Research Article

Efficacy and Safety of Ablative Fractional Er:YAG Laser in Treatment and Prevention of Early Post-Surgical Scars

Abstract

Background: Scarring following surgery continues to represent a considerable clinical and psychological challenge. The Er:ZYAG laser (2,940 nm) provides highly targeted tissue removal at the optimal water absorption wavelength, positioning it as a valuable option for the early prevention of scars. However, research supporting well-defined post-operative Er:YAG laser treatment protocols among Iraqi patients remains limited. Aim: To assess the effectiveness and safety of ablative fractional Er:YAG (2,940 nm) laser therapy in managing and preventing early post-surgical scars in Iraqi patients. Patients and Methods: This was a prospective interventional study carried out at Al-Kufa University in Iraq between August 2017 and April 2019. A total of 31 patients, including 23 females and 8 males with Fitzpatrick skin types ranging from 3 to 5, who presented with early post-surgical scars, underwent three Er:YAG laser treatment sessions with parameters set at fractional + thermal mode with 3 pulses in 2 horizontal and vertical passes. Sessions were spaced four weeks apart and began 4 to 6 weeks following surgery. Treatment outcomes were evaluated through the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and photographic records. Results: A total response rate of 96.8% was established. Mean total VSS score improved from 7.23 ± 2.75 to 1.61 ± 1.94 (77.7% improvement; p <0.001, Wilcoxon). The greatest improvement was in scar height (89.1%), followed by vascularity (75.5%), pliability (72.8%), and pigmentation (67.0%). Observer POSAS satisfaction was 77.0% (satisfied) and patient satisfaction was 65.8%. A statistically significant inverse correlation was identified between baseline VSS score and percentage improvement (Spearman rho=0.468, p=0.008). No significant sex-based differences were found (p=0.837). One non-responder had uncontrolled Type 1 Diabetes Mellitus. Conclusion: Ablative fractional Er:YAG laser is a highly effective and safe modality for early post-surgical scar prevention. Earlier intervention on less severe scars yields superior outcomes. Pre-treatment metabolic screening is strongly recommended.