Stacked pulse technology enables fractional CO2 laser systems to treat mature hypertrophic scars by delivering multiple sequential energy pulses to a single ablation site. This technique significantly increases the vertical depth of the laser channel—potentially reaching up to 6mm—without expanding the zone of thermal damage horizontally, ensuring deep tissue remodeling without unnecessary surface injury.
Core Insight: The primary advantage of stacked pulses is the decoupling of penetration depth from spot size. It allows clinicians to "drill" down to deep-seated collagen networks in thick scars while preserving the surrounding healthy tissue essential for rapid healing.
The Mechanics of Stacked Pulse Technology
Sequential Energy Delivery
Standard laser applications often utilize a single pulse of energy per microscopic zone.
Stacked pulse technology changes this paradigm by firing multiple, rapid pulses into the exact same microscopic channel. This cumulative delivery concentrates energy vertically rather than spreading it across the skin's surface.
Maximizing Depth Without Lateral Damage
The defining feature of this technology is its ability to increase the depth of the laser channel without widening the "horizontal thermal damage zone."
If a clinician attempted to reach the same depth with a single, high-power pulse, the heat would likely dissipate outward, causing excessive collateral damage to the epidermis. Stacking pulses allows for deep penetration while keeping the surface footprint, or Micro-Thermal Zone (MTZ), distinct and contained.
Targeting Deep Hypertrophic Tissue
Reaching the Source of the Scar
Mature hypertrophic scars are characterized by thick, disorganized fibrous tissue that can extend deep into the dermis.
References indicate that stacked pulse technology allows the laser to penetrate up to 6mm into the dermal tissue. This depth is critical for accessing the root of the scar, which superficial treatments often fail to reach.
Remodeling Collagen Networks
The goal of deep penetration is not just ablation, but the stimulation of remodeling.
By creating these deep vertical columns, the laser disrupts the disorganized collagen bundles responsible for the scar's stiffness and height. This mechanical and thermal disruption triggers the skin's repair mechanisms, inducing the deposition of new, organized collagen and "softening" the fibrous tissue.
The Critical Balance: Precision vs. Safety
Preserving the Biological Reservoir
The safety of fractional CO2 lasers relies on leaving bridges of healthy, untreated tissue between the laser channels.
Stacked pulses respect this principle by maintaining a narrow ablation column. Because the lateral (side-to-side) damage is minimized, the surrounding healthy tissue remains intact to act as a "biological reservoir," facilitating rapid re-epithelialization and healing despite the significant depth of the treatment.
Reducing Physical Tension
Beyond thermal effects, the creation of densely arranged micro-holes mechanically reduces the physical tension within the scar.
By physically removing microscopic columns of rigid tissue, the laser immediately reduces the tightness of the scar. This release of tension, combined with subsequent collagen remodeling, leads to a flatter, more flexible skin texture.
Making the Right Choice for Your Goal
When evaluating laser protocols for scar revision, consider how stacked pulse capabilities align with your specific clinical objectives.
- If your primary focus is Reducing Scar Thickness: Prioritize stacked pulse settings to penetrate dense fibrous tissue up to 6mm, directly targeting the deep collagen networks responsible for elevation.
- If your primary focus is Minimizing Recovery Time: Rely on the stacked pulse's ability to limit horizontal thermal damage, ensuring that the surrounding healthy skin is preserved to accelerate wound healing.
Summary: Stacked pulse technology transforms the fractional CO2 laser from a surface-level resurfacing tool into a deep-tissue remodeling device capable of flattening thick scars through precise, vertical energy delivery.
Summary Table:
| Feature | Single Pulse Technology | Stacked Pulse Technology |
|---|---|---|
| Penetration Depth | Shallow to Moderate | Deep (Up to 6mm) |
| Lateral Thermal Damage | Increases with energy | Minimal/Contained |
| Scars Targeted | Superficial/Atrophic | Mature Hypertrophic/Thick |
| Healing Reservoir | Variable | Maximized (Preserves healthy tissue) |
| Primary Benefit | Surface Resurfacing | Deep Collagen Remodeling |
Elevate Your Clinic's Scar Treatment Results with BELIS
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References
- Molly E. Baumann, Heather M. Powell. FXCO2 laser therapy of existing burn scars does not significantly improve outcomes in a porcine model. DOI: 10.1016/j.burnso.2019.04.004
This article is also based on technical information from Belislaser Knowledge Base .
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