Dr. Jill Waibel discusses the evolution of scar treatment options, enabling trained dermatologists and providers to effectively treat any scar type—even extensive scarring from burns.
Jill S. Waibel, MD, Chief of Dermatology at Baptist Hospital, Voluntary Assistant Faculty at the University of Miami Miller School of Medicine, and Owner, Miami Dermatology and Laser Institute, Miami, Florida
“In 2023, in many cases, we can almost erase scars completely whether they are acne scars, surgery scars, keloid scars, or burn and trauma (my favorite),” said Jill S. Waibel, MD, who cochaired the Optimizing Outcomes for the Treatment of Scars session at ASLMS 2023 in Phoenix, Arizona.
It is well known that lasers are the gold standard for treating scars, but to be successful dermatologists have to customize scar treatment, said Dr. Waibel.
“Scars can be red, brown, or white. They can be hypertrophic or atrophic. It’s a journey. I always tell patients to give us a year to make their scars better.”
According to Dr. Waibel, the faculty and session attendees talked about how they use multiple energy-based devices for scar treatment, from lasers and microneedling to other methods, including radiofrequency, laser-assisted delivery of medication, and compression.
“Mitchel P. Goldman, MD, [a panelist] talked about using radiation, so it really highlighted the range. What’s exciting for me, having been a dermatologist for 20 years, is that when I started there really were no solutions for scars other than injecting with Kenalog.”
“Now we can take a burn patient—a wounded warrior who has burned their entire body—and make them 80% to 90% better,” said Dr. Waibel.
Tips for Optimizing Treatment
There are lots of tips to improve scar treatment, said Dr. Waibel.
“The first is to go to a meeting like ASLMS. Training is really important. You really need to know which devices are going to be the best.”
Dermatology practices don’t need 100 lasers to treat scars. They probably need only 3 or 4 devices, said Dr. Waibel.
“You probably need a vascular laser, which could be a pulsed-dye laser, an intense pulsed light (IPL), a broadband light (BBL), or 532 nm laser. Then you need a fractional laser. I’m a big fan of fractional CO2 or erbium. Nonablative fractional lasers have a role. And then laser-assisted delivery is helpful.”
Fractional devices are more challenging to use because there aren’t tissue endpoints, said Dr. Waibel.
Another tips is to give scars time to heal between treatment sessions, she said.
“When you treat a scar, it’s not like treating a cosmetic patient with a laser. You have to wait 2 or 3 months because that skin and the collagen are damaged.”
Think about turning down the device settings, which might be considered counterintuitive, said Dr. Waibel.
“We’re more aggressive when we treat cosmetic patients. When we treat a scar patient, we’re more subtle.”
Laser-tissue interactions are important, especially for new residents and people who are new to the field, she said.
“A tip we gave was start out with surgical scars… and maybe move onto acne scars—then move on later to burn and trauma scars.”
Be passionate and help your patients because scar treatment isn’t generally reimbursed, said Dr. Waibel.
“The session’s Co-chair Peter R. Shumaker, MD, had an eloquent commentary about the status of coding. Unfortunately, we do not have medical CPT codes to cover these treatments.”
Dr. Waibel, Rox Anderson, MD, and Murad Alam, MD, wrote a code for burn and trauma patients, focusing on children with symptoms after a burn and wounded warrior veterans, but achieving reimbursement for these patients has been a challenge, said Dr. Waibel.
“We have an experimental code and that’s not reimbursed. [Getting a medical CPT code for scar treatment] is a steep hill to climb, but we have to advocate for our patients. Many of us do a lot of pro bono work.”
Disclosures: Dr. Waibel is a speaker, consultant and advisory board member for Candela; an advisory board member and consultant for Cytrellis Biosystems; advisory board member for Sciton; consultant and clinical trial investigator for Lumenis; and clinical trial investigator and consultant for Skinceuticals.
