Laser Treatment of Scars and Skin of Color

Conclusions

• Laser therapy can improve many scar types, but the best outcomes usually come from combining modalities rather than relying on a single device.
• In skin of color, safer scar treatment generally requires lower fluences, lower densities, fewer passes, more cooling, longer intervals, and careful test-spotting to reduce post-inflammatory hyperpigmentation.
• Erythematous and hypertrophic scars respond well to vascular lasers such as pulsed dye laser, especially when started early and combined with intralesional corticosteroids or 5-fluorouracil when needed.
• Non-ablative fractional lasers, especially 1550-nm systems, are a versatile mainstay for atrophic acne scars, post-inflammatory erythema, and some surgical or burn scars, with multiple sessions often needed.
• Ablative fractional resurfacing can produce stronger scar remodeling and is particularly useful for stable, thicker, traumatic, surgical, or burn scars, but it carries greater downtime and side-effect risk in darker skin.
• Newer focal-point or intradermally focused laser delivery may improve efficacy by targeting deeper dermal injury while minimizing epidermal damage and pigmentary complications.
• Picosecond lasers and high-intensity fractional radiofrequency microneedling are valuable options for scars in patients with skin of color, especially when pigment risk limits more aggressive laser approaches.
• Hyperpigmented scars are often treated with low-energy pigment-targeting or low-power fractional diode/thulium approaches, while hypopigmented scars may benefit from fractional lasers and adjunctive repigmenting strategies.
• Earlier treatment of newer scars tends to yield better results and may reduce the number of sessions required.
• Laser-assisted drug delivery and combination approaches with agents such as triamcinolone, 5-fluorouracil, bimatoprost, or poly-L-lactic acid can further enhance scar outcomes in selected patients.