Efficacy and safety of fractional 1064‐nm picosecond laser for atrophic traumatic and surgical scars: A randomized, single‐blinded, split‐scar‐controlled study

Abstract Objective A fractional 1064‐nm picosecond laser is an efficient and safe treatment for atrophic acne scars. However, evidence of using a picosecond laser for atrophic posttraumatic and surgical scar therapy is lacking. This study aimed to evaluate the efficacy and safety of using a 1064‐nm picosecond laser with a microlens array (MLA) for the treatment of atrophic posttraumatic and surgical scars. Methods This was a prospective, intraindividual, single‐blinded, randomized split‐lesion‐controlled trial. Twenty‐five subjects with atrophic traumatic or surgical scars that existed for more than 1 year were enrolled. All atrophic scars were divided at the midline into two halves and randomly assigned to a treatment or control side. The treatment group was treated with a 1064‐nm picosecond laser with an MLA handpiece (spot size: 6–8 mm, fluence: 1.0–1.2 J/cm2, repetition rate: 5 Hz, three passes) for 3 monthly sessions. The scar volumes were objectively measured using a three‐dimensional (3D) photograph at baseline, 1 month after the first and second treatments, and 3 and 6 months after the final treatment. Subjective assessments were conducted by a blinded dermatologist and patients' self‐assessment to evaluate improvements at 3 months after the final treatment. Results The treated sides exhibited a significant volume reduction, with statistically significant improvements over the control group at 1 month after the first and second treatments and at 3 months after the final treatment (p = 0.024, 0.005, and 0.019, respectively). At 3 months after the final treatment, a blinded dermatologist correctly identified the treated side in 24 of 25 patients (96%). The patients rated the improvements as excellent (>75%) and marked (50%–75%) in 36% and 48% of patients, respectively. Conclusion At 3 months, the 1064‐nm picosecond laser with a fractionated MLA can significantly reduce the posttraumatic and postsurgical atrophic scar volume in patients with Fitzpatrick skin types III‐V. Insufficient data preclude inferences regarding efficacy at 6 months.