Treatment of Atrophic Scars with Fractionated CO₂ Laser Facilitating Delivery of Topically Applied Poly- L-lactic Acid

AUTHORS: Ali Rkein, MD¹, David Ozog, MD¹; Jill S. Waibel, MD²

RESEARCH SITES: ¹Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA; ²Miami Dermatology and Laser Institute, Miami, FL, USA

PUBLICATION: Dermatologic Surgery Vol. 40 No. 6, pp. 624-631

YEAR: 2014

BACKGROUND: Atrophic scars represent a loss of collagen and a challenging reconstructive dilemma with disappointing traditional treatments.

OBJECTIVE: To study the safety and efficacy of the treatment of atrophic scars using an ablative fractionated CO2 laser and topical poly-L-lactic acid (PLLA) immediately after to improve atrophic scars.

MATERIALS AND METHODS: This was an uncontrolled, institutional review board-approved, prospective study evaluating the treatment of atrophic scars. Four blinded dermatologists evaluated a total of 20 photographs taken at baseline and 3 months after the laser and PLLA treatments using the Modified Manchester Scar Scale. Four criteria were evaluated: (1) overall improvement, (2) improvement in scar atrophy, (3) improvement in scar color/dyschromia mismatch, and (4) improvement in scar contour.

RESULTS: All 4 observers accurately identified 76 of the 80 “before” and “after” photographs. Therefore, the blinded evaluating physicians agreed that at the 3-month follow-up visit, 95% of the scars had improved. Each criterion demonstrated an average improvement of at least 33%.

CONCLUSION: The combination of using an ablative fractional CO2 laser and PLLA in the treatment of atrophic scars has a synergistic effect on their inherent properties in up-regulating new collagen synthesis to improve atrophic scars.