Cosmetic Surgery Tips

Co2 Laser For Keloid Scars

Both the person with keloid scars and others around them may feel burdened by them. They may be large enough to cover the entire shoulder or chest, painful, and thick. As the body produces more collagen in response to trauma, these scars are the result. Although it’s a natural procedure, if you don’t address it quickly away, it could cause keloid scarring.

Keloid scars can be prevented from developing in some cases, but if they do, only time will be able to make them disappear. While there are methods for eradicating keloids, many people are apprehensive about what they might do to their skin because many of them involve lasers or other sources of heat that, if used improperly or by a novice practitioner, could permanently harm the skin.

Thankfully, CO2 lasers have been proven effective at treating keloids without causing any long-lasting side effects on your skin or health! In this blog post we’ll go over what CO2 lasers are and how they work; how they compare with other methods of treating keloids; where you can find a good practitioner near you who uses these lasers; and finally how much it costs!

This post also answers questions like can laser treatment cause keloids and hypertrophic scar laser treatment cost.

Co2 Laser For Keloid Scars

Keloids are benign hyperplasias which may or may not be preceded by injury. They are refractory to treatment most of the times. Intralesional corticosteroids,[1] topical retinoic acid,[2] topical imiquimod cream,[3] surgery,[4] cryotherapy,[5] laser[6] and silicon sheeting[7] are mainly used for their treatment. We assessed the effect of carbon dioxide (CO2) laser ablation followed by intralesional steroid on 35 keloids of 28 patients.

MATERIALS AND METHODS

Twenty-eight patients having 35 keloids were included in the study. A detailed clinical history and examination were done for each patient. Diagnosis of keloid was done on clinical basis. Size of each keloid was noted with the help of a scale. The patients with keloids of size less than 10 cm in any dimension, any duration and with or without any treatment taken in the past were included in the study. However, patients of age < 12 years, pregnant females and infected or secondary changes on surface of keloid (e.g., excoriation/ eczema) were not included in the study. Written informed consent was taken. Photographs were taken on every follow-up e.g., after 3-4 weeks.

The CO2 laser machine used (model no CL20, Sunny Optoelectronic Co. Ltd, Shanghai, China) has continuous, repetitive and super-pulse mode. Energy per second (power) ranges from 0.5 to 15 W. Field block anesthesia(2% lignocaine with epinephrine 1:200000 infiltrated around the margins of the keloid) was given prior to the procedure. Patients were treated on the basis of the size of lesions. Smaller lesions were vaporized using super pulse with 15 W power. Larger lesions were treated in single or stagewise manner by multiple puncture technique or by excision. In multiple puncture technique, small full thickness punctures were created throughout the keloid tissue with a gap of 1-2 mm between the two punctures by CO2 laser. Super pulse (for firm keloid) or continuous (for hard keloid) mode was used with 15 W power [Figure 1]. In excision, keloid tissue was excised from base with super pulse (for firm keloid) or continuous (for hard keloid) with a power output of 15 W [Figure 2]. Keloid was ablated till upper reticular dermis, indicated by yellow to light brown (faun) color change.[8] Orally, 500 mg of tab amoxycillin with 125 mg clavulanic acid was given two times a day for 7-14 days depending on the healing of the lesion. Topically mupirocin cream was given till the healing of the lesion. Patients were advised to maintain proper hygiene of the wound till complete healing. Patients were evaluated weekly for 1 month to assess the wound healing. Injection triamcinolone acetonide 40 mg/ml was infiltrated around the margins just after surgery and again after a gap of every 3-4 weeks for 6 months. For the first two visits, dose of intralesional triamcinolone acetonide 40 mg/ml was 2 U (0.050 ml) of insulin syringe was injected per cm2 area and after that the steroid was injected only at the places where itching or pain or reappearance of keloid tissue (surface elevation) was present. Detailed examination was done after 3 and 6 months of the surgery and size of keloid tissue with local and systemic side effects of corticosteroid were noted. After that, patients were followed up to look for recurrence. Patients were categorized as satisfactorily treated, if there was a thin scar (parchment like) or supple texture and no surface elevation, absence of pain/pruritus and absence of tracts.[9] If not, patient was considered as treatment failure.

