Medical Lasers; Engineering, Basic Research, and Clinical Application 2017; 6(2): 107-109  
Facial Scars after a Road Accident – Combined Treatment with Pulsed Dye Laser and Picosecond Neodymium:Yttrium-Aluminum-Garnet Laser
Jean S. McGee1, Won Soon Chung2, Hannah Lee3, and Hye Jin Chung4
1Department of Dermatology, Boston University School of Medicine, Boston, MA, USA, 2Yonsei Star Skin & Laser Clinic, Seoul, Korea, 3Lexington Christian Academy, Boston, MA, USA, 4Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
Correspondence to: Hye Jin Chung, Department of Dermatology, Boston University School of Medicine, 609 Albany Street, Boston, MA 02118, USA, Tel.: +1-617-390-6620, Fax: +1-617-638-5575, E-mail: hyejin.chung@bmc.org
Received: November 25, 2017; Revised: December 21, 2017; Accepted: December 21, 2017; Published online: December 30, 2017.
© Korean Society for Laser Medicine and Surgery. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract

A 34-year-old man presented with facial scars one month after a road accident. A physical examination revealed erythematous, minimally hypertrophic scars with bluish brown pigments from traumatic tattoos on the left cheek and left upper cutaneous lip. He was treated with combined laser therapy of a pulsed dye laser (PDL) and picosecond neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. After three sessions of this combined technique, the patient showed significant clinical improvement without side effects. To the best of the authors’ knowledge, this is the first case of traumatic scars after a road accident treated effectively and safely with combination laser therapy of PDL and picosecond Nd:YAG laser, targeting the traumatic scars and tattoos, respectively.

Keywords: Scar, Road accident, Pulsed dye laser, Picosecond, neodymium:yttrium-aluminum-garnet laser
INTRODUCTION

Sustaining injury from a road accident is a common occurrence. However, scars resulting from such injury tend to be challenging to treat due to the complexity of their shapes, depths, and pigmentations. In addition, these scars are often accompanied by traumatic tattoos. Therefore, the most optimal therapeutic approach should be of an individualized, combination laser therapy. Here, we report a successful case of a scar treated with a pulsed dye laser (PDL) and a picosecond laser (PSL).

CASE REPORT

We report the case of a 34-year-old male, who suffered a road accident 1 month prior that resulted in erythematous, minimally hypertrophic scars with bluish brown pigments from traumatic tattoos (Fig. 1A). We performed combination laser therapy using the PDL (Vbeam Perfecta; Syneron-Candela, Wayland, MA, USA) and the 1,064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with the pulse duration of 450 ps (Picoway; Syneron-Candela). We started treatment with Vbeam Perfecta (5.5–5.75 J/cm2, 1.5 ms pulse duration, 10.0-mm spot size) concurrently with Picoway (starting at 1.2 J with 0.4 J increase at each subsequent session, 4.0-mm spot size). After just two treatments in 1 month, there was a significant improvement in erythema and hypertrophy, as well as the appearance of the traumatic tattoos (Fig. 1B). A total of three combination sessions resulted in an excellent cosmetic outcome without any reported side effects or complications (Fig. 1C).

DISCUSION

Traumatic injuries can cause a wide array of scars; they can be erythematous, hypertrophic, atrophic, and/or pigmented. Scars after a road accident have been treated with various lasers. Martins et al. reported a case of traumatic scar successfully treated with combination of PDL and Q-switched (QS) Nd:YAG lasers.1 They started treatment with five sessions of PDL 595 nm (8.0 J/cm2, 1.5 ms pulse duration, 7.0-mm spot size) over a 10-month period. With the improvement of erythema, traumatic tattoos from the encounter with asphalt became more noticeable. Subsequently, they were treated with two session of QS 1,064-nm Nd:YAG laser (4.0 J/cm2, 10 Hz, 3.0-mm spot) over a 6-month period, resulting in complete clearance. In another case report, a facial scar after a road accident was successfully treated with combined therapy of fractional photothermolysis and alexandrite laser.2 Initially, the patient was treated with QS alexandrite laser (6.0 J/cm2, 3.0-mm spot), resulting in significant lightening of the traumatic tattoos. This was followed by three sessions of 1,550-nm erbium:glass laser monthly to achieve overall cosmetic improvement of the scars.

In this patient, the trauma resulted in erythematous and hypertrophic scars, along with traumatic tattoos from the encounter with asphalt. We performed combined treatment with PDL and picosecond Nd:YAG laser. The role of PDL in treating erythematous, hypertrophic scars is well established in literature.3 In addition to treating scar-associated erythema and telangiectasia, the PDL has been shown to reduce scar bulk by selectively destroying the microvasculature of the scar.4 Moreover, it has been shown to improve the scar texture and pliability.5 As for the treatment of traumatic tattoos within scars, both QS Nd:YAG and QS alexandrite lasers have been successfully employed to achieve complete clearance.1,2 These lasers with shorter pulse duration and longer wavelengths can effectively remove small tattoo particles and minimize interaction with epidermal melanin. In 2012, the picosecond laser technology was approved by the US Food and Drug Administration for tattoo removal. Theoretically, PSL with shorter pulse duration should destroy smaller tattoo pigments more effectively than the QS lasers. In clinical practice, PSLs demonstrated superior efficacy over QS lasers for tattoo removal.6,7

Of note, there exists controversy over the use of high power QS lasers for the treatment of scars in the proliferative phase of wound healing, as it can induce superfluous inflammation. In our case, the scar was 1 month old at the start of the treatment. Therefore, it was expected to be at the peak of the maturation and remodeling phase of wound healing. As such, we did not anticipate that our PSL to induce the inflammation. In this report, we demonstrated that traumatic scars can be effectively and safely treated with combination laser therapy of PLD specifically targeting scar erythema, telangiectasia, and bulk and the picosecond Nd:YAG laser targeting traumatic tattoos.

Figures
Fig. 1. (A) Clinical photograph at presentation before treatment. (B) Clinical photograph after 2 sessions of pulsed dye laser and picosecond neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in 1 month. (C) Clinical photograph after 3 sessions of pulsed dye laser and picosecond Nd:YAG laser.
References
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  7. Herd, RM, Alora, MB, Smoller, B, Arndt, KA, and Dover, JS (1999). A clinical and histologic prospective controlled comparative study of the picosecond titanium:sapphire (795 nm) laser versus the Q-switched alexandrite (752 nm) laser for removing tattoo pigment. J Am Acad Dermatol. 40, 603-6.
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