Different laser modes are combined to create a multi-dimensional intervention that addresses the full complexity of keloid tissue. By utilizing high-energy low-density modes, clinicians can reach deep into the dermis to remodel the keloid's core, while low-energy high-density modes simultaneously target the skin's surface to improve texture and color.
By synergizing deep-tissue remodeling with surface-level refinement, this dual-mode approach ensures a comprehensive repair process that treats the keloid's structural root while restoring the skin's visible appearance.
The Dual-Layer Strategy
Keloids are complex scars that exist in three dimensions, affecting both the deep structure of the skin and its visible surface. To treat them effectively, one must address the tissue layer by layer.
Targeting the Core with High Energy
The primary structural challenge of a keloid is its thickness and depth. The high-energy low-density mode is specifically engineered to address this.
Because the energy is concentrated but the density is kept low, the laser can penetrate into the deep dermis. This allows the treatment to bypass the upper layers and directly target the dense core of thick keloids for remodeling.
Refining the Surface with High Density
Treating the deep core reduces volume, but it does not necessarily fix the outward appearance. This is where the low-energy high-density mode becomes essential.
This mode focuses its energy on the exterior of the skin. By increasing the density of the coverage at a lower energy setting, it specifically targets surface irregularities to improve both texture and color, helping the treated area blend with the surrounding skin.
Understanding the Necessity of Combination
A single-mode approach often results in an incomplete treatment. Understanding the limitations of using these modes in isolation highlights why the combination is superior.
The Limitation of Depth Without Surface Care
If a practitioner relied solely on the high-energy mode, they might successfully flatten the keloid by remodeling the deep dermis.
However, this would likely leave the surface texture rough or discolored. The structural problem would be solved, but the aesthetic concern would remain.
The Limitation of Surface Care Without Depth
Conversely, focusing exclusively on the low-energy high-density mode would improve the scar's color and smoothness.
Yet, without the deep penetration of the high-energy mode, the thick core of the keloid would remain untouched. The scar would look better on the surface but retain its bulk and height.
Optimizing Keloid Treatment Plans
The most effective treatment plans acknowledge that keloid repair requires a "whole-structure" approach, moving from deep tissue to the epidermis.
- If your primary focus is structural reduction: Rely on the high-energy low-density mode to penetrate the deep dermis and remodel the bulk of the keloid core.
- If your primary focus is aesthetic refinement: Prioritize the low-energy high-density mode to smooth surface texture and correct color mismatches.
True comprehensive repair is achieved only when these two distinct mechanical goals are unified into a single treatment strategy.
Summary Table:
| Laser Mode | Target Layer | Clinical Objective | Main Benefit |
|---|---|---|---|
| High-Energy Low-Density | Deep Dermis | Core remodeling | Reduces keloid bulk and structural thickness |
| Low-Energy High-Density | Epidermis/Surface | Aesthetic refinement | Improves skin texture and color blending |
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References
- Sean Hickey, Jeremy Goverman. 327 Treatment of Keloids with CO2 Fractional Photothermolysis, Intralesional, and Topical Steroids. DOI: 10.1093/jbcr/iry006.249
This article is also based on technical information from Belislaser Knowledge Base .
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