Treatment of Facial Hypopigmented Scars by the Laser Hole Technique Using a Nonfractional Carbon Dioxide Laser in Asians

Background: Facial hypopigmented scars are usually characterized by white color and a glossy surface. To correct the two problems simultaneously, the authors attempted to induce persistent postinflammatory hyperpigmentation for color and to build multiple pitted scars like facial skin pores for texture. This study describes a laser hole method using a traditional nonfractional carbon dioxide laser for treatment of facial hypopigmented scars and evaluates the clinical results. Methods: Forty-three facial hypopigmented scars in 27 patients were treated, excluding protruding or thick scars. A carbon dioxide laser was set in the superpulse mode by continuous delivery. Multiple small holes were made in the scar at a distance of 1 to 3 mm. Each laser hole was produced by continuously repeated shots at one point until the deep dermis was involved. All lesions were exposed without protection. At 1 or 2 months after initial treatment, the remaining hypopigmentation was treated by the same procedure. Results: Treatment sessions were performed once for nine scars, twice for 22 scars, and three times for 12 scars. In most cases, postinflammatory hyperpigmentation was slightly diminished but maintained until the last follow-up. The fine irregular surface with multiple pitted scars was similar to that of normal skin. Scar improvement evaluation showed marked or excellent in 39 scars (90.7 percent) and minimal or partial in four deep or thick scars. Conclusion: The laser hole technique using a nonfractional carbon dioxide laser may be an excellent option for simultaneously treating the color and texture of superficial or thin hypopigmented facial scars in Asians.