Comparison of the Scar Prevention Effect Between a Carbon Dioxide Fractional Laser and a Continuous Ablative Carbon Dioxide Laser with a 595-nm Nd:YAG Laser

Abstract

Purpose

A linear surgical scar, when located in the head and neck region, can be a significant cosmetic concern. Laser skin resurfacing with a fractional laser and a pulsed dye laser has been proven to be useful for treating such scars. As alternatives, we used a classic ablative CO₂ laser in continuous mode with a 1-mm spot size and a 595-nm Nd:YAG laser. We investigated the effect of the combination of the continuous CO₂ laser and 595-nm Nd:YAG laser and compared it to the effect of fractional CO₂ laser monotherapy on linear scars.

Methods

This was a retrospective, case-controlled study designed to compare the efficacy between fractional CO₂ laser therapy and combination therapy with a conventional CO₂ laser in continuous mode and a 595-nm Nd:YAG laser. Treatment efficacy was evaluated by two different scar scales: the Stony Brook Scar Evaluation Scale (SBSES) and the modified Vancouver Scar Scale (mVSS). Laser treatments were performed every month until the 6th month after surgery.

Results

The SBSES and mVSS scores improved over time in both the monotherapy and the combination therapy (P < 0.001). No significant differences were found between the therapies for all the subcategories of the SBSES. However, among all the subcategories of the mVSS, pigmentation showed a better prognosis with combination therapy (P = 0.04).

Conclusion

Monotherapy and combination therapy can provide similar positive effects on linear scar improvement after repeated treatment, whereas combination therapy exerts more favorable anti-pigmentation effects than monotherapy. The combination of a continuous ablative CO₂ laser with a 595-nm Nd:YAG laser can be used as a favorable alternative to a fractional CO₂ laser. The 1-mm spot size of the CO₂ laser beam may mimic the fractional laser form and offer more effective results for linear incision scars.

Level of Evidence III

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