Mitigation of Postsurgical Scars Using Lasers: A Review

Ofir Artzi, MD; Or Friedman, MD, MD; Firas Al-niaimi, MD; Yoram Wolf, MD; Joseph N. Mehrabi, MD


Plast Reconstr Surg Glob Open. 2020;8(4):e2746 

In This Article


The initial database search yielded 124 studies. Twenty-five studies were added from reference lists of reviews and filtered using the inclusion and exclusion criteria specified above.[3,4] One hundred articles were excluded following title and abstract review. Thirty-five studies were excluded following full-text screening. A total of 14 studies remained and discussed in this review (Figure 2).

Figure 2.

Schematic for study selection. CO2, carbon dioxide. Er, erbium.

A summary of the study characteristics is depicted in Table 1. Fourteen studies met the inclusion criteria of attempting to treat postsurgical scars with lasers and assessed the quality of scar healing with a final scar assessment score.[5–18] Nine studies used split scars, 2 used controlled cohorts, 1 used a split body (breasts) comparison, and 2 were prospective pilot studies. A total of 271 scars were treated with 247 matched control scars. The number of patients per study group ranged from 5 to 40 (mean = 18.5). Pulsed dye lasers (PDL), carbon dioxide (CO2) lasers, and diode lasers were the most commonly used devices followed by erbium glass (Er-Glass) and potassium titanyl phosphate (KTP) lasers.

Various protocols were employed; laser treatments were performed 2–10 times at 2- to 10-week intervals. Most study protocols included 3–4 treatments at intervals of 2–4 weeks. For all but one study,[16] the first laser treatment was scheduled after suture removal.

The VSS was used in 8 of the 15 studies. Most of the studies used multiple scales for each objective (physician) and subjective (patient) evaluations of the outcomes of scars. The objective SMD between treatment and control for all cumulative studies was calculated to be 0.777 (95% CI, 0.368–1.186). Statistically significant differences were measured between treated and untreated scars among physicians and patients.

Diode lasers treatment lead to the greatest SMD of 0.624 (95% CI, 0.322–0.925) and CO2 the lowest overall SMD with 0.43 (95% CI, 0.0794–0.780). The SMD for KTP, 2.669 (95% CI, 1.558–3.779), and Er-glass lasers, 0.876 (95% CI, 0.194–1.557), had the best results compared with controls, however, with low weights and a wide CIs. Objectively, the SMD of PDL, 0.45 (95% CI, 0.116–0.784), was similar to that of CO2. These results are shown in Figure 3.

Figure 3.

Graphical depictions of standardized mean differences between treatment and controls among (A) objective results achieved by the studies, (B) objective results achieved by specific devices, and (C) subjective results achieved by specific devices. The box size of each data point depicts the weight of the device, which was deemed dependent on the number of patients treated. The whiskers of each box depict the standard error and thus the 95% CI.

Patients' evaluations reflected the same results, as shown in Figure 3C. The SMD for diode lasers was 0.844 (95% CI, 0.275–1.413). KTP lasers reflected an SMD of 1.868 (95% CI, 0.88–2.848) in a few patients. CO2, with an SMD of 0.353, had statistically insignificant results among patients (95% CI, −0.483 to 1.189).