RESULTS

A total of 28 patients with 35 keloid lesions were treated with CO2 laser followed by intralesional triamcinolone acetonide injection infiltrated at the margins of treated keloid. Nineteen (68%) were males and nine (32%) females. Twenty-eight keloids were on chest, one was on ankle, three were on right flank, one was on abdomen, one was on left arm and one was on lateral side of right thigh. Seventeen keloids (51.42%) were asymptomatic; however, 17 (45.71%) had itching and pain and one (2.85%) had only pain as symptoms. After 21 days of CO2 laser ablation, healing with erythematous scar tissue was seen in 33 keloids (94%); however, two keloids became secondarily infected and hence healing was delayed. There was no or minimal pain after 7 days of procedure. Thirteen patients with 17 keloids came for follow-up regularly and completed the protocol and took upto eight intralesional triamcinolone acetonide 40 mg/ml 3-4 weeks apart. Only two patients showed recurrence, one with marginal elevation and another with 70% recurrence. Rest 11 patients having 15 keloids showed complete flattening without any recurrence after a follow-up of 1 year [Figures ​[Figures3a3a and ​andb,b, ​,4a4a and ​andb].b]. Eight keloids showed no local side effects of intralesional steroid, three developed telangiectasias, five developed depigmentation and one developed atrophy. Intralesional steroid dose, which was 10 U (1 ml=40 U of insulin syringe, 1 U=0.025 ml) or 0.25 ml of 40 mg/ml of injection triamcinolone acetonide on an average at first two follow-ups, decreased to an average of less than 2 U or 0.050 ml of injection triamcinolone acetonide at the end of 6 months period [Figure 5]. Ten patients with 12 keloids did not come for follow-up regularly for intralesional steroid and hence did not complete the protocol. In this group, three keloids did not show any recurrence, five keloids showed 100% recurrence and remaining four keloids showed 10-70% recurrence after 1 year of follow-up [Table 1]. An average of three doses of intralesional steroids was taken by these irregular patients in comparison with eight doses of intralesional steroids of regular patients. Five patients were lost to follow-up.

Can Laser Treatment Cause Keloids

She explained that scar formation is affected by the level of wound trauma, personal genetics, and location of scar. Keloids tend to form in the same location multiple times due to tension; however, Waibel said that the issue could be deeper than what it seems.

Although it is usually used for wrinkles, ablative fraction laser (AFL), according to Waibel, was the laser that changed the treatment world for scars. She says combination treatment is needed when choosing an approach, but the scar type determines the different combination therapies to use.

“The one thing that I almost always do with every scar patient I treat and every keloid patient I treat is laser assisted drug delivery,” Waibel said. She expanded on this, noting that when using a fractional ablative laser, columns open on the skin and these holes are open for about 48 hours. She said, most research suggests a physicians can inject FDA approved medication into a scar. Previously when she treated triplets, Waibel injected 1 of the triplets, resulting in the 1 patient healing 60% better than her other 2 sisters.

When treating hyperpigmentation, Waibel uses 1927 nm laser and AFL for treatment. For hypopigmentation, which she said is tough to treat, she said she can use a multitude of solutions, like a nonAFL (NAFL), AFL, AFL and bimatoprost, and CelluTome (KCI). When she uses bimatoprost, which is FDA approved to treat glaucoma, she injects immediately after the laser treatment then twice a day for a week, which repigments the skin.

For atrophic scars, the dermal depressions occur after a loss of dermal collagen and can represent a reconstruction challenge. Waibel’s solution is AFL with an after topical treatment of poly-L-lactic acid (PLLA) for both deep atrophic and thin skin atrophic scars. She reminds her patients that it does take 3 to 6 months for collagen remodeling.

For post inflammatory erythema (PIE) and post inflammatory hyperpigmentation (PIH), which she stated comes from acne which must be treated first. She treated a patient with a pulse dye laser, and while some inflammation remained, it stopped the spread.

Hypertrophic Scar Laser Treatment Cost

The cost of hypertrophic scar removal treatment in India is variable. Check out the following cost details to make an informed decision that suits your budget:

  • Laser Therapy: Comes at a price range between Rs 7,000 to Rs 20,000 per session.
  • Topical Medications: Priced between Rs 900 to Rs 7000.

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