Laser stacking is utilized for scars exceeding 5mm because it allows practitioners to achieve the deep tissue penetration required to break down dense, fibrous masses. By delivering consecutive pulses to the same location—often referred to as double-pulse or triple-pulse technology—this technique overcomes the resistance of thick tissue that typically blocks standard laser applications. It ensures that energy reaches the base of the scar to trigger effective remodeling.
The primary challenge with severe scarring is that thick, fibrous tissue acts as a barrier to standard laser energy.
Laser stacking solves this by using a cumulative energy effect to "drill" vertically into the tissue, enabling deep ablation and collagen rearrangement without requiring excessive width in the treatment area.
Overcoming the Density Barrier
The Cumulative Energy Effect
The core mechanism of laser stacking is the continuous release of multiple energy pulses at a single pixel point. Rather than treating a broad area superficially, the laser fires repeatedly in the exact same spot.
This creates a cumulative effect. The first pulse opens the tissue, and subsequent pulses drive heat and ablation deeper into the dermis.
Penetrating Fibrous Tissue
Mature, hypertrophic scars are characterized by extremely firm and thickened tissue. This density makes it difficult for single-pulse lasers to penetrate beyond the surface layers.
Stacking specifically targets this resistance. By concentrating energy vertically, the laser can bypass the dense fibrous cap and act upon the deep layers of the scar tissue.
The Mechanism of Remodeling
Reaching the Deep Layers
For a scar thicker than 5mm, surface treatment is insufficient. Optimal remodeling results depend on treating the entire depth of the pathology.
The stacking technique ensures the laser acts on the deep reticular dermis. This is necessary to structurally change the foundation of the scar, rather than just polishing the surface.
Inducing Collagen Rearrangement
The ultimate goal of this deep ablation is to trigger biological repair. The deep thermal injury induces collagen fiber rearrangement.
By breaking down the disorganized, stiff collagen bundles deep within the scar, the process stimulates the production of new, organized fibers. This significantly improves the flexibility of the tissue and reduces the overall thickness of the scar.
Understanding the Trade-offs
Thermal Intensity
While effective, stacking significantly increases the thermal load delivered to a specific point. This requires precise control to ensure the heat remains targeted within the scar tissue.
Specificity of Application
This technique is a specialized tool, not a default setting. It is specifically designed for old or hypertrophic scars where tissue density is the primary obstacle. Using this intensity on thin or delicate skin would be unnecessary and potentially damaging.
Making the Right Choice for Your Goal
The decision to utilize laser stacking depends entirely on the physical characteristics of the scar tissue you are treating.
- If your primary focus is treating hypertrophic scars >5mm: The stacking technique is essential to penetrate the dense, fibrous barrier and initiate remodeling at the root of the scar.
- If your primary focus is surface texture or minor discoloration: Standard single-pulse fractional treatments are likely sufficient and offer a gentler approach.
Laser stacking transforms the treatment of severe scarring by turning insurmountable density into manageable, remodelable tissue.
Summary Table:
| Feature | Standard Single-Pulse Laser | Laser Stacking Technique |
|---|---|---|
| Penetration Depth | Superficial to Mid-Dermis | Deep Dermis (>5mm) |
| Energy Delivery | Single pulse per spot | Multiple pulses at a single pixel |
| Tissue Resistance | Blocked by dense fibrous caps | Bypasses density via cumulative heat |
| Primary Goal | Surface texture & pigmentation | Deep structural remodeling |
| Ideal For | Minor scars & fine lines | Hypertrophic & mature thick scars |
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References
- Jennifer Zuccaro, Joel Fish. Laser Therapy for Pediatric Burn Scars: Focusing on a Combined Treatment Approach. DOI: 10.1093/jbcr/irx008
This article is also based on technical information from Belislaser Knowledge Base .
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