Sequential Dual-Wavelength CO2/1540 nm Laser Combined with Pulsed Dye Laser for Hypertrophic and Retractile Scars: A Case Series

Background: Hypertrophic and retractile scars cause functional, aesthetic, and psychosocial burdens and are challenging to treat due to abnormal collagen, inflammation, and vascularity. Traditional therapies show variable results, whereas lasers, fractional CO₂, non-ablative 1540 nm, and pulsed dye laser (PDL), effectively target different aspects of scar pathology. Objectives: To describe the clinical outcomes of a sequential multimodal laser protocol combining fractional CO₂ (µSCAN DOT), 1540 nm non-ablative laser, and 595 nm dye laser in a small series of patients with hypertrophic and retractile scars across different anatomical sites. Methods: This pilot retrospective case series was conducted on five patients with eight scars who underwent three to four treatment sessions using a dual‑wavelength CO₂/1540 nm system and adjunctive PDL. Treatment parameters were standardized, and no topical anesthesia or antiviral prophylaxis was used. Outcomes were assessed through standardized photography and the Modified Vancouver Scar Scale (mVSS) before treatment and at follow‑up. Results: A clear and notable reduction emerged not only in the total mVSS score but also across every individual parameter (vascularity, pigmentation, pliability, height, pain, and pruritus), underscoring a broad and consistent improvement. The mean total mVSS score decreased from 11.0 ± 2.7 to 3.8 ± 1.7. No adverse events were reported, and overall tolerability was high. Conclusions: This case series suggests that a sequential multimodal laser approach combining CO₂, 1540 nm, and PDL may represent a safe and useful option for the management of complex scars. Further studies are needed to confirm these observations.