Jill Waibel, MD, FAAD: Innovations in Laser Modalities for the Treatment of Scars

At the 2024 American Academy of Dermatology Annual Meeting in San Diego, California, Jill Waibel, MD, FAAD, presented sessions on the topic of laser and other modalities for the treatment of various types of scarring.

Waibel, the chief of dermatology for Baptist Hospital and inpatients and a clinical voluntary assistant professor at the University of Miami, owns 2 private practices in Miami, Florida, spoke with Dermatology Times to discuss highlights and pearls from her sessions, "Advances in Lasers and Light Sources: What's the Truth?," "Laser and Device-based Treatment of Scars," and "Fractional Laser and Light-based Technologies."

Transcript

Jill Waibel, MD, FAAD: My name is Dr Jill Waibel, and I'm a board-certified dermatologist. I own 2 private practices in Miami, Florida. I'm the Chief of Dermatology for Baptist Hospital and inpatients, and I'm a clinical voluntary assistant professor at the University of Miami.

Dermatology Times: What are key takeaways from your talks at the conference?

Waibel: I'm going to talk about all scars. They're all treated very differently. We really break scars down into 4 categories. The first thing you have to understand is: Where did this car come from? We talk about acne scars, surgical scars, burn and trauma scars, and then I always kind of lump stria in there, and stretch marks, which, they might not be a scar, but for right now, we put them in there. Then the result of that: how a scar looks, is also 4 categories, and that is: They're hypertrophic or elevated; they are atrophic or depressed. They are contractures, which usually only happens across joints in very severe trauma cases, and they're keloids. When I give this talk, I'll really address: How did we get the injury? And then within that category of acne scars, on the face, we usually see depressed scars, but on the body, we see elevated scars. It's very fascinating, and we've learned a lot about scars, their pathogenesis, their genetic backgrounds, and certainly, what devices are the best.

We've done a lot of clinical trials, a lot of consensus reports, and typically one of the techniques that we use is multiple lasers in the same session, because scars are very complicated. You might have a scar that's red over here and white over here, so you really need to, I always say, "Color the picture," because I have 4 children. So instead of coloring in, we're taking away the red, the brown, we're flattening out the elevation, we're lifting up.

I do have some new genetic information I'm going to share for the first time. I did a genetic study with polylactic acid, which is Sculptra, which, again, we were the first to do this in the world. I published it in 2009 with David Ozog, who's the Chair of Henry Ford. We laser, and then we call it laser-assisted delivery, where we literally just rub on the PLLA, and we prove that with one treatment, that improved atrophic scars about 70%. I did a genetic analysis with Galderma's support, and we went on-label, but we wanted to look at the genetic pathway, so we actually injected it in the nasal labial folds on patients.

The genetics showed that PLLA is regenerative, from the fat to the dermis, and we showed that pathway was incredible. We compared it to radius, which had a lot more inflammation, so I will be sharing that for the first time, really, the whole story in the scar world, so that people will continue to use PLLA for acne scars and depressed scars. It's incredible, and especially for children, there's no needles. I have little kids all the time that come in with a little scar, you can do one laser, one second, rub on some medicine, and that scar is almost impossible to see with the visible eye.

Dermatology Times: Are lasers always the most ideal approach for all scarring?

Waibel: Well, I honestly believe there's almost always a role for laser with scars, but my lead slide most of the time when I'm giving a lecture is: This is like going out to dinner; there's an appetizer, main course, and a dessert. Scars are very customized approach, and they're multimodal, so all the time, we're doing compression with silicone gel sheeting. We do injections with Kenalog, or triamcinolone acetonide. Especially for keloids, we might do a laser, and then I might have a patient come in every 2 weeks for injections. I do a lot of Z-plasty, which is a surgical flap technique that really address tension.

There are times I'm like, "You know what? You should just get a surgical revision." I'm in Miami; we have a lot of plastic surgery here. There are times a woman comes in and her breast surgery or her abdominal plasty or C-section scar, I'm like, "I could do laser on it. But why don't you go get a surgical revision?" So I think you're always very dynamic when you're treating a scar. One of the things that my staff does is they put up a before and after picture every single time, it's so much work, but it teaches me and the patient the progress, and you might do a certain combination one time and get 60% improvement. But then the next time, you need to do something totally different, to your point, more traditional. But honestly, we didn't have great treatments for scars, and we had nothing for burn and trauma patients. So lasers have really given us a new paradigm to get them back to a normal life, and that's really my favorite thing to do, and it changes lives.

Dermatology Times: What would you like your colleagues to know about scar treatment?

Waibel: I think the other important point is: One of the goals for me at this middle-age point of my life is that really everyone, not just in the United States, but all over the world can help scar patients. We will be touching on that so many devices can improve. It might be that this one's the best--it might be that the Lamborghini is faster than the Toyota, but the Toyota will still get you to the airport. I want people that are interested in this work and if they aren't doing it already, know that there's a lot of different tools that you can help scar patients with. I hope everyone has an opportunity to treat patients with scars, because it's very worthwhile as a physician, as a dermatologist, that we can help our patients.

[Transcript has been edited for clarity.]