Successful Use of 1064 Nm Nd:YAG in Conjunction With 2790 Nm YSGG Ablative Laser for Traumatic Scarring

Patients with traumatic scarring often seek both aesthetic and functional improvement and can be a challenge to treat; however, advances in laser and light technologies have helped to treat many of these patients with rather minimally invasive approaches.

A nineteen-year-old girl with Fitzpatrick skin type III presented for the evaluation of extensive hypertrophic traumatic scarring involving her right cheek, right chin, and right oral commissure that she sustained after a motor vehicle accident four years prior (Figures 1A and 1B). She was very self-conscious of her scars to the point that she constantly had her face covered with her hair.

The patient underwent six weekly treatments with the 1064 nm (nanometer) Nd:YAG [neodymium-doped yttrium aluminum garnet] (Laser Genesis, Cutera, Brisbane, California) using the following settings: 5 mm (millimeter) spot size, 0.3 msec (millisecond) pulse duration, energy of 18 J/cm² (Joules per centimeter squared) with 2000 pulses delivered to the scarred area at each treatment. One week following the final treatment with the 1064 nm Nd:YAG, the 2790 nm YSGG [yttrium-scandium-gallium-garnet] ablative laser (Pearl Fractional Laser, Cutera, Brisbane, CA) was initiated at the following settings: 280 mJ/cm² (millijoules per centimeter squared), density of 3 (coverage of 12%), and 1300 pulses delivered.A second treatment with the 2790 nm YSGG was performed six months after the first treatment at the following settings: 280 mJ/cm², density of 3 (coverage of 12%), and 1300 pulses delivered.

Our patient reported a notable improvement in the appearance of her traumatic scarring with decrease in contracture of the right oral commissure (Figures 2A and 2B). In addition, the previous hypertrophic areas softened considerably, and the patient felt the texture of her right face improved as well. She felt less self-conscious after the treatments and was very pleased with her results.

Both nonablative and ablative laser therapies have been evidenced in the literature to help treat traumatic scarring. The nonablative microsecond 1064 nm Nd:YAG laser has shown to stimulate new collagen formation in the papillary dermis, improve skin texture, and lessen facial erythema without damage to the epidermis, and younger patients with limited photodamage are believed to incur the greatest improvement from nonablative laser therapies.¹ Histologic evidence has documented a statistically significant reduction in collagen fiber diameter indicating new collagen production.¹ The photothermal stimulation of fibroblasts and vascular endothelial cells is thought to induce cytokines and enzymes that stimulate dermal remodeling as is noted in the normal wound healing process.² This short-pulsed microsecond 1064 nm Nd:YAG laser has also proven effective for facial acne scarring and photorejuvenation without downtime or severe adverse effects.³ For these reasons, the 1064 nm Nd:YAG laser was utilized initially with clear benefits; however, we felt an ablative laser in conjunction would optimize her results.

Unlike traditional ablative lasers that remove the entire epidermal layer and superficial dermis, fractionated laser resurfacing such as the 2790 nm YSGG ablative laser creates minimal disruption of the epidermis with generation of noncontiguous microcolumns of thermal injury (also known as microscopic thermal zones or MTZ) deep into the dermis. The intact surrounding tissue aids in rapid re-epithelialization of the microscopic treated tissue. The efficacy of fractional photothemolysis in scarred skin is thought to be a result of limited dermal heating yielding a cascade of events for optimal collagen remodeling.⁴ The 2790 nm YSGG laser is thought to have finer control of dermal damage in comparison to the CO₂ (10,600 nm) laser while providing greater residual thermal effect than the Er:YAG (erbium-doped yttrium aluminum garnet) (2940 nm) laser, thus optimizing the aesthetic response while minimizing downtime and adverse events. The 2790 nm YSGG has shown to be effective and well-tolerated for