By Janette Daher
Photography by Jamie Kripke
Scars may indicate where we have been, but they need not impact where we’re headed. Thanks to trailblazing doctors and fractional ablative laser techniques, it’s a new dawn for those living traumatic scarring.
February 10, 2008 is a day that Lari Pierce will never forget. Pierce, a police officer and part-time fitness trainer, had always been in great physical condition. She’s the mother of four young adult sons—three in college, one still at home—and was making dinner when a grease fire exploded in her kitchen. The fire spread to her left arm, bringing her body down on top of the blazing stovetop. She awoke from a medically induced coma, with burns covering 53 percent of her body. Her first time looking in the mirror was nothing short of traumatic. “The only thing that was familiar to me were my eyes,” Pierce recalls.
Although scars resulting from acne, surgery, burns, or an injury can rock you to your core, there is always hope; more hope now than ever before. All of these scars—big and small, cosmetic or traumatic—can be dramatically improved with revolutionary new treatments using fractional ablative resurfacing. These innovative treatments serve dual purposes— improving the appearance and function of scarred skin and mollifying the sufferer’s social discomfort by offering an exciting new vision for the future.
Scars are often a perpetual reminder of a traumatic or negative event. People commonly feel self-conscious about their disfigurement, avoiding activities that reveal their injured body for fear of rejection. Those with particularly unsightly scars often fall into isolation and depression—a Pandora’s Box of issues that compound the trauma of the initial scarring event. This emotional factor can be equally, if not more, disabling than the physical pain. (Of course, physical pain and dysfunction can be similarly associated with scars, depending on the nature of the injury.) Scars can restrict the skin’s movement as well as the muscles, tendons, and ligaments that lie beneath the affected area. Scars tend to burn or itch. In the case of scars covering large areas, they are just painful.
For Pierce, the worse part was the isolation and emotional turmoil that resulted from her injuries. “I didn’t go anywhere because I looked scary, and people would stop and stare,” she says. “I was feeling very depressed, and I thought that if my scars weren’t so obvious, I would feel better.”
Dermatologist and Mohs surgeon Dr. Joel Cohen finds that men and women alike are deeply affected by scarring, and frequently pursue scar revision following cancer surgery. “Many of my scar revision patients are male—PhDs and lawyers who do not want to explain the scars on their face.”
Erin DeGraff was very apprehensive about her own Mohs surgery (chemosurgery). Her sister had noticed a white spot on her forehead, and this prompted her to see Dr. Cohen, who discovered a melanoma. “I was nervous about the cancer, but also scared that there would be a huge scar marking the area on my forehead,” says Erin, a front-office liaison for a professional sports team who interacts with athletes and VIPs on a daily basis. “I was very self-conscious about it but Dr. Cohen reassured me that with a little time and a short series of laser treatments, he could make the scar barely noticeable. I noticed a significant change after the first treatment, and I am overjoyed with my result. You can barely see where the scar once was, even without makeup.”
Scars naturally form as skin heals after injury, accident, or surgery. The extent of scarring depends on the location, depth, and size of a wound, as well as a person’s age, skin color, propensity to scar, and genetics. Whether scars are an unwanted result of cosmetic surgery or the after effect of traumatic injury, their treatment is always a complicated and delicate process. Until recently, treatment has yielded less than desirable results. Scar treatment has historically required a collaboration between many specialists—surgeons, dermatologists, psychiatrists, and physical or occupational therapists. A litany of medications, topical dressings, topical steroids, and specialized surgeries traditionally came with the territory. At the end of the day, these approaches had little ability to improve the natural appearance and functionality of the skin. “Treating scars takes a village,” says Miami dermatologist and scar expert Jill Waibel. “We work with a team of doctors and therapists over time to restore the skin to normal as best we can.”
Dr. Waibel has treated over 10,000 burns and traumatic scars, and was one of the first medical professionals to use fractional ablative lasers in the treatment of severe burn scars. She was instrumental in designing the SCAAR FX mode by Lumenis, designed specifically to treat scars. “Fractional ablative resurfacing is an adjunctive therapy to traditional scar treatment, but from what we have seen, it performs magic in reducing not only the appearance of scars, but also their composition and improved elasticity of the affected area.”
Pierce sought out Dr. Waibel’s services after reading a magazine article about burn scar treatments she had provided to triplets who had been badly burned in a house fire. “I saw the amazing photos of the results, and read about how the treatment changed their lives,” Pierce says. “I knew that this was something I needed to pursue.” Despite Pierce’s injuries and physical limitations, she optimistically made the trek from Wichita, Kansas to Miami, Florida to see Dr. Waibel. “Dr. Waibel generously entered me in one of her clinical trials, so I was able to receive the treatments at no charge, because insurance doesn’t cover it,” recalls Pierce. “I feel so much better about how I look now. Dr. Waibel is a godsend.”
