Scars have historically been difficult to treat and for years patients have suffered because there was no effective, safe treatment for them. Advances in fractional resurfacing technologies have made treating scars a more effective and less painful endeavor. South Florida dermatologist Dr. Jill Waibel has been a pioneer in the efforts to treat scars and worked closely with the Berns triplets - three sisters who were all burned as babies and are now undergoing treatment to reduce the appearance of their scars.
Dr. Waibel says that fractional resurfacing isn't the only tool in her arsenal to treat scars. "I approach each scar like a work of art, so fractional [resurfacing] is always kind of the beginning stages because you're trying to make a thick scar thinner or a thinner scar thicker and a red scar less red and a brown scar less brown - so you have to look at what your goals are with that patient in that location and for that scar. So you might start out with a stronger more powerful, forceful laser and when they come back you look at the before and after pictures and then you might start to finesse it a little bit. I do a lot of surgery, I do z-plasties and excisions in combination so because the burn scars especially are so complicated, it does take a combination approach."
Berns triplets Chandra, Jordan, and Trae
The future of scar treatment is bright as physicians seek ways to not only treat scars, but intervene in their formation. According to Dr. Waibel, "The scar subject is really exciting right now and I really see it going in two different directions - scar prevention - one of the neatest things is a fetus in utero does not form scars, so we know there is a model that exists for no scars. So if I did surgery on you tomorrow and and could do something to it like that baby, so we might have a scarless wound. I'm doing some work right now at University of Miami to try to prevent scars from forming or to fix them immediately so I think there are some real advantages in that arena that we're just starting to get into."
Dr. Waibel also says that there are studies in Europe on lasers designed to interrupt the scar's formation process. She says, "Interestingly enough, this morning Dr. McDaniel's talk about photomodulating scars with LED - that's the first time I've heard that presented where as the scar is forming you would change its shape and what it's doing. So that's exciting and then the work that I've been doing and many colleagues around the world for the last five years is once you have a scar, how do we improve it? So the lasers and especially the fractional lasers have been pivotal for that."
Patients require multiple treatments to see resolution of their scars, and the number of treatments needed varies based on the individual scar's needs. "My average burn patient - and of course there is a spectrum from 1st degree to 3rd too - but the average 3rd degree fairly severe patient is anywhere from 2 - 5 treatments so not too bad really. The ablative fractional lasers have made a big difference. They are a lot more powerful and they ablate tissue and they remove the bad scar in a very organized way so new healthy skin heals in so they have been a great supplement to our artillery that we have to treat scars."
It takes some time to see the final results, so patience in treating scars is important. As Dr. Waibel details, "A lot of our lasers and fillers can give instant gratification, but scars aren't like that.... I tell every patient, give me a year. Collagen remodeling, which right now is what we are thinking is one of the most important mechanisms of action - to build up this new healthy collagen takes anywhere from 3 - 6 months but I've had patients that I have treated one time and they improve for a whole year, so I usually say give me a year and if you look I have several sequences of one month follow-ups you start to really see it around month 3 - 4 and that's doing treatments every 8 weeks or so. And it just gets better from that."