The adjustment of laser power and stack settings is critical because it dictates the physical dimensions of the microscopic holes, or ablation channels, created in the skin. By tailoring these settings, practitioners ensure that laser energy and topical medications can penetrate deep enough to reach problematic fibrous tissue in thick scars without causing unnecessary trauma to thinner scars.
To treat burn scars effectively, you must match the laser's physical penetration to the scar's thickness: high energy and stacking are required to drill into deep fibrous tissue, while lower settings preserve the integrity of thinner scar tissue.
The Mechanics of Ablation Channels
Controlling Depth and Density
Laser treatments for scars generally work by creating vertical columns of vaporized tissue.
These columns are not uniform; their depth is determined directly by your device settings.
Power intensity controls the force of the energy, while stack settings determine how many times the laser fires into the exact same microscopic channel.
Strategies for Thick Scars (>5mm)
Reaching Deep Hyperplastic Tissue
Burn scars exceeding 5mm in thickness are characterized by dense, deep-seated fibrous tissue.
To impact this tissue, you must utilize higher power combined with multiple stack modes.
Stacking pulses allows the laser to drill progressively deeper into the same channel, effectively bypassing the superficial layers to reach the core of the scar.
Facilitating Medication Delivery
Laser treatments for burns are often paired with topical medications.
Deep ablation channels act as physical conduits for these drugs.
By increasing stack and power settings, you ensure the channels are deep enough for medications to reach the underlying hyperplastic tissue rather than sitting ineffectively on the surface.
Strategies for Thin Scars
Modulating for Safety
For scars that are significantly thinner, the target tissue volume is much smaller.
Using the high-intensity settings required for thick scars would result in excessive tissue damage.
Lower parameters are utilized here to maintain efficacy in remodeling the surface without penetrating too deeply or causing unnecessary thermal injury.
Understanding the Trade-offs
The Risk of Thermal Injury
While increasing stack settings improves depth, it also increases the total heat delivered to a specific spot.
If settings are too aggressive on a scar of intermediate thickness, you risk causing bulk heating and collateral damage to healthy tissue.
The Cost of Under-Treatment
Conversely, using "safe" low settings on a thick, fibrous scar often leads to treatment failure.
Shallow channels will not break up the rigid collagen networks located deep in the dermis.
This results in a procedure that offers surface-level resurfacing but fails to address the functional restriction of the scar.
Making the Right Choice for Your Goal
When configuring your laser device, assess the scar thickness physically before selecting your parameters.
- If your primary focus is treating thick scars (>5mm): Utilize higher power and multiple stack modes to ensure energy and medications penetrate the deep-seated fibrous tissue.
- If your primary focus is treating thin scars: Utilize lower parameters to remodel the tissue while strictly minimizing the risk of excessive damage.
Precision in parameter selection is the only way to transform rigid scar tissue into pliable skin without compromising safety.
Summary Table:
| Scar Type | Thickness | Recommended Settings | Treatment Goal |
|---|---|---|---|
| Thick Scars | > 5mm | High Power + Multiple Stack | Reach deep fibrous tissue & enable drug delivery |
| Thin Scars | < 5mm | Lower Power + Single/Low Stack | Surface remodeling while minimizing thermal injury |
| Intermediate | Variable | Balanced Parameters | Controlled remodeling without collateral damage |
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Our advanced CO2 Fractional Laser systems and Nd:YAG lasers provide the precise power and stack adjustments necessary to treat everything from deep burn scars to fine surface imperfections. Beyond scar treatment, our portfolio includes:
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References
- Bassam Younes, Tarek Shoukr. The efficacy of fractional CO2 laser with or without triamcinolone acetonide or 5-fluorouracil in the treatment of early postburn hypertrophic scars. DOI: 10.1007/s10103-024-04256-z
This article is also based on technical information from Belislaser Knowledge Base .
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