Abstract
Background
The use of lasers has been proposed for scar revision. A recent pilot clinical study demonstrated that lasers could also be used immediately after surgery to reduce the appearance of scars. The LASH (Laser-Assisted Skin Healing) technique induces a temperature elevation in the skin which modifies the wound-healing process. We report a prospective comparative clinical trial aimed at evaluating an 810-nm diode-laser system to accelerate and improve the healing process in surgical scars immediately after skin closure.
Methods
Twenty-nine women and 1 man (mean age = 41.4 years; Fitzpatrick skin types I-IV) were included to evaluate the safety and performance of the laser system. The laser dose (or fluence in J/cm²) was selected as a function of phototype and skin thickness. Each surgical incision (e.g., abdominoplasty) was divided into two parts. An 8-cm segment was treated with the laser immediately after skin closure. A separate 8-cm segment was left untreated as a control. Clinical evaluations (overall appearance ratings, comparative scar scale) of all scars were conducted at 10 days, 3 months, and 12 months by both surgeon and patients. Profilometry analysis from silicone replicas of the skin was done at 12 months. Wilcoxon signed-rank test analyses were performed.
Results
Twenty-two patients were treated using a high dose (80–130 J/cm²) and 8 patients with a low dose (<80 J/cm²). At 12 months in the high-dose group, both surgeon and patients reported an improvement rate of the laser-treated segment over the control area of 72.73 and 59.10%, respectively. For these patients, profilometry results showed a decrease in scar height of 38.1% (p = 0.027) at 12 months for the laser-treated segment versus control. Three patients treated with higher doses (>115 J/cm²) experienced superficial burns on the laser-treated segment, which resolved in about 5–7 days. For the eight patients treated at low dosage (<80 J/cm²), there was no significant difference in the treated segment versus the control segment. No side effects were observed.
Conclusion
This prospective comparative trial demonstrates that an 810-nm diode laser treatment, performed immediately after surgery, can improve the appearance of a surgical scar. The dose plays a great role in scar improvement and must be well controlled. There is interest in LASH for hypertrophic scar revision. LASH can be used to prevent and reduce scars in plastic surgery.
Similar content being viewed by others
References
Rhett JM, Ghatnekar GS, Palatinus JA, O’Quinn M, Yost MJ, Gourdie RG (2008) Novel therapies for scar reduction and regenerative healing of skin wounds. Trends Biotechnol 26:173–180
Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA et al (2002) International clinical recommendations on scar management. Plast Reconstr Surg 110:560–571
Tierney E, Mahmoud BH, Srivastava D, Ozog D, Kouba DJ (2009) Treatment of surgical scars with nonablative fractional laser versus pulsed dye laser: a randomized controlled trial. Dermatol Surg 35(8):1172–1180
Colwell AS, Longaker MT, Lorenz HP (2003) Fetal wound healing. Front Biosci 8:1240–1248
West TB (1997) Laser resurfacing of atrophic scars. Dermatol Clin 15:449–457
Alster TS, West TB (1997) Treatment of scars: a review. Ann Plast Surg 39:418–432
Chan HH, Wong DS, Ho WS, Lam LK, Wei W (2004) The use of pulsed dye laser for the prevention and treatment of hypertrophic scars in Chinese persons. Dermatol Surg 30:987–994 discussion 994
Kye YC (2003) Laser therapy of skin diseases. Korean J Dermatol 2003:1–6
Nouri K, Jimenez GP, Harrison-Balestra C, Elgart GW (2003) 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg 29:65–73
Conologue TD, Norwood C (2006) Treatment of surgical scars with the cryogen-cooled 595 nm pulsed dye laser starting on the day of suture removal. Dermatol Surg 32:13–20
Choe JH, Park YL, Kim BJ, Kim MN, Rho NK et al (2009) Prevention of thyroidectomy scar using a new 1, 550-nm fractional erbium-glass laser. Dermatol Surg 35(8):1199–1205
Capon A, Souil E, Gauthier B, Sumian C, Bachelet M et al (2001) Laser assisted skin closure (LASC) by using a 815-nm diode-laser system accelerates and improves wound healing. Lasers Surg Med 28:168–175
Capon AC, Gosse AR, Iarmarcovai GN, Cornil AH, Mordon SR (2008) Scar prevention by laser-assisted scar healing (LASH): a pilot study using an 810-nm diode-laser system. Lasers Surg Med 40:443–445
Capon A, Iarmarcovai G, Mordon S (2009) Laser-assisted skin healing (LASH) in hypertrophic scar revision. J Cosmet Laser Ther 11(4):220–223
Souil E, Capon A, Mordon S, Dinh-Xuan AT, Polla BS, Bachelet M (2001) Treatment with 815-nm diode laser induces long-lasting expression of 72-kDa heat shock protein in normal rat skin. Br J Dermatol 144:260–266
Capon A, Mordon S (2003) Can thermal lasers promote skin wound healing? Am J Clin Dermatol 4:1–12
Shah M, Revis D, Herrick S, Baillie R, Thorgeirson S et al (1999) Role of elevated plasma transforming growth factor-beta1 levels in wound healing. Am J Pathol 154:1115–1124
Dallon J, Sherratt J, Maini P, Ferguson M (2000) Biological implications of a discrete mathematical model for collagen deposition and alignment in dermal wound repair. IMA J Math Appl Med Biol 17:379–393
Dallon JC, Sherratt JA, Maini PK (2001) Modeling the effects of transforming growth factor-beta on extracellular matrix alignment in dermal wound repair. Wound Repair Regen 9:278–286
Alam M, Pon K, Van Laborde S, Kaminer MS, Arndt KA, Dover JS (2009) Clinical effect of a single pulsed dye laser treatment of fresh surgical scars: randomized controlled trial. Dermatol Surg 32(1):21–25
Acknowledgments
The authors thank the Plastic and Reconstructive Surgery Department of APHM, Conception Hospital, Marseille, France, and that of the Lille University Hospital, Lille, France, for their support. The authors are grateful to Sonia Saai (Ekkyo SA, Aix en Provence, France) and Marie Guilbert (Lille University Hospital, Lille, France) for their help in database collection and study monitoring, and to Dr. David Black of the Bioengineering and Imaging Department of Pierre Fabre Dermocosmétique (Toulouse, France) for technical assistance and use of the Dermatop device. Finally, the authors thank Pascal Servell for careful review of the English language of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Capon, A., Iarmarcovai, G., Gonnelli, D. et al. Scar Prevention Using Laser-Assisted Skin Healing (LASH) in Plastic Surgery. Aesth Plast Surg 34, 438–446 (2010). https://doi.org/10.1007/s00266-009-9469-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-009-9469-y