“Fractional ablative resurfacing is an adjunctive therapy to traditional scar treatment, but from what we have seen, it performs magic.”
Fractional ablative lasers treat skin by vaporizing microscopic columns of skin tissue while leaving the surrounding skin intact—similar to the way one would aerate a lawn. In essence, the doctor is administering a “controlled injury” to an area that is already burned or scarred. “The laser creates a type of burn that the body has never seen before,” says Naval dermatologist Nathan Uebelhoer. “Fractional ablative lasers allow us to drill very thin cylinders deep into the skin, without triggering the body’s scarring response. This drilling immediately creates a mechanical change—making the skin more pliable— as well as a physical change that induces the production of new collagen.”
Scar tissue behaves differently than normal skin. There is more pigment, making it darker than normal, as well as an imbalance in the ratio of two types of collagen found in skin. The type of collagen found in scars gives them their thickened, stiff, and shiny appearance. The healing process following a fractional ablative treatment results in the formation of healthy collagen, changing the scar architecture to normal skin architecture, bringing the collagen ratio back into balance.
Fractional lasers have been used for cosmetic enhancement for over seven years, with stunning results. These devices have revolutionized laser resurfacing by minimizing down time while maximizing facial rejuvenation. Doctors Waibel, Uebelhoer, and Dr. Peter Shumaker of the US Navy quickly recognized the benefit of fractional ablative lasers in the cosmetic improvement of scars, but improvements in range of motion and mobility were unexpected. There are two types of fractional lasers—erbium and CO2. The consensus among our experts is that for the treatment of cosmetic or surgical scars, these types can be used interchangeably. “We are finding that range of motion responds in as little as three to five treatments, at two-month intervals,” comments Shumaker. “We have seen some of our wounded soldiers respond in as little as one treatment. In terms of texture and pigment, it can take as many as fifteen treatments for an optimal result.”
There is no statute of limitations between the date of injury and the date of treatment. “We have treated patients as soon as three months and as long as thirty years after injury, with positive results,” continues Dr. Shumaker. This is significant for those who have scars that occurred before the technology was available. All of our experts attest that although it cannot take the place of surgical scar revision, fractional ablative treatments can be used before, at the same time, and following surgery to improve outcomes for traumatic scars. Treatment is adaptable to any body area and any skin color. “We can safely treat all skin types, from face to toes,” Shumaker remarks.
There is no statute of limitations between the date of injury and the date of treatment. “We have treated patients as soon as three months and as long as thirty years after injury, with positive results,” continues Dr. Shumaker. This is significant for those who have scars that occurred before the technology was available. All of our experts attest that although it cannot take the place of surgical scar revision, fractional ablative treatments can be used before, at the same time, and following surgery to improve outcomes for traumatic scars. Treatment is adaptable to any body area and any skin color. “We can safely treat all skin types, from face to toes,” Shumaker remarks.Doctors Uebelhoer and Shumaker have treated many injured soldiers with burns and blast injuries. The results of improved skin function and range of motion allow them to return to active duty, despite missing fingers. “The ability to turn a key or reach into your pocket may seem trivial, but for those who struggle to bring their fingers together to grasp objects, this is huge,” says Dr. Uebelhoer.
When it comes to surgical scars, Dr. Cohen uses a variety of laser devices but prefers the Sciton Profractional, post-Mohs surgery. “We begin to treat the scar six to eight weeks postsuture removal for the best result,” Cohen says. “On average, we see drastic improvement after four to five treatments. With the technology available today, patients no longer have to live with the stigma of a physical scar.”
All four of these trailblazing physicians conduct frequent studies to further the advancement of scar treatments. All would like to see fractional ablative laser treatment become the standard of care for all scarred patients. Some of their research involves the delivery of topical medications via pathways through affected skin, made possible by fractional ablative lasers. Dr. Waibel is currently working in conjunction with the University of Miami studying the uses of stem cells and fractional ablative laser technology in treatment of third degree burns created on pigskin.
In their efforts to bring this treatment to the mainstream, these scar experts have hosted joint symposiums to expose physicians to the functionality and mobility benefits of laser scar treatment. Dr. Shumaker had the recent opportunity to share this knowledge at the National Institute of Burns in Hanoi, Vietnam. The USNS Mercy, a naval hospital ship, had fractional ablative lasers on board as part of a humanitarian mission in Southeast Asia this year, and many patients in rural areas were treated for traumatic scars.
We all know someone with a scar of some sort—whether it resulted from acne, surgery, trauma, or burns. Fractional ablative treatment can mean the difference between disability and employment, self-esteem and deep depression. More than an issue of science, it’s an issue of emotional health, and these new techniques—administered by caring doctors—can turn something traumatic into something transcendent.
