Multi-Modal Laser Combination Therapy of Pigmented Scars: A Case Series of 30 Patients

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Background and Objectives: This study reports an adaptive experience of pigmented scar treatment management with different characteristics. It is complicated to define a single solution for all the patients. For this reason, we report a multi-modal approach combining CO 2 laser, Q-switched lasers (QSL), and dye laser to adapt to every different patient clinical situation. Materials and Methods: Thirty patients were enrolled to treat pigmented scars. Twenty patients presented scars with exogenous pigment (such as traumatic tattoos) and 10 with endogenous pigment (hyperpigmentation cases). A combination of CO 2 laser, QSL, and dye laser was used. The number of treatment sessions performed for each laser, or their combination was as follow: For keloid scars from tattoo: 1–4 combined treatment sessions with QS and dye lasers; 3–4 combined treatment sessions with dye and CO 2 laser;1–4 treatment sessions with QS followed by dye laser; for asphalt traumatic tattoo: 2–3 treatment sessions with QS; for surgical hypertrophic scars: 2–3 combined treatment sessions of QS and CO 2 laser; for burn scars (due to asphalt contact) and hyperpigmentation: one treatment session with QS followed by CO 2 laser. Six months after the final treatment, the patient’s scar improvement was evaluated compared with baseline (T0) using a five-point Global Aesthetic Improvement Scale (GAIS). Results: Regardless of the type of lesion and treatment, the whole population of the study showed satisfactory clinical results. The GAIS mean value was 3.3 ± 0.6. Specifically, 47% of the patients reported good results while 43% had excellent ones. No serious side effects were observed. Conclusions: Our results suggest that a combination of CO 2 , dye, and Nd:YAG lasers is a feasible strategy for treating scars, reducing the pigmentary, fibrotic, and vascular components.

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