Efficacy of combining erbium:YAG and fractional CO2 laser for the treatment of facial scarring

Background: Laser intervention is increasingly recognized as an effective approach to preventing scars, however, as lasers of different wavelengths reach different target tissues, an appropriate combination of laser treatment is required. Objectives: To evaluate the efficacy of combining erbium: yttrium aluminium garnet (Er:YAG) 2,940-nm laser and fractional carbon dioxide (CO2) 10,600-nm laser for the treatment of facial scarring. Materials & Methods: Medical records of 39 patients with facial scars were retrospectively reviewed. Treatments initiated within six months post-injury were defined as "early-intervention", whereas those initiated >six months post-injury were defined as "delayed-intervention". Patients' scores on the Vancouver Scar Scale (VSS) and Visual Analogue Scale (VAS) were collected and compared between different timepoints using the paired t-test. Improvement in pigmentation, height, vascularity and pliability was analysed between baseline and after final treatment. Results: Between March 2020 and March 2022, 39 patients underwent dual-laser therapy at our laser clinic. The average number of treatments was 4.69 +/- 1.54; 18 patients in the early-intervention and 21 patients in the delayedintervention group. Facial scars significantly improved after the first treatment in the delayed-intervention group (p< 0.001), however, there was no significant improvement until two sessions were completed in the early-intervention group (p< 0.001). In the delayed-intervention group, improvement in vascularity was insignificant (p = 0.083), however, improvement in height and flexibility was prominent (p< 0.001). In the early-intervention group, facial scars improved in all four dimensions of VSS (p< 0.05), with improvement of vascularity being the most significant. Side effects were self-limited, and complications were not noted. Conclusion: The combination of Er:YAGand fractionalCO(2) laser is a safe and effective therapeutic modality for facial scarring.