Military Pioneers Use of Lasers to Treat Scars Published Aug. 11, 2014 Health.mil Staff WASHINGTON -- Military dermatologists have pioneered the use of laser treatments developed for cosmetic purposes to heal scar tissue from injuries sustained by service members in the line of duty. "It was a serendipitous finding - it just made sense to try it," said Lt. Col. (Dr.) Chad Hivnor, who recently left the Air Force and is now in the reserves. Healing damaged skin through a 'controlled burn' What he realized is that ablative fractional lasers commonly used to smooth out wrinkles or erase acne marks can also improve battlefield scars, helping patients regain use of the area. The lasers deliver tiny columns of heat quickly to the damaged skin, producing a new wound on top of the original burn that then heals with the help of the surrounding healthy skin tissue. Hivnor likened the procedure to maintaining a lush lawn. "You get your lawn aerated to help it 'breathe' - that's the same principle we're applying here. We are putting holes in the skin," he said. "It's like a controlled burn.... The goal is to find that perfect degree of damage to allow the right amount of skin to heal, to have a little controlled damage to allow it to rehabilitate the scar." And it takes time. "We have to do this very slowly and methodically, with multiple treatments over multiple months, if not years" he said. Research that restores range of motion Last year, Hivnor, now 42, received the Air Force Association's prestigious Paul W. Myers Award for his work using lasers to improve skin texture and flexibility in wounded warriors. He was awarded a $1.1 million grant to conduct a study into these treatments in a joint research project with Massachusetts General Hospital and Shriners Hospital for Children in Boston. Hivnor began his own research in 2010. The laser treatments enhance the patient's range of motion, allowing someone with scar tissue on his hands to type or fire a weapon again, for example. One patient who had been a sniper could no longer pull a trigger on a gun. "Now he's back out there doing all his Black Ops sniper stuff," said Hivnor. "So you're getting people back out into the fight." Amputees benefit from new treatments The treatments are also effective for amputees. Hivnor has found he is able to use lasers to increase the ability to sweat and decrease hair growth to help prevent frictional folliculitis, a skin condition caused by inflammation of hair follicles from wearing prosthetics. "We're allowing normal function to slowly come back," he said. "Sweat can regenerate if you still have normal sweat glands beneath the scar." Too much sweat can also be a problem. Patients can literally run into trouble if perspiration impairs the seal of a prosthetic limb, causing it to become detached, sometimes mid-stride. "What will happen is that the amputee will fall flat on his face," Hivnor said. He discovered that botulinum toxin A injections (sold under the brand name Botox) decrease perspiration where the prosthetic limb attaches, keeping it from slipping off when it's hot outside. "Just a little thing like that - using Botox for a prosthetic limb - can