A Non-Ablative Fractional Laser (NAFL) is a non-wounding laser, it does not damage the integrity of your epidermis. NAFL uses a wavelength that does not evaporate the water in the tissue, and the energy from the laser heats the tissue in a controlled manner. Therefore, many patients prefer NAFL to ablative laser treatment. The rise in temperature stimulates the production of new collagen. By producing new collagen, the remodelling of the scar tissue is improved. Although NAFL is less invasive, requires less recovery time and has less complication risks, is not as effective as ablative laser resurfacing.
The Ablative Fractional Laser (AFL) is a wounding laser, which delivers micro fractional columns of laser light to the top layers of the skin. This treatment works by creating thousands of microscopic areas, through heat, where the top layer of the skin is ablated (removed). These tiny areas of damage are surrounded by untreated skin, this allows healing of the skin. Traditional ablative laser resurfacing can take on average up to three weeks to heal. Types of ablative treatments include the carbon dioxide (CO2) laser and the erbium laser. AFL is performed under local anaesthesia.
Intense Pulsed Light (IPL) is not the same as a laser. IPL releases pulses of energy through light in a broad wavelength range which produces heat on the skin. A laser projects energy in a very narrow wavelength range which is more focused and therefore produces bleeding (purpura). Thanks to the broad wavelength range, IPL gives less focused heat which reduces the amount of bleeding. The light targets haemoglobin in red blood cells which aims to close the local vessels and reduce the blood supply to the growth of the scar tissue.
Annually, 200 million incisions (surgical cuts) are performed worldwide. The treatment of aesthetically unacceptable scars can be challenging, although several options are available. These options vary from non-invasive options to invasive scar revision. As there are lots of options along this spectrum it is important that you seek advice for your specific concerns from a surgeon specialised in scar.
Patients often see a plastic surgeon once they have tried lots of other non-invasive options. However, sometimes there are non-invasive options that could be more appropriate than surgery; again, an assessment by your scar specialist is important.
While various surgical options exist, all surgery carries risk and therefore a full assessment is important so that you can let the surgeon know what your concerns are. The surgeon can explain all the possible procedures, the pros and cons of each one and what can or can’t be achieved with surgery. Sometimes more than one surgery will be needed and follow up after surgery is also important.
The healing of cutaneous wounds after surgery is the result of a cascade of complex biochemical events that can be categorized into four overlapping phases: haemostasis, inflammation, proliferation, and remodelling. All these phases of wound healing are influenced by both intrinsic and extrinsic (inside and outside) mechanical forces which effect the tension in the skin. Evidence shows that extracellular matrix remodelling can be upset by these forces. For example, wounds over or near joints may be more likely to develop hypertrophic scars because of joint movements causing repeated tension on the wound, leading to abnormal scarring.
