Abstract
Post-traumatic facial scars cause significant emotional distress. Early multimodal approach combining topical and laser treatments may improve outcomes. A 26-year-old woman presented with multiple upper-facial lacerations after a car accident. Silicone gel was applied twice daily beginning 1-month post-injury, followed by 4 monthly sessions of combined Neodymium-doped Yttrium Aluminum Garnet (15 J/cm2, 9 mm, 0.6 ms) and fractional Erbium-doped Yttrium Aluminum Garnet (60 J/cm2, 1.2 Hz, 300 ms) laser therapy starting at 1.5 months. After 6 months, excellent cosmetic results were achieved. This case highlights the importance of early multimodal intervention with silicone gel and laser treatment as an effective method to improve esthetic and psychological outcomes in post-traumatic facial scarring.
Introduction
Scarring is the process by which normal skin is replaced by fibroblasts, resulting in the formation of organized, unidirectional collagen bundles. Various approaches can be used for scar management, including silicone gel, laser and light-based therapies, microneedling, platelet-rich plasma, and other modalities. 1
Early intervention in scar management using a combination of different modalities can yield the best cosmetic results. 2
Case presentation
A 26-year-old healthy woman presented with multiple upper facial wounds sustained during a car accident while escaping a bomb threat explosion in Lebanon (Figure 1).
Patient 1-week post-accident showing multiple lacerations on the upper facial area.
The patient started to apply topical silicone gel twice daily, starting 1 month after the trauma. In addition, she underwent four sessions of laser therapy (Fotona Dynamis Pro), spaced 4 weeks apart, beginning 1.5 months after the trauma. The first step consisted of three passes with the Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser (fluence 15 J/cm2, spot size 9 mm, pulse duration 0.6 ms). The second step involved four passes of fractional resurfacing with the 2940 nm Erbium-doped Yttrium Aluminum Garnet (Er:YAG) laser (fluence 60 J/cm2, frequency 1.2 Hz, pulse duration 300 ms).
After 6 months, significant improvement was observed in the scars, which became barely visible, with marked reduction in erythema, vascularity, width, thickness, and overall appearance (Figure 2).
Patient 6-months post-accident showing marked improvement in scar erythema, thickness, and overall appearance.
Discussion
Silicone-based formulations are the gold standard and first-line option in scar management. They have demonstrated significant efficacy in both preventing and treating pathological scars. 3
In most studies, application of silicone-based products is initiated following suture removal or once the wound is fully epithelized. These interventions consistently improve overall scar quality, including pliability, pigmentation, and thickness. Despite that, results on vascular improvement have been less consistent. 4
Laser therapy represents another valuable modality for the treatment of abnormal scars. It targets surface irregularities, residual redness, telangiectasias, as well as hyperpigmentation. 5
In a study by Kim et al., fractional ablative 2940 nm Er:YAG laser therapy was initiated at least 4 weeks after wound repair and performed four times at monthly intervals. This protocol yielded significant improvements in the appearance of traumatic facial scars, reflected by lower Vancouver Scar Scale scores and high patient satisfaction (93.3%). 6
A more recent retrospective study enrolled 36 patients following facial nevus excision. Fourteen patients underwent post-surgical laser therapy with long-pulsed 1064-nm Nd:YAG laser, while 22 used topical scar ointments only. After 2 months, the laser-treated group demonstrated a significantly greater reduction in Japan Scar Workshop redness and erythema scores compared to controls. 7
The combination of laser therapy and silicone gel has been infrequently investigated in the literature. In a comparative study, combining silicone gel with a 577-nm diode laser applied in 3 monthly sessions led to a marked improvement in pigmentation, pliability, height, and overall Vancouver scores. A Combination of laser and silicone gel demonstrated significant better improvement compared with silicone gel alone. 8
In the present case, the combination of early twice-daily silicone gel application and laser treatments significantly improved scar appearance and outcome. We suggest early intervention and combination therapies for optimal clinical results, hoping such results help diminish the emotional impact and negative memories associated with the traumatic event that caused the injury.
Footnotes
Consent to participate
Written informed consent was taken from the patient.
Author contributions
Hamad El Hajj: writing, drafting, editing, methodology, diagnosis, and management. Maya Habre: investigation, validation, supervision, writing – review and editing.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
The data used to support the findings of this study are included within the article.