Before & After Photos

Introduction

Healing is the inevitable consequence of the Acute Inflammatory Response, once the injurious agent(s) has been removed and necrotic material is demolished.

Healing can take one of three forms:

1. Resolution: occurs when there has been no cell death, involves removal of inflammatory exudate
2. Regeneration of cells occurs after cell death. For this to occur, cells must be able to replicate and the anchoring structure (basement membrane) to be intact
3. Fibrous Repair: the process where a wound is replaced by a scar; involves granulation tissue, cell proliferation, collagen synthesis, scar contracture and scar remodelling.

Complications

There can be numerous complications of wound healing. One complication is the formation of hypertrophic scar or keloid.

• An excessive deposition of extracellular matrix at the wound side results in a hypertrophic scar.
• A keloid is an exuberant scar that tends to progress beyond the side of initial injury and recurs after excision.

  Histopathology

  The dermis is markedly thickened by the presence of collagen bundles with random orientation and abundant cells Biophysiological effects

  • EM examination: Showed that the laser stimulated fibroblasts accumulated collagen fibrils and electron-dense, intracytoplasmic vesicles compared to unstimulated fibroblasts.
  • Increased collagen production: measurements indicated a marked increase in collagen production following laser stimulation
  • Humoral activity: activity levels also increased in untreated areas of the wound. This led to a study designed to discover if a humoral substance is released, which can activate neighbouring areas. It showed that irradiated leucocytes released a substance (interferon) that can affect other cells, at least within a limited area.
  • Increased enzyme activity: laser irradiation can increase the activity of specific enzymes, while it can also increase recapillarisation.
  • Increased cell production: cell reproduction is increased. An increase in the prostaglandin level was also documented.
  • Anti-inflammatory properties • Reduced Fibrous Tissue Formation
  • Repairs and stimulates DNA
  • Reduction or “shut down” of faulty, inflamed microvasculature
  • Neovascularisation: laser’s ability to stimulate the microcirculation is of greatest importance. This also contributes to an increased ability of infected wounds to clean themselves very rapidly, thus leading to correct wound healing.

  Method & Equipment

  1. Unilaser (LLLST): 670 & 830 nm; 140mW
  2. Vasculite Plus (Epilight + Photoderm + 1064 Nd-Yag Laser) Filters range from 515 to 755nm.
  The treatment approach utilises a combination of IPL and LLST. Non-contact IPL (without soothing gel) is the method of choice except in skin types V and VI. Where soothing-gel is applied (room temperature). Usually 4 to 6 passes are performed each session and with different filters (i.e.: 590, 645, 695 or 755nm). Not only is the scar treated, but also the wide area around the scar ( I have noticed increased vasculature 4-5 cm away from the scar) Gentle contact LLLST is administered and each point is treated with 50-100 Joules. Top-up or maintenance therapy is recommended every 6 to 12 months or as soon as acne appears

  Conclusion

  Photolaser Rejuvenation is an exciting approach in the treatment of hypertrophic and keloid scars. Since 1992, we have treated numerous patients with this pathology. Virtually all scars/keloids will respond to this treatment. I strongly recommend early treatment, even prophylactic treatment, in people prone to development of these scars based on past medical or family history. The scar and surrounding tissue should be treated simultaneously with Low Laser Stimulation Therapy (LLST) and Intense Pulsed Light.

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