This laser (I use both the V Beam Prima & Perfecta) does not break the epidermis as it has an inbuilt cooling system that protects the upper layers of skin. I employ this laser to treat thinner scars (not hypertrophic). This laser works by reducing redness. It also works by non-selectively modulating cytokine expression. This means it makes scars softer (as compared to selective photo thermolysis that targets red).

About 3-8, it really depends. If you have mild hypopigmentation, 1-3 sessions will do. For more extensive areas, additional sessions may be required.

Lasers can stimulate melanin production via increased absorption of chemicals that stimulate these cells. Addition of medical phototherapy can compound pigment production.

Recovery takes 6-14 days. In many cases, scars will decrease in thickness. Skin will become more flexible and less red. But we caution patients to set realistic expectations. Your scar will only soften, not disappear. Your scar will be softer & in most cases symptoms such as itch will improve.  

You may also experience bleeding, infection & skin pigment changes. In exceptionally rare cases scars may feel tighter after a laser treatment. If you are not compliant with silicone dressings, I may not treat your scars as this may worsen with treatments.

White or hypopigmented scars have a lack of pigment, this means that pigment cells known as melanocytes are either low in number or non-existent. In order to improve pigment, I must either transfer new melanocytes or awaken sleeping cells in the scars. This is the only way to get pigment back.

Melanocytes account for one in thirty-five cells that form the basal layer of skin. Their job is to produce pigment. Pigment packets are then transferred to the keratinocytes. In hypopigmented burn scars the number is reduced. Hence pigment is either greatly diminished or non-existent.

Melanocyte transfer in burns is much more complicated than in vitiligo or traumatic scarring. This is due to poor wound healing due to lack of hair follicles in burns.

My preferred method is micrografting with autologous melanocytes. This is an involving treatment as it requires surgery with healing times. Micrografting is successful in most, but not all cases. This treatment cannot be conducted aggressively in scar tissue that lacks hair follicles.

This procedure transfers pigment cells from a donor site (most commonly the inner arm, upper thigh or buttock) to the recipient site (hypopigmented scar). This is a form of autologous cell transfer.

In more detail-

• A sliver of skin including melanocytes & keratinocytes are harvested by hand using a blade.
• Donor site harvesting is painless as I use local analgesia
• Pigment cells are processed into small units
• Recipient site is prepared with either manual dermabrasion or laser
• Cells are placed on the hypopigmented scars
• Pigment cells populate the recipient site over the next 10 days
• Pigment starts to develop at week 3
• Maximal pigment is achieved at 9 to 12 months after the surgery

FUE or follicular unit extraction is my preferred method of repurposing hair. Scar tissue is very difficult compared to normal tissue. My preferred method is to normalize scar tissue as much as possible before hair transplantation. This allows a better recipient bed for transplanted hair follicles. This increases the survival rate.

This can be done on scalp & eyebrow hair. Most often I conduct test spots to check for follicular viability prior to full transplantation. PRP can be used as adjunctive therapy post transplant to improve survival rates.

ReCell is marketed as a spray on skin. It can be useful for acute burns, but in the context of what I do (remodel & revise established scars) it has limited value. In my hands, limited micrografts are better.

ReCell uses your own skin cells as a donor & transfers both keratinocytes & melanocytes to the burnt areas. A special enzymatic process breaks down the donor skin into small pieces. This is then sprayed or painted on to the affected sites.

Unlike normal tissue, burn tissue has extensive fibrosis. This means scar tissue is compact & hard. Even with super powerful motor driven pens devices, penetration is limited. CO2 lasers with very short pulse durations can penetrate dense scar tissue with ease, hence they are my preferred method of revision. Needling devices come in a distant second.

OK, let’s say I don’t have access to lasers, my next choice is a derma roller. Why? Because I can generate more force with roller & stamps over pens. In this context needling is only useful to allow steroid penetration. This will gradually soften the scar.

Don’t get me started on this. The idiots who decide on Medicare item number should really understand (experience) the physical & psychological effects of burn scars.

Medicare subsides many skin conditions. For example, if you have a patch of dry skin that resembles psoriasis on your elbows or knees, treatments are available. Medicare subsides over $6000 worth of phototherapy a year, for many, many years. A psoriasis patient can accumulate up to $30,000 worth of subsidised Medicare & PBS bills within 5 years. They are entitled to a lifetime of subsidised (often fully paid treatments by Medicare).  A patient with full thickness burns that finds it difficult to swallow has zero subsidy. Talk about retardation of our medical system. 

The evidence that fractional lasers, in particular CO2 lasers have on burn scarring is irrefutable. All burn units throughout the world recognise this as a treatment that gives unparalleled improvements, both psychologically & physically. Despite this, Medicare does not recognise fractional CO2 laser as an appropriate treatment for scarring. I have lobbied, written, & faced committee panels. I have provided them with evidence, I have also got other senior dermatologists to do the same. Despite all our efforts the idiots at the top won’t listen.

Depending on the severity of your scars, some treatments are covered under Medicare. The medical insurance system in Australia, in the context of scarring, has illogical reasoning as fractional lasers are not covered. As a guide, for the treatment of burns, I charge about one third the costs compared to lasers for cosmetics.

• Micrografting & split grafts- POA, depending on area.
• Fractional lasers – from $490
• Microneedling & topicals- from $440
• Phototherapy – no charge. Bulk billed under Medicare

The Royal Brisbane Hospital has an Ultrapulse SCAAR FX Lumenis CO2 laser. You can book an appointment with the Plastics team for an assessment. They do run this laser intermittently.