What lasers/ combination tx are good for treating burn scars?

Take a look at the SmartXide DOT by DEKA . The DOT is the best of both worlds when it comes to fractional CO2 technology. The DOT allows you to selectively decrease the heat to mimic Erbium, but is able to go far deeper into the scar tissue. It is the most versatile CO2 on the market. It would be worth your time to at least check it out.

I have seen the Total Fx , CO2 fractionated. this laser does an exceptional job on treating burn scars. The wavelength makes sense and the technology is proven successful.

I am achieving great results with Erbium fractional lasers.

The Sciton Profractional FX provides amazing results on extensive scarring. I have a friend who is using this laser as well as BBL and she is achieving exceptional results on burn victims.

Don't go CO2. The last thing you want to throw into a scar is heat injury as that can be the nidus for more scarring.

I have got very good results using Contour TRL plus BBL in hypertrophic scars.

Fractional laser is not first choice because the risk of relapse is high. I suggest you consider 585-1064 nm, non ablative, group of 4 irradiations with interval of 20 days between the irradiations.

We have very good results with the combination of Sciton Er YAG then BBL after 3 weeks. So far, so good. Results are promising.

In addition to lasers + cortisone tx, I am also seeing positive results in the use of cryotherapy. If all else fails, try excision + radiation.

Check out a new product called Cryoshape. It is not a laser, rather a probe that was developed for the intralesional delivery of liquid nitrogen to necrose the tissue from the inside out. This product was developed and FDA cleared recently for keloid and hypertrophic scars. A single treatment can reduce scar volume by 92% without recurrence or any associated morbidity of the outlying healthy tissue.

Have you heard of Dermapen?: Dermapen is a microneedling tool that mechanically stamps holes in the skin. Since it is a non-light based modality it produces no heat and can be safely used on any skin type without risk. Even better is it's ability to infuse serums deep into the dermis to achieve better results. A cutting edge, emerging scar treatment is to use Dermapen with a topical PRP solution driven deeply into the scar tissue, up to 2500 microns, to loosen the fibers and stimulate collagen to soften the scars appearance. Dermapen is providing some very impressive results with no complications.

Combination of fractional ablative microplasma (Pixel RF) and fractional erbium is what I would use.

I got outstanding result in reduction of mature hypertrophic scar (almost completely disappeared, hardly visible) after two consecutive treatments with fractional, ablative, microplasma (stationary tip, not roller, 4 weeks apart) followed by one strong treatment (6 weeks after the second fractional RF treatment) with fractional Er:YAG laser, both from same premium manufacturer.

Several recent reports have demonstrated the clinical value of fractional resurfacing lasers (Er:YAG and CO2) and fractional ablative RF technology in atrophic burn scars, with dramatic results observed even in matured scars. That said, the timing of scar treatment may have an impact on clinical outcome. Since nonablative pulsed, or fractionated lasers place minimal mechanical stress on the tissues, earlier treatments may be of benefit. Earlier intervention can in theory alter the inflammatory phase of wound healing and change fibroblast migration, leading to a reduction in the appearance of scars.

I think that you can get good results with either Fractionated Erbium or CO2 but the advantage of Erbium is the ability to get very clean ablation with very minimal coagulation. Not really sure how you could mimic Erbium with CO2 as that wavelength is 10-12 times less efficiently absorbed in water which will always cause a zone of coagulation. Good luck!

Three new laser- and light-based technologies are poised to dramatically alter the reconstructive algorithm and create a quiet (or not so quiet) revolution in the management of burn scars:

-Vascular specific pulsed dye laser (PDL) therapy to reduce hyperemia and hypertrophic scar formation
-Ablative or nonablative fractional and microfractional laser resurfacing to help correct the abnormal texture and pliability of the burn scar
-Intense pulsed light (IPL) therapy to improve burn scar dyschromia and alleviate chronic folliculitis

I got outstanding result in reduction of mature hypertrophic scar (almost completely disappeared, hardly visible) after two consecutive treatments with fractional, ablative, microplasma (stationary tip, not roller, 4 weeks apart) followed by one strong treatment (6 weeks after the second fractional RF treatment) with fractional Er:YAG laser, both from same premium manufacturer.

Combination of fractional ablative microplasma (Pixel RF) and fractional erbium is what I would use.

The treatment mentioned was done on myself four years ago, and results are still perfect.

We are using Lutronic's eCO2 to create deep, low density ablative pattern over scars, than applying injectable triamcinolone topically with excellent results,

What about Cutera's Laser Genesis as a non-ablative option?

The V beam vascular laser for vascular hypertrophic scars followed by the CO2RE fractional CO2 laser gives excellent results. Other adjunctive treatment is endoret PDGF,(platelet derived growth factor), topical steroids and recell technology

@shapero: Cutera's Laser Genesis plays a definite role in our scar revision choices! We often treat indurated, hypertrophic scars with device, wait 10-15 minutes to allow scar to swell, then inject TAC with 30 gauge needle, followed by crush compression of scar. After swelling, intralesional can be delivered almost painlessly with small gauge needle, even flow throughout scar! Really optimizes use of intralesional steroid scar injections. If scar red, will alternate weekly with 532 KTP ExcelV handpiece, or, occasionally, both same day. Series of Genesis sessions alone will soften, flatten many scars, reduce redness.

I agree with ZB. This combo is highly effective. Use of Palomar 1540XF pre-op, Icon MaxG or V-Beam Perfecta post-op virtually eliminates most cosmetically objectionable scarring! Would love to know if others use fractional lasers pre-op?

The PDL laser has best results but it's treatments effect is visible only on patients with new scars ( it is not very effective on old scars ) A combination of Sclero Plus with the Co2 Fractional is the best choice.

We are using Dr. Wabel's technique of applying the steroids topicaly after fractionated laser-- we are seeing excellent results.We use Solta's fraxel repair/restore.

I have no ablative , but the laser genesis definitely shrinks and softens in each treatment.

Just wanted to get an opinion, I am going for this procedure in a month, I had a scar revision done on hypertrophic scars about 5 years ago that are still red. I feel pretty confident with this doctor but still a little nervous because of my past experience with the scar revisions. This is was the dr. recommended:

Total FX Laser for the red scars,
Deep FX to target the blood vessels and get collagen remodeling and then Active FX to blend the edges of the scar with normal tissue

PRP right after the laser to encourage rapid healing and collagen with the growth factors in the PRP

Is it ok to do these together and will either of them make the scarring worse?

Kenacort 10mg + 5-FU is very effective and cheap. + pulsed dye laser og BBL 560 nm.
Needs repeat treatments.
If the scar is hard, it can make it softer and easier to inject to use cryotherapy prior to injection.

I have tried lases (CO2, erbium (both fractional), surgical excision+Aldara etc) but in my experience Kenacort + 5FU is most effective.