The future of aesthetic dermatology and many dermatological procedures is moving towards laser technology. Yet so many surgical procedures remain rooted in the use of scalpels, and for good reason. This also does not touch on the fact that lasers can be used for much more than simply creating incisions and excisions in the skin — certain dermatological procedures utilize lasers for resurfacing and much more. 

With this in mind, today we will discuss some of the roles played by both lasers and scalpels in modern dermatological procedures, whether lasers or scalpels are best for standard surgeries, and the role that scalpels continue to play in dermatology.

 

Laser Skin Resurfacing

Laser skin resurfacing is an outpatient procedure that attacks blemishes on the surface of the skin. This is accomplished by removing the top layer of dead skin tissue and some live skin tissue with either:

Ablative lasers which are used to remove the undesirable skin. Ablative lasers do the bulk of the work in laser skin resurfacing by actively purging the skin from unwanted blemishes. In some cases, local anesthetic injections may be administered to improve patient comfort. Ablative lasers are generally Erbium YES lasers or CO2 lasers.

Non-ablative lasers pass through the top layer of skin without damaging or removing any skin tissue. Unlike ablative lasers, non-ablative treatment generally do not cause patient discomfort and are less invasive overall. The primary purpose of non-ablative lasers is to stimulate collagen production within the skin. Collagen production naturally tightens the skin and has an anti-aging impact. These types of lasers utilize pulsed light (IPL) technology.

 

The Role of Scalpels in Traditional Dermatology

For now, scalpels are an irreplaceable tool for dermatologists. Not only do they make the classic incisions and excisions required by many dermatological procedures, but they can also be used for a number of more specific functions such as tissue dissections. The modern mindset seems to be that the old is inherently inferior to the new — that scalpels are inherently inferior to lasers because scalpels have been in use for far longer.

This simply is not the case. Scalpels remain the best choice for plastic surgery and traditional dermatological procedures. This is for three simple reasons:

1. They are as effective as lasers in most situations.
2. They are generally easier to use than lasers.
3. They produce the same levels of scarring (more on this below).

We don’t have to go into the details of what procedures use scalpels, because the truth is that most surgical procedures do. What is important to remember that within the field of dermatology is that scalpels should not be looked at as a second choice to lasers just because laser technology is newer.

 

Advantages and Disadvantages of Lasers and Scalpels

Do laser scalpels leave less scarring after surgery?

The cosmetic impact of lasers vs scalpels often comes back to a singular argument: which will leave a less pronounced scar? For years, lasers were touted as a cleaner alternative to scalpels in many respects, including scarring. Scientific research has shown that surgeries using diamond lasers to make excisions create virtually identical scars to those which utilize steel scalpels. The study evaluated scarring after 1 day, 7-10 days, 4 weeks, and finally at 8-12 weeks.

This was a double blind study where physicians were asked to evaluate the incision scar based on cosmetic outcome. Histologic evaluations were also performed on all excisions to determine collateral thermal damage. In all cases, the scars were determined to be essentially equal regardless of excision tool.

Are lasers safer than scalpels in derm surgeries?

It can be argued that lasers are safer than scalpels for a few reasons:

• Lasers are inherently sterile. There is virtually no way for a laser procedure to cause infection from the incision/excision method. Scalpels are highly sterile when used properly, but some risk always persists.
• Lasers seal nerve endings and small blood vessels as they cut. This can lead to safer incisions as well as less patient pain post-op.
• Lasers are more efficient at microsurgery due to their greater precision and the fact that surgeons can have a better line of sight at the impacted area(s) without tools blocking their vision.
• Some laser procedures are able to be effective without opening up the skin at all. Consider non-ablative lasers for skin resurfacing.

Music City SCALE Conference Laser Talks

The 2019 Music City SCALE conference boasted dozens of panels and discussions on the use of laser technology in our field. In 2020, we hope to see that trend continue. Join us on July 22-25th in the Music City Convention Center in Downtown Nashville to enjoy the highest quality dermatology and laser education conference in the world! We will be covering topics including injectables, aesthetic surgery, energy-based devices, acne, psoriasis, and much more. Cadaver dissection workshops with 3-D visualizations are included to bring the education to our attendees.

What started as a small gathering amongst colleagues 14 years ago has turned into the biggest party of the year within the field of aesthetic dermatology. Join us alongside hundreds of attendees and industry vendors to find out what you’ve been missing!