Scars are an expected outcome of surgery. Many will mature normaly and blend into surrounding skin. However some will remain noticeable and a few will even give rise to symptoms.Laser and high energy technology has recently beceome a tool of choice in dealing with peristent scars that refuse to settle. It is very difficult but not entirely impossible to erase a scar. Much depends on the skill of your plastic surgeon in this area, the branding of the tool or the make of the laser is important, but only a part of the story.

Factors such as genetic and hereditary features, skin type, play a part known as pre-existing risk factors. Other factors which we call acquired include the surgical technique, orientation of the scar, the tension on the edges, and presence of infection, as well as wound care after your operation.On one hand of the spectrum, some scar become, thin, sunken and crepey. These are known as atrophic scars. On the other end of the spectrum some scars become red raised and proud of surrounding skin, called Hypertrophic scars. Some will even start to invade surrounding skin, at which point they are known as keloid.

Scars are definitely not just a question of appearance, actually more often than not they are related to functional issues which affects health. Scars can become itchy and painful. When they are found next to noble organs such as the eyelids, the mouth, the nose and the ears, or even the hands, they can start to contract and distort adjacent structures. This could result in difficulty eating, opening your eyes, breathing through your nose, or even moving your fingers.

Laser treatments can significantly improve the appearance of many surgical scars. Depending on the type of scar, lasers may reduce redness, improve skin texture, soften thick scar tissue, and encourage more balanced collagen remodelling. The goal is not perfection but noticeable improvement in the scar's colour, texture, and overall appearance.We also use a number of terms to describe the more visual elements of the scar. Contour describes how raised or sunken the scar is. Vector describes how the scar is distorting its immediate tissue or surrounding structures. Texture means the way the scar feels or looks. A scar can feel rough or smooth and it can look more matt or glossy than surrounding tisssue. Finally, colour of the scar can be due to reds (blood) browns (pigment) or outside pigments (such as tattoos).

A very experienced practitioner can leverage the way lasers and other high energy devices work, to manipulate scars into settling down, grow up from their sunken depth, or flatten from their raised contour. We can use them to manipulate different parts of the skin to repair themselves, affecting the way and extent the skin reflects light (lustre) or the way they feel (rough and smooth). We can also take out stray blood vessels and remodel pigment into or out of scars.The end result is manipulating the healing process. In sunken scars, certain lasers on certain settings will induce a perceived injury and the body reacts by laying down new tissue. Certain lasers manipulate the excessive blood vessles to a raised scar helping it to flatten. Yet others still break down pigment into tinier pieces that can be cleared by the body.Selecting the most suitable laser is an art and it takes lots of experience to select the optimal laser. For this reason the ideal laser practice will have acces to a wide variety of lasers. Always be a bit careful of the practice with one laser where “if all they have is a hammer, then every problem becomes the same nail”. But even here, much depends on the particular consultant’s experience.

This has changed a lot as our understanding of lasers has sped up and become more mature. Any scar at any age may be improved with laser. However it seems that for most scars, the earlier the treatment the better. All scars are different - and it depends on the type of scar. Some scars are better treated with injections of biologic agents or other modalities such as nanofat. Others will benefit from lasering as soon as the sutures are out.

With the right kit and experience, no laser should be panful, it should be uncomfortable at best. Ways to achieve this are dynamic air cooling, ice packs, local anaesthetic infiltration, and, rarely, oral analgesia.The recovery really depends on the purpose and aim of the procedure. Some lasers will have next to no down time (such as LARAM type procedures), and produce slow and steady improvement that may take a few months to start showing Other types of lasers will be more intense. Ablative lasers may involve from next to no downtime to 14 days of more involved care. A consultation is critical in establishing what to expect from laser and in the days to follow

The number of sessions depends on the scar's age, size, location, and severity. Some patients notice improvement after just one procedure. Others, after only a few treatments, while others require a series of sessions to achieve optimal results. Treatment plans are usually tailored to the individual's needs and expectations.Regular reviews help ensure that progress is monitored and treatment is adjusted when necessary.

A consultant who offers laser treatment should be able to show validated experience and training in this field. The best possible here is for your consultant to show evidence of fellowship-level training which has been accredited by the Specialist Accreditation Council (in the UK). Simply teaching about lasers, or even evidence of some research into lasers, may not be sufificent.

Most patients can expect improvement rather than complete scar removal. Successful treatment often results in a scar that is flatter, softer, less red, and better blended with the surrounding skin. Improvements may continue for several months after treatment as collagen remodelling progresses.In many cases, there may be an initial result, but, and this very much depends on the qulity of laser and the procedure, some, like sublative lasers, LARAM endoscopic procedures and the like, which rely on leveraging wound healing processes, require on average approximately 6 months for the result to mature as a minimum.However, lasers often induce very long term changes in the skin, and results can last a good many years. Lasers are often a long game and not for persons who may wish for a more instant result.Setting realistic expectations is an important part of the treatment journey. It is often important to distinguish what is the medical expected outcome and whether this will likely meet your expectation.

Good scar care remains crucial. Some lasers, especially those that take away skin, so called ablative lasers, require more intensive care, and supervision in the first few weeks. In general, use of simple non perfumed emollients and moisturisers, and attention to good sun protection is important. For more extensive procedures, nutrition and attention to prevent infection play a more important role. The most extensive procedures, usually in the context of larger burns, require hospitalisation and increasing intensity of care, physical therapy and rehabilitation therafter.