The primary mechanism of action for Fractional CO2 lasers in keloid treatment is the creation of Microscopic Treatment Zones (MTZs) that penetrate the skin's surface. This process induces a precise physical thermal injury that triggers the rearrangement and remodeling of fibroblasts and collagen fibers, effectively inhibiting the continuous growth of pathological scar tissue.
Core Takeaway Fractional CO2 lasers do not simply "burn off" a scar; they utilize fractional ablation to create controlled columns of thermal injury. This stimulates a biological repair response that reorganizes disordered collagen structures while simultaneously creating pathways to deliver medication deep into the dense keloid tissue.
The Biological Mechanism: Remodeling and Regulation
The effectiveness of Fractional CO2 lasers lies in how they manipulate the skin's natural healing processes. By moving beyond simple tissue removal, these lasers alter the cellular behavior within the keloid.
Creation of Microscopic Treatment Zones (MTZs)
The laser emits beams that target water within the tissue, creating precise columns of thermal injury known as MTZs or Microscopic Ablative Zones (MAZs).
Unlike traditional lasers that ablate the entire surface, this fractional approach leaves bridges of intact skin between the injured columns.
Fibroblast and Collagen Rearrangement
The thermal injury generated by the MTZs disrupts the existing pathological structure of the keloid.
This disruption forces fibroblasts—the cells responsible for collagen production—to reorganize. The result is a shift from the chaotic, overabundant collagen typical of keloids to a more organized structure, effectively flattening the scar.
Inhibition of Pathological Growth
Beyond physical remodeling, the thermal effects help regulate fibroblast function.
By modulating these cells, the treatment reduces the synthesis of new collagen, halting the continuous, aggressive growth cycle that characterizes keloid formation.
The Physical Mechanism: Laser-Assisted Drug Delivery (LADD)
While the primary reference highlights tissue remodeling, supplementary data indicates a secondary, critical mechanism: the physical breaking of the skin barrier.
Establishing Micro-Conduits
Keloids are composed of dense, fibrous connective tissue that resists topical treatments and makes injections difficult.
The fractional laser creates physical "micro-channels" or conduits that penetrate deep into the dermis.
Enhancing Bioavailability
These channels act as a delivery system, a process often compared to skin electroporation.
When followed by the application of corticosteroids or other medications, these channels allow the drugs to bypass the dense scar barrier. This significantly enhances the penetration depth and uniform distribution of the medication.
Understanding the Trade-offs
While Fractional CO2 lasers offer a sophisticated approach to scar revision, it is vital to understand the limitations and risks associated with the mechanism.
Ablation vs. Healing Time
The mechanism is ablative, meaning it vaporizes tissue (epidermis and upper dermis).
While the fractional nature allows for faster healing than fully ablative lasers, it still creates a wound that requires downtime and careful management to prevent infection.
The Necessity of Combination Therapy
Reliance on the laser's thermal remodeling alone is often insufficient for aggressive keloids.
Data suggests that using the laser merely to drill holes for steroid delivery (combination therapy) creates significantly lower recurrence rates than using the laser as a standalone solution.
Making the Right Choice for Your Goal
The utility of Fractional CO2 lasers changes based on whether you are using them for physical resurfacing or as a delivery tool.
- If your primary focus is Scar Flattening: Leverage the ablative thermal effect to vaporize tissue volume and trigger the biological rearrangement of collagen fibers.
- If your primary focus is Managing Resistant Keloids: Utilize the laser primarily as a "drill" to create micro-channels, immediately following up with corticosteroid injections to maximize drug penetration.
The most effective use of this technology often combines the physical reduction of scar volume with the biological inhibition of regrowth through enhanced drug delivery.
Summary Table:
| Mechanism Type | Primary Action | Biological/Physical Impact |
|---|---|---|
| Biological | MTZ Creation | Triggers fibroblast rearrangement and collagen fiber remodeling |
| Physical | Ablative Channels | Creates micro-conduits to bypass dense scar tissue |
| Synergistic | Drug Delivery (LADD) | Enhances bioavailability and penetration of corticosteroids |
| Regenerative | Thermal Regulation | Inhibits pathological growth cycles and flattens scar volume |
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- Advanced Energy Control: Achieve the perfect balance of ablation and thermal injury for optimal collagen reorganization.
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References
- Jinhui Wang, Xiaohong Yang. Application of fractional carbon dioxide laser monotherapy in keloids: A meta‐analysis. DOI: 10.1111/jocd.16106
This article is also based on technical information from Belislaser Knowledge Base .
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