distressing and painful, disrupting sleep patterns, mobility and sexual performance as well as having psychological consequences due to draining pus with its accompanying unpleasant odor – significantly limiting physical mobility and sexual enjoyment.
Long-term complications of HS can include osteoarthritis and skin fibrosis. Surgery was traditionally seen as the best solution, yet complications with post-surgery scarring and disease recurrence prevented its success. CO2 laser excision has proven itself an effective means for treating resistant lesions that have not responded to traditional medical and surgical treatments.
CO2 laser surgery can be performed safely in an outpatient setting using local anesthesia, eliminating both costs and risks associated with general anesthesia in a hospital setting. Usually lasting 2 1/2 to 3 hours, CO2 laser surgery removes all affected tissue while an examination of its periphery reveals hidden tunnels which may contribute to disease process.
CO2 laser surgery for hypertrophic scars conducted at an urban academic dermatology center proved highly successful at treating resistant lesions. Results demonstrated significant improvements to MSS scores after surgery, and ultrasound measurement revealed statistically significant decreases in both minimum and maximum thickness scars following the procedure.
The HS Institute wants this treatment to become widely accessible, so we advise patients suffering from refractory HS to reach out to their insurance provider and educate them on its benefits. As more insurers gain knowledge about this therapy, they will begin covering it appropriately reducing cost-of-care and providing patients with life-changing therapy treatments such as this one.
