CASE REPORT Fractional photothermolysis for the treatment of surgical scars: A case report DANIEL S. BEHROOZAN 1,2 , LEONARD H. GOLDBERG 1,3 , TIANHONG DAI 4 , ROY G. GERONEMUS 5 & PAUL M. FRIEDMAN 1,6 1 DermSurgery Associates, Houston, TX, USA, 2 Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, 3 Department of Medicine (Dermatology), University of Texas, MD Anderson Cancer Center, Houston, TX, USA, 4 Department of Bioengineering, Rice University, Houston, TX, USA, 5 Laser & Skin Surgery Center of New York, NY, USA, and 6 Department of Dermatology, University of Texas Medical School, Houston, TX, USA Abstract Background. Surgical scars are a challenging condition to treat. Fractional photothermolysis provides a promising new modality for treatment. Case report. A 55-year-old white female patient with a surgical scar on the chin was treated with fractional photothermolysis (1550 nm Fraxel TM SR laser). A single treatment session was performed at pulse energy of 8 mJ (MTZ) and a final density of 2000 MTZ/cm 2 . The treatment response was assessed by comparing pre- and 2-week post-treatment clinical photography. Results. A greater than 75% clinical improvement of scarring was achieved at 2 weeks after a single treatment based on indepen- dent physician assessment. No significant adverse effects were noted. The improvement was persistent at 1-month follow-up. Conclusion. Fractional photothermolysis offers a new, effective, and safe modality for the treatment of surgical scars. Key words: Fractional photothermolysis, Fraxel, scar, laser, surgical Background Hypertrophic scars are a common complication among patients suffering from surgical procedures, traumatic wounds, or burn injuries. They are elevated, firm and erythematous because of the increase in microvasculature (1). Hypertrophic scars are primarily of cosmetic concern, especially on the face; however, some lesions can cause contractures, which may result in loss of function if overlying a joint. They can be both painful and pruritic, and approximately 1.5–4.5% of the general population is affected (2). The mechanism of hypertrophic scar formation is still not completely understood. Abundant collagen accumulation and fibroplasia may result from either excessive synthesis of collagen, fibrin, and proteoglycans or deficient matrix degradation and remodeling (3). The treatment of hypertrophic scars is challenging because of the high recurrence rate and the incidence of side effects associated with treatment (4). The pulsed dye laser at the 585–595 nm wavelength, which relies on the principle of selective photothermolysis (5), is the current standard for treatment of hypertrophic scars (2,6–22). However, clinical studies have shown that complete clearing of erythema and/or thickness of scars is not commonly achieved, and multiple treatment sessions are usually required to obtain optimum clearing (2,8,14,15,17– 22). Moreover, in some cases, hypertrophic scars are poorly responsive to conventional pulsed dye laser irradiation (23). In contrast to selective photothermolysis, which aims to produce bulk thermal injury in particular targets within skin, fractional photothermolysis creates hundreds to thousands of microthermal zones (MTZs) and spares the tissue surrounding each MTZ (24,25). We report the case of a white female patient with scarring of the chin secondary to surgical excision of a basal cell carcinoma who was treated with a single treatment of fractional photo- thermolysis resulting in a greater than 75% clinical improvement based on independent physician assessment of clinical photography. Correspondence: Paul M. Friedman, DermSurgery Associates, 7515 S. Main Street, Suite 210, Houston, TX 77030, USA. Fax: 1 713 791 9927. E-mail: pmfriedman@dermsurgery.org (Received 15 September 2005; accepted 30 November 2005) Journal of Cosmetic and Laser Therapy. 2006; 8: 35–38 ISSN 1476-4172 print/ISSN 1476-4180 online # 2006 Taylor & Francis DOI: 10.1080/14764170600607251