Evaluating the efficacy of fractional laser therapy in scar remodeling and reducing scar-related complications: Systematic Review

Abstract

Atef Eid Madkour Elsayed, Dounia saeed mubark alshahrani, Raghad ebrahim Mohammed majrashi, Leen Tarik Mohammad Saeed Baeshen, Hiam Alahmed, Noora Mohamed Alsisi Albuainain, Suad ahmed mohamed aladnani, Cristina Mancino, Faris Fahad Alhumaid, Mona sameer ahmed alsulaimani*

Background: Scarring remains a significant aesthetic and functional challenge, with fractional CO? laser therapy increasingly recognized as a key modality for remodelling both early and mature scars. Despite its growing use, clinical outcomes across different scar types, treatment timings, and combination protocols remain variably reported.

Objectives: To systematically review and synthesize peer-reviewed clinical evidence on the efficacy, safety, and optimal use of fractional CO? laser therapy for surgical scars, hypertrophic scars, atrophic acne scars, and other dermatological scar conditions.

Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and Embase for studies published in English from 2003 to 2025. Eligible studies included randomized controlled trials, cohort studies, case series, and systematic reviews reporting objective or patient-reported scar outcomes after fractional CO? laser treatment, alone or in combination with adjunctive modalities. Data extraction included study design, population, scar type, treatment parameters, outcomes, follow-up, and adverse events. Results: Thirty-two studies met inclusion criteria, encompassing surgical scars, hypertrophic scars, atrophic acne scars, Pediatric post burn scars, steroid-induced atrophy, and striae distensile. Fractional CO? laser significantly improved scar scales such as VSS and POSAS, with early intervention (within 2–6 weeks post-injury) yielding optimal results. Combination regimens with pulsed dye laser, topical agents, or mechanical succession enhanced efficacy. Adverse effects were generally mild and transient. Histological evidence confirmed improved collagen organization and reduced fibrosis.

Conclusions: Fractional CO? laser therapy is effective and versatile for scar remodelling across multiple aetiologies, with strong evidence supporting early use and multimodal approaches. Standardized protocols and long-term outcome data are needed to optimize treatment strategies and guide clinical decision-making.