After a decade of military conflict, thousands of wounded warriors have suffered debilitating
and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for
effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of
these patients. Traditional treatments, including aggressive physical and occupational
therapy and dedicated wound care, are essential. Adjunctive treatments with established
laser technologies, such as vascular lasers and full-field ablative lasers, have had a
somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable
side effect profile in compromised skin. Refractory scar contractures often require surgical
revision, which can be effective, but is associated with additional surgical morbidity and a
significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate
scar maturation for approximately a year to allow for spontaneous improvement before
surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San
Diego has been treating scars and scar contractures in wounded warriors and others using
ablative fractionated laser technology. Although traditionally associated with the rejuvenation
of aged and photo-damaged skin, our clinical experience and a handful of early reports
indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an
excellent side effect profile when applied to the functional and cosmetic enhancement of
traumatic scars and contractures. This article discusses our clinical experience with
ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic
injuries, including a possible shift in scar treatment paradigms toward earlier procedural
intervention. Potential benefits include the optimization of scar trajectory and higher
levels of full or adapted function in a more favorable time course.
Semin Cutan Med Surg 31:110-120 © 2012 Published by Elsevier Inc.
Transient adverse events, such as mild injection pain, are typically minor and spontaneously remitting. Headache, nausea and flu-like symptoms, lid and brow ptosis after upper face injection, lower face asymmetry after perioral injection, and fine motor impairment after palmar injection are uncommon to rare.
The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
Semin Cutan Med Surg 31:105-109 © 2012 Elsevier Inc. All rights reserved.
Historically, the approach to body contouring has largely involved invasive procedures,
such as liposuction. Recently, several new devices for noninvasive fat removal have
received clearance by the Food and Drug Administration for the treatment of focal adiposity.
Modalities are aimed primarily at targeting the physical properties of fat that differentiate
it from the overlying epidermis and dermis, thus selectively resulting in removal. This
review will focus on 3 novel approaches to noninvasive selective destruction of fat.
Semin Cutan Med Surg 31:121-125 © 2012 Published by Elsevier Inc.