Lasers and Burn Scars: An Exciting New Era in Burn Reconstruction
by Pirko Maguina, MD
Five years ago three beautiful young sisters–-triplets, to be precise—caused a stir in the burn survivor community after they appeared on “Today” and “20/20” and shared their courageous story with the world. As toddlers, the Berns triplets had survived a house fire that tragically took their mother’s life. Growing up, all three underwent numerous reconstructive surgeries, which left them with extensive scars throughout their bodies.
In 2008, the sisters underwent treatment for their scars with lasers. The results surprised many—their scars had changed dramatically. None of the scars had disappeared but all three were overjoyed to report marked improvement. Laser technology had evolved to make scars flatter, softer, more elastic, and of more even color.
Their experience was followed by other similar reports. As a result, many medical studies were performed to better understand the effects of lasers on burn scars. These days, laser therapy has evolved to be a key treatment option for burn survivors.
More than 50 different lasers are used in medicine. Of these, 3 types have proven most useful: the fractionated carbon dioxide laser (FCO2), the pulse dye laser (PD), and the hair removal lasers. (There are many of the latter—we use one called “Alexandrite.”)
Fractionated lasers, such as FCO2, treat only a fraction of the scar, “zapping” away thousands of microscopic columns of scar tissue. The scar reacts over time by gradually flattening and softening. Scars that are dark tend to lose some of their pigment and in many cases lighten up to better match the skin around them.
PD lasers target the tiny blood vessels that nourish the scars. These blood vessels are also responsible for making some scars red and it is through them that the chemicals responsible for itching are released. By reducing the blood flow in the scars with the PD laser, many scars gradually appear less red, less swollen, and less itchy.
Hair removal lasers target the dark pigment in the hair follicles (melanin) and can reduce or sometimes even stop hair growth. This is particularly useful for scars that have ingrown hairs. (We mostly see them on men who survive burns and develop ingrown hairs all over their beards.) They also work well for unwanted hair that may result after reconstructive surgery with skin from the scalp. Unfortunately, because they target the dark pigment in the hair follicles, they don’t work well for blondes or people with very light hair color.
Laser treatments are not magic. The changes take months and while scars can improve dramatically, they never disappear. Like all medical procedures, they can have complications such as infections that require antibiotics or even severe eye injuries. (We use special protective goggles to prevent these.) It is important to use the newest equipment as some of the older, outdated lasers caused much more problems and didn’t offer the benefits of the newest technology.
Our team in Sacramento has been treating burn survivors with lasers for about 4 years now. Adults are seen at the University of California Davis Medical Center and children at the pediatric burn unit at Shriners Hospital for Children—Northern California. After several hundred treatment sessions, we are very encouraged by this initial experience. Laser treatments are done as outpatient procedures and typically don’t need anesthesia, instead just numbing creams. Most patients do need several treatments, especially if they have very extensive scars. No, we don’t treat the whole body at once! The results vary—sometimes we are amazed at the marked improvement and other times we don’t see a lot of change. We don’t know yet why some patients respond better than others but we are hoping to find out. It is a very inspiring time for research and the latest equipment has brought amazing innovations!
We now have the option of improving scars (rather than just cutting them out). Lasers are allowing us to treat scars that are years or even decades old. My friend and mentor Matt Donelan, MD, of Shriners Hospital for Children—Boston has worded it best: “Scars have a right to live and get better.”
We are experiencing a new era in burn reconstruction, and it’s exciting!
Dr. Pirko Maguina is a plastic and reconstructive surgeon at Shriners Hospitals for Children—Northern California and the University of California Davis Medical Center.