Is Laser Keloid Scar Removal Ideal For You?

Laser keloid scar removal treatment is often sought by patients in Singapore. After all, laser treatments are frequently recommended by many doctors in Singapore for medical aesthetics conditions such as pigmentation, pores, acne, scarring, and even skin rejuvenation. So patients expect that laser treatment will do wonders for their keloid scars. Can laser keloid scar removal produce the miraculous results promised?

Why Laser Keloid Removal?

Lasers are often advertised as cutting-edge technology. In contrast to injectibles, no chemicals are introduced into the body. Thus lasers carry little risk of medication side effects. Unlike keloid scar removal surgery, they are non-invasive and hence have less risk of aggravating the keloid.

The effectiveness of lasers for keloid scar removal ultimately depends on the type of laser used. Lasers exert their effects on us depending on variables such as wavelength, pulse duration, intensity, and power. Many types of lasers have been trialled for keloid scar removal with varying degrees of efficacy.

Lasers Used For Keloid Scar Removal

Ablative Lasers

The most basic method of using lasers to treat keloid scars involves using ablative lasers to vaporize the keloid. Laser wavelengths that are strongly absorbed by the water in human cells are ideal for this purpose. Examples of such lasers include Erbium-YAG and carbon dioxide (CO2) lasers.

Laser keloid ablation can be very gratifying as the entire bulk of the keloid can be removed quickly and immediately. However, while the keloid may look like it is gone, the welcome sight of a keloid-less skin surface often doesn't last long.

Although the entire keloid may be gone, the large raw surface produced by vaporizing the keloid often takes a long time to heal. The resultant inflammation is a massive stimulant to keloid regrowth.

Hence, keloid scar removal using ablative lasers often results in keloid recurrence. Furthermore, it is not uncommon for the keloid to grow back even larger, particularly if keloid-suppressing injections were not strictly instituted during the peri-orbital and postoperative period.

In my opinion, keloid scar removal with ablative lasers should be used exceptionally carefully in very select cases where the nature of the keloid is particularly suitable. Otherwise, it should be avoided as it risks worsening the keloid. Keloid scar removal surgery typically produces better results for most keloids.

Vascular Lasers

Vascular lasers use light energy that is selectively absorbed by the blood in blood vessels feeding keloids. As they have long pulse lengths, heat is generated in the blood causing damage to the blood vessels which are then reabsorbed. Thus, the blood supply to the keloids is reduced, resulting in a reduction in size and activity. Moreover, vascular lasers may also produce an anti-inflammatory effect within keloids. Examples of vascular lasers include pulsed dye lasers (PDLs), long pulse NdYAG or diode (e.g. 980nm or 940nm) lasers, yellow lasers, and gold lasers.

Unlike ablative lasers that vaporize cells more indiscriminately, vascular lasers produce far less collateral damage. Hence, they carry less risk of aggravating the keloid scar. However, over-aggressive settings can still produce excessive skin damage that can worsen the keloid. Even conservative settings may produce some stimulation in certain more sensitive keloids, so they are best combined with keloid injectibles to suppress keloid growth.

Another drawback of vascular lasers is their limited penetration. Vascular lasers can only penetrate about 1-3mm into the skin. Thus the deeper parts of raised keloids may not be affected by vascular lasers. This usually necessitates multiple laser sessions.

Even with multiple sessions of vascular laser keloid scar removal treatments, keloids with a mature core may not respond. Thus it is important to identify such keloids during the consultation, as these are usually best treated with keloid scar removal surgery.

Overall, vascular lasers are a great complement to injections in non-surgical keloid treatment. They can also be very useful after keloid scar removal surgery where there are visible blood vessels or persistent redness, to hasten maturation of the keloid.

Fractional Lasers

Fractional lasers damage a fraction of the skin. This disrupts the skin's barrier function allowing deeper and better penetration of topical medication. Fractional lasers have been explored as a means of delivering keloid medications into the skin without actually injecting them into the keloid. The advantages of using fractional lasers instead of an actual injection are a reduction in injection-related pain, increased scar pliability, and reduced side effects.

However, fractional laser-assisted drug delivery is still poorer than direct injection in terms of the depth and amount of drug delivered. It also increases treatment costs since a laser is much more expensive than a simple syringe. Moreover, there is certainly relatively more trauma to the keloid than a simple injection, increasing the chance of keloid growth.

Q-Switched Laser Toning

Q-switched Nd:YAG lasers are very widely available in Singapore medical aesthetics clinics, where they are more commonly used for pigmentation removal, tattoo removal, or light skin rejuvenation. It is not very commonly used for keloid scar removal, however, a few studies have shown a positive result in this regard. Even though the research evidence is scant, it is likely that using such lasers in keloid scar removal is low-risk. The main issue is that such treatment protocols usually require very frequent low-intensity laser treatments, and the overall improvement in keloid scars can be very slow and minor.

However, since such lasers are relatively accessible, you may encounter them being suggested for keloid scar removal.

My Approach To Laser Keloid Scar Removal

Lasers have certain advantages over keloid scar removal surgery or injections. However, my view is that laser keloid scar removal is not a replacement for surgery or injections but can be a good adjunct to them. Situations in which laser keloid scar removal can be invaluable include:

• very sensitive or large surface area keloids that are too painful for any keloid injections - consider fractional laser-assisted drug delivery and q-switched laser toning
• in combination with injections as part of a non-surgical approach - consider vascular lasers
• keloids that are persistently red or have significant blood vessels associated with them - consider targeted and gentle vascular lasers

However, it is best to steer clear of over-aggressive laser treatment of keloids such as laser vaporization, as this has a high risk of aggravating the keloid. Avoid indiscriminate usage of lasers for keloid removal in the mistaken belief that lasers are far superior to other modalities. The truth is that they are not. Lasers are best used as part of a holistic plan for keloid scar removal.

If you have a keloid for which you're considering laser keloid scar removal, please feel free to schedule a consultation. I'll be happy to evaluate your case in detail and recommend a suitable course of action.

References

1. Mamalis, A. D., Lev-Tov, H., Nguyen, D. H., & Jagdeo, J. R. (2014). Laser and light-based treatment of Keloids--a review. Journal of the European Academy of Dermatology and Venereology : JEADV, 28(6), 689–699. https://doi.org/10.1111/jdv.12253
2. Ali, F. R., Forbat, E., & Al-Niaimi, F. (2017). Laser Treatment of Keloid Scars. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 43(2), 318. https://doi.org/10.1097/DSS.0000000000000995
3. Garg, G. A., Sao, P. P., & Khopkar, U. S. (2011). Effect of carbon dioxide laser ablation followed by intralesional steroids on keloids. Journal of cutaneous and aesthetic surgery, 4(1), 2–6. https://doi.org/10.4103/0974-2077.79176
4. Abd El-Dayem, D. H., Nada, H. A., Hanafy, N. S., & Elsaie, M. L. (2021). Laser-assisted topical steroid application versus steroid injection for treating keloids: A split side study. Journal of cosmetic dermatology, 20(1), 138–142. https://doi.org/10.1111/jocd.13521
5. Cho, S. B., Lee, J. H., Lee, S. H., Lee, S. J., Bang, D., & Oh, S. H. (2010). Efficacy and safety of 1064-nm Q-switched Nd:YAG laser with low fluence for keloids and hypertrophic scars. Journal of the European Academy of Dermatology and Venereology : JEADV, 24(9), 1070–1074. https://doi.org/10.1111/j.1468-3083.2010.03593.x