Energy settings must be differentiated because the thickness of the dermis and the depth of scar tissue vary drastically depending on the anatomical location. Treating thin skin on the hands requires lower energy (typically 15mJ) to restrict ablation depth to approximately 190µm, preventing injury to underlying structures. Conversely, the thick, fibrous scars often found in the axilla or on the trunk demand significantly higher energy (30–60mJ) to achieve a penetration depth of up to 560µm.
Successful Fractional CO2 laser therapy relies on matching the pulse energy to the specific tissue characteristics. Precise regulation ensures the laser penetrates deeply enough to remodel hypertrophic scarring without causing thermal damage to the healthy tissue beneath.
The Principles of Anatomical Variation
Matching Energy to Skin Thickness
The primary reason for adjusting settings is the physical depth required to reach the target tissue. Skin on areas like the hands is naturally thinner. High energy here would penetrate too deeply, risking damage to nerves, tendons, or healthy subcutaneous tissue.
Overcoming Deep Fibrosis
Scars in the axilla or trunk often involve hypertrophy, where collagen proliferation is dense and deep. Low energy settings used for the hands would be ineffective here. These areas require high-energy pulses to penetrate deep dermal fibrosis, breaking down the collagen bundles responsible for the scar's rigidity.
The Role of Micro-Channels
Higher energy settings create deeper "micro-ablative zones" or channels. In thick scars, these deep channels release physical tension and "tightness" at the source. They also provide a physical pathway for subsequent drug delivery, which is often necessary for treating thick, resistant plaques.
Optimizing Laser Parameters
Pulse Energy Determines Depth
It is critical to distinguish between power and pulse energy. Pulse energy determines the penetration depth and ablation volume of a single laser beam. By modulating this energy (e.g., between 15mJ and 60mJ), you control exactly how far into the dermis the column of thermal injury extends.
Power Determines Heat Delivery
Power, measured in Watts, dictates the amount of heat delivered per unit of time. Optimizing the balance between power (e.g., 12–14 W) and pulse energy ensures efficient cutting. This balance triggers collagen regeneration while preventing excessive heat accumulation that could char the incision area.
Mechanical Destruction of Collagen
The goal of high-energy settings in thick tissue is mechanical restructuring. The laser creates densely arranged micro-holes that physically destroy excessively proliferated collagen fibers. This induces the skin's self-repair mechanism, promoting the migration of normal epidermal cells to replace the scar tissue.
Understanding the Trade-offs
The Risk of Thermal Damage
While higher energy is needed for thick scars, it carries a risk of "secondary thermal damage." If the energy is too high for the specific tissue type, heat accumulates laterally. This can lead to prolonged healing times and increased scarring, defeating the purpose of the treatment.
Density vs. Safety
In addition to energy, the density of the laser coverage matters. Standard treatments use 5–10% density. Treating stubborn nodules may require 15% density or higher to break foreign bodies or nodules. However, this higher density increases the risk of post-inflammatory hyperpigmentation, a trade-off that must be managed carefully.
Pediatric Considerations
Children generally have more delicate skin than adults. Regardless of the anatomical area, pediatric cases often require a "low-energy mode." This provides clinical efficacy while significantly reducing pain and avoiding excessive thermal stimulation.
Making the Right Choice for Your Goal
To achieve the best clinical outcomes, you must categorize the treatment area by tissue density and depth.
- If your primary focus is safety on thin skin (e.g., hands): Restrict energy settings to approximately 15mJ to limit ablation depth to 190µm and protect underlying anatomy.
- If your primary focus is remodeling thick, hypertrophic scars (e.g., axilla): Utilize higher energy settings (30–60mJ) to drive the laser beam up to 560µm deep to break down dense fibrosis.
- If your primary focus is treating pediatric patients: Default to low-energy modes to balance effective scar management with pain reduction and safety.
Precise energy regulation is the defining factor between effective scar remodeling and iatrogenic injury.
Summary Table:
| Anatomical Area | Skin Type | Recommended Energy | Ablation Depth | Primary Treatment Goal |
|---|---|---|---|---|
| Hands / Face | Thin Dermis | ~15 mJ | ~190 µm | Protect underlying structures & nerves |
| Axilla / Trunk | Thick/Fibrous | 30 – 60 mJ | ~560 µm | Break deep fibrosis & remodel collagen |
| Pediatric | Delicate | Low-Energy Mode | Variable | Reduce pain & minimize thermal stimulation |
| Hypertrophic | Dense Nodules | High Energy + High Density | Deep | Mechanical destruction of collagen fibers |
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Achieving superior scar remodeling results while ensuring patient safety requires advanced equipment capable of precise energy modulation. BELIS specializes in professional-grade medical aesthetic equipment designed exclusively for clinics and premium salons.
Our advanced CO2 Fractional Laser systems provide the versatility you need to safely treat delicate areas like the hands or aggressive hypertrophic scars on the trunk. Beyond laser systems, our portfolio includes Nd:YAG, Pico lasers, HIFU, Microneedle RF, and specialized body sculpting solutions like EMSlim and Cryolipolysis.
Why Choose BELIS?
- Targeted Efficacy: Equipment designed for specific anatomical challenges.
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References
- Nadia Hussein Sahib, Ihsan Jara Atiyah. The Role of Fractional CO2 Laser in Treatment of Keloid and Hypertrophic Scar used Alone and in Combination with Intralesional Steroids. DOI: 10.37506/ijfmt.v14i3.10638
This article is also based on technical information from Belislaser Knowledge Base .
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