Laser–Tissue Interaction in Burn and Traumatic Scars, with Implications for the Face: A Narrative Review

Facial scars resulting from burns or trauma present substantial clinical and psychosocial challenges. This narrative review synthesizes current clinical and mechanistic evidence on ablative fractional lasers (AFLs), non-ablative fractional lasers (NAFLs), pulsed dye lasers (PDLs), and intense pulsed light (IPL), linking wavelength-dependent chromophore targeting, pulse duration relative to thermal relaxation time, and treatment density to therapeutic outcomes. Carbon dioxide (CO2) AFL demonstrates the strongest evidence base among these modalities, although evidence certainty is rated low to very low. NAFL offers reduced downtime with a favorable safety profile in darker skin types, while PDL targets vascular scar components. Pooled evidence supports starting laser treatment within the first year after burn injury, and facial traumatic scars have been treated within weeks, but no single window is optimal across outcome domains. Consensus recommendations favor combining modalities according to the dominant scar component, phase, and phototype. We separate face-specific evidence from findings extrapolated from other body sites, compare facial with non-facial skin and facial subsites with each other, and summarize these data as frameworks for parameter selection. Because most evidence derives from mixed anatomical sites and only one study reports outcomes for a single facial subsite, future trials should report outcomes by subsite.