Why Is The Adjustment Of The Stacks Parameter Critical In Lads? Master Depth Control For Deep-Tissue Healing

The Stacks parameter is the primary mechanism for controlling the vertical depth of laser penetration during Laser-Assisted Drug Delivery (LADS). By delivering multiple laser pulses to a single, precise location, practitioners can extend the reach of micro-ablative channels without altering the surface area of the treatment site.

Core Takeaway: The adjustment of Stacks is essential for overcoming the physical barrier of dense tissue. It ensures that micro-ablative channels are drilled deep enough to allow therapeutic agents to permeate the entire thickness of a scar, rather than pooling superficially.

The Mechanics of Depth Control

Defining the Stacks Parameter

In LADS procedures, the Stacks parameter dictates how many times the laser fires at one specific coordinate before moving to the next.

Instead of spreading energy across a wider area, stacking concentrates energy vertically.

Regulating Channel Depth

The primary purpose of this adjustment is to precisely regulate the depth of the micro-ablative channels.

Each additional pulse acts like a drill, removing tissue layer by layer. This allows the practitioner to tailor the channel depth to the specific anatomical needs of the patient.

Optimizing Treatment for Scar Tissue

Challenges with Fibrotic Tissue

Treating dense or thick hypertrophic and keloidal scarring presents a unique challenge due to the toughness of the tissue.

A single pulse is often insufficient to penetrate these hardened fibrotic layers. Without stacking, the laser energy may only affect the surface, leaving the core of the scar untreated.

Breaking Through the Barrier

Increasing the number of stacks is the solution for penetrating deep into this fibrotic tissue.

By repeatedly pulsing the same spot, the laser establishes a channel that bypasses the dense upper layers of the scar.

Ensuring Full Therapeutic Coverage

The ultimate goal of LADS is the delivery of medication.

Deep channels created by higher stack settings allow therapeutic agents to travel down to the base of the scar. This ensures the drug covers the entire thickness of the tissue, maximizing clinical efficacy.

Understanding the Trade-offs

The Risk of Under-Treatment

If the Stacks parameter is set too low for a thick scar, the micro-channels will be too shallow.

This results in the therapeutic agent failing to reach the deeper layers of the fibrosis, potentially rendering the treatment ineffective for the bulk of the scar tissue.

The Necessity of Precision

While increasing stacks improves depth, it requires precise regulation.

The goal is to match the channel depth to the scar thickness exactly. This ensures the medication is delivered where it is needed most without unnecessary energy expenditure.

Making the Right Choice for Your Goal

To maximize the effectiveness of Laser-Assisted Drug Delivery, you must match the Stacks setting to the tissue density.

If your primary focus is treating thick, keloidal scars: Increase the Stacks parameter to ensure the laser penetrates the dense fibrosis and creates a path for the drug to reach the bottom of the scar.
If your primary focus is surface-level irregularities: Use fewer stacks to limit the depth of the channels and keep the therapeutic effect localized to the upper layers.

Correctly tuning the Stacks parameter bridges the gap between surface application and deep-tissue healing.

Summary Table:

Parameter Setting	Laser Action	Clinical Application	Treatment Goal
High Stacks	Multiple pulses at a single point	Thick hypertrophic & keloidal scars	Penetrate dense fibrosis to reach scar base
Low Stacks	Fewer pulses per coordinate	Surface-level irregularities	Localized treatment of upper tissue layers
Zero/No Stacking	Single pulse per spot	Sensitive areas or thin skin	Minimal penetration for superficial drug delivery

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References

Ni Putu Susari Widianingsih, Cita Rosita Sigit Prakoeswa. Fractional laser and laser assisted corticosteroid delivery for hypertrophic scars in thermal burns. DOI: 10.4081/dr.2019.8073

This article is also based on technical information from Belislaser Knowledge Base .