Private: Non-ablative Lasers with Corticosteroids

Compare To Other Treatments

Non-ablative (non-skin-removing) lasers work by shining an intense beam of light onto the skin, causing a controlled injury in the dermis (the deep layer of the skin) without ablating (removing) the epidermis (skin surface). Non-ablative laser treatment degrades excess collagen in the scar tissue and reduces the appearance of a raised scar.1

Because non-ablative lasers cause the skin to slowly reshape itself from the inside (from the dermis), the results they achieve are more gradual and moderate compared to ablative lasers, which ablate (remove) the epidermis, but they offer the advantages of a short recovery time and a relatively low risk of side effects.2

Non-ablative lasers can come in one of two forms:

  • Non-fractional lasers, also known as non-fractionated lasers: These older lasers treat the whole skin surface without leaving any gaps. Because an entire section of skin is damaged, healing time is longer than with fractional lasers.
  • Fractional lasers, also known as fractionated lasers: These newer lasers deliver many small pinpoints of laser light in a grid-like pattern so that areas of skin in between the pinpoints are left untouched. Because a smaller portion of the skin is damaged, healing time is shorter than with non-fractional lasers.2

There are different subtypes of lasers, each named after the material used inside the laser device, and your doctor can discuss with you which is better for your particular raised scar(s). Lasers can be created using glass, crystals, or gasses, and the specific material determines the color of the laser light.1-8

The materials in lasers used for non-ablative fractional skin resurfacing include:

  • Nd:YAG (neodymium:yttrium-aluminum-garnet) fractional laser
  • Er:Glass (erbium glass) fractional laser2

Each laser subtype penetrates the skin to a different depth. In general, non-ablative fractional lasers penetrate deep into the dermis.

  • Nd:YAG (neodymium:yttrium-aluminum-garnet) laser: Goes deep into the dermis and reaches the subcutaneous fat
  • Er:Glass (erbium glass) fractional laser: Does not go as deep into the dermis as Nd:YAG (neodymium:yttrium-aluminum-garnet) lasers

Next comes corticosteroid treatment, which involves injecting drugs called corticosteroids directly into the raised scar (intralesionally) or applying them topically on the scar surface.3,4 Corticosteroids are synthetic (made in a laboratory) drugs that may help further reduce scar size by:

  • Stimulating collagen breakdown
  • Decreasing collagen production
  • Decreasing fibroblasts (cells that produce collagen)
  • Reducing inflammation (which is what led to scar formation in the first place)

Summary of non-ablative fractional lasers with corticosteroids for raised scars:

  • How it works: Non-ablative fractional lasers generate controlled damage in the skin dermis, causing the degradation of excess collagen. Corticosteroids further promote the degradation of collagen, decrease the production of collagen and the proliferation of cells that produce collagen, and reduce inflammation.
  • # of treatments: 4-6 treatments at 4-week intervals1,5,6
  • Advantages: Good results with short recovery time
  • Disadvantages: Expensive, requires multiple sessions2

As with all scar revision treatments, non-ablative fractional laser with corticosteroids is sometimes combined with other scar revision procedures to attain the desired results.

Non-ablative fractional laser with corticosteroid treatment cannot be performed when there is an active skin infection or skin condition such as a bacterial infection, eczema, or psoriasis. Ensure your skin is clear before seeking laser resurfacing.1-6

Doctors do not recommend undergoing any laser scar treatment for 6 months after taking oral isotretinoin (Accutane®), because during this time, the skin may respond unpredictably to laser treatment.1,2

Before agreeing to undergo non-ablative fractional laser with corticosteroids, discuss your treatment options, expected outcomes, and treatment prices with multiple doctors.

Procedure details:

Before booking your treatment, your doctor should first schedule a session to discuss the procedure, expected results, and possible complications with you and to answer your questions.

Non-ablative fractional laser with corticosteroid treatment is performed in an outpatient setting. 

During the treatment, your doctor will give you protective eyewear to prevent the laser from damaging your eyes.

First, she will perform the non-ablative fractional laser procedure. In general, non-ablative fractional lasers do not cause major skin damage. How much skin damage any given laser produces can vary significantly depending on different variables. Your doctor will have to fine-tune the laser settings to get the best results while minimizing recovery time and side effects.

