Successful Treatment of Chronic Ulcerative Facial Scar Using Multimodal Regenerative Therapy: A Case Report

Abstract

Aims: To report successful management of a chronic ulcerative facial scar following ablative laser therapy using multimodal regenerative treatment combining photobiomodulation and fractional laser. Presentation of Case: A 29-year-old female presented with a 3 cm ulcerative scar on the left cheek secondary to undocumented ablative laser treatment. The lesion showed persistent granulation tissue, fibrinous exudate, and poor healing. Initial management included mechanical debridement to remove fibrin and necrotic debris, followed by surgical suturing to approximate the wound edges. A multimodal approach was implemented, consisting of four sessions of red and near-infrared light-emitting diode photobiomodulation therapy combined with five sessions of fractional ablative Erbium:YAG laser. This regimen resulted in approximately 80% clinical improvement, with the Vancouver Scar Scale decreasing from 11 to 2. Discussion: Chronic ulcerative scars after ablative laser therapy remain uncommon but challenging, often resulting from prolonged inflammation, impaired re-epithelialization, and collagen disorganization. The combination of photobiomodulation and fractional Erbium:YAG laser likely promoted tissue regeneration through mitochondrial stimulation, reduced inflammation, enhanced angiogenesis, and controlled neocollagenesis. Photobiomodulation accelerates wound closure and modulates inflammatory pathways, while fractional laser induces microthermal zones that trigger collagen remodeling and scar maturation. This synergistic effect appears particularly effective for chronic ulcerative scars, offering a safe, non-invasive alternative to prolonged conservative care or more aggressive interventions. Conclusion: Early multimodal therapy combining photobiomodulation and fractional ablative Erbium:YAG laser is highly effective for managing chronic ulcerative facial scars post-ablative laser, achieving rapid healing and excellent aesthetic outcomes.