Dr. Jill Waibel offers a multi-course menu of treatments, with the ablative fractional laser as the main course, designed to improve scar color, collagen, and discomfort.
From surgical techniques to silicone adhesives, scar management techniques have been around for years. It’s the addition of the ablative fractional laser that has changed the game, according to Jill Waibel, MD, a dermatologist in Miami, Fla., who discussed her strategic approach to scar management at the virtual meeting of the ASDS 2020.
“The real innovation in scars have been ablative fractional lasers,” says Dr. Waibel. “I tell patients it's like boiling water on the stove with steam coming out. We're literally steaming away scars.”
Add to that the benefit of using the ablative comes from the CO2 or erbium laser for drug delivery, and physicians can achieve an enhanced therapeutic response, she says.
The formation of any scar is affected by multiple factors, including level of trauma, location, and genetics. As a result, the best treatment approaches include a combination of therapies that address color, collagen, and discomfort. Dr. Waibel says she likes to use a specific analogy to explain it to patients.
“I tell patients it's like going out to dinner,” she says. There’s an appetizer, main course, and dessert that together create the ideal scar treatment menu.
The appetizer is determined by scar color. If it’s red, she uses pulse dye laser, intense pulsed light (IPL), or broad band light (BBL).
“If it's atrophic I use a nonablative fractional. If it's hyperpigmented I tend to use a thulium,” she says.
The main course is usually the fractional ablative CO2 or fractional ablative erbium lasers.
For dessert, she chooses from an extensive list of laser-assisted delivery techniques and molecules, from 5-Fluorouracil (5-FU) and poly-l-lactic acid (PLLA) to z-plasties and punch biopsies.
Before choosing the treatment menu, however, physicians need to understand the scar they’re treating.
“The first thing you have to do when treating scars is figure out the etiology. Is it acne, surgical striae, burn, or trauma? And then the physical classification can be atrophic, keloid, hypertrophic, or hypertrophic contracture,” says Dr. Waibel.