Once the settings are dialed in, your doctor may first apply a cooling gel to the skin to enhance the effectiveness of the laser and to protect the skin from burning. However, many non-ablative lasers now incorporate cooling mechanisms, built-in cooling devices, or external cooling systems, to minimize discomfort and protect the surrounding tissues.

Next, she will go several times over your scar with the laser, which can produce mild pain.

About 5 to 10 minutes later, the doctor injects a corticosteroid (usually triamcinolone, although other corticosteroids may also be used) directly into the raised scar. The corticosteroid is injected into the middle of the dermis, the deeper skin layer underneath the raised scar.6 Injecting the drug into the middle of the dermis helps it work best and reduces the chances of skin thinning (atrophy), which can be a side effect of intralesional corticosteroids.

  • Corticosteroids dose: Typical doses of corticosteroids are 10-20 mg/ml, but can be as high as 40 mg/ml for very thick scars. Your doctor must weigh the efficacy of the treatment, which tends to increase with a higher dose, against the risk of side effects, which also increases with a higher dose.7

Topical application of corticosteroids: Alternatively, corticosteroids can also be applied topically to the scar surface 2-3 hours after non-ablative fractional laser treatment in the form of cream or suspension (a liquid form of corticosteroid). Usually, your doctor will give you a corticosteroid and instruct you regarding how and when to use it. Triamcinolone is a commonly used corticosteroid for topical application, however, betamethasone is another common corticosteroid when topical application is used. Both are usually given in a dose of 10-20 mg/ml.6

Anesthesia:

Laser scar treatment can be uncomfortable and even painful. To numb your skin before the procedure, your doctor may:

  • Inject a local anesthetic into your skin before beginning the treatment
  • Apply a topical anesthetic to your skin 30-60 minutes before the treatment
  • Provide you with a topical anesthetic to apply to your skin before you arrive for your treatment6,7

Intralesional injection of corticosteroids can also be painful. In some cases, even if no anesthetic is applied before non-ablative fractional laser, an anesthetic may be mixed with the corticosteroid in the same syringe before being injected.

Before-and-after:

References
  1. Heidari Beigvand H, Razzaghi M, Rostami-Nejad M, Rezaei-Tavirani M, Safari S, Rezaei-Tavirani M, Mansouri V, Heidari MH. Assessment of Laser Effects on Skin Rejuvenation. J Lasers Med Sci. 11(2), 212-9 (2020).
  2. Mattos, R., Jordão, J.M., Signor, K.C., de Souza, L.G. Non-ablative Fractional Lasers for Scars. In: Issa, M., Tamura, B. (eds) Lasers, Lights and Other Technologies. Clinical Approaches and Procedures in Cosmetic Dermatology. Springer, Cham (2017).
  3. Zhou J, Hao F, Huang L, Fu Q, Yuan L, Luo G, Tan J. Treatment of hypertrophic scars with ablative fractional carbon dioxide laser assisted with different topical triamcinolone delivery ways. Heliyon. 9(12), e22818 (2023).
  4. Alexander S, Girisha BS, Sripathi H, Noronha TM, Alva AC. Efficacy of fractional CO2 laser with intralesional steroid compared with intralesional steroid alone in the treatment of keloids and hypertrophic scars. J Cosmet Dermatol. 18(6), 1648-56 (2019).
  5. Cheon JH, Hwang YJ, Yoon ES, Jung KY, Park SH, Chung JH. Effectiveness of a combination therapy using non-ablative fractional laser and intralesional triamcinolone injection for thyroidectomy scar treatment: a prospective, randomized, blinded pilot study. J Cosmet Dermatol. 21(7), 2793-800 (2022).
  6. Guo Q, Xu P, Ye J. Observation on the efficacy of 1565-nm non-ablative fractional laser combined with compound betamethasone topical application on the treatment of early scar in Chinese patients. Lasers Med Sci. 37(7), 2947-53 (2022).
  7. Shin J, Cho JT, Park SI, Jung SN. Combination therapy using non-ablative fractional laser and intralesional triamcinolone injection for hypertrophic scars and keloids treatment. Int Wound J. 16(6), 1450-6 (2019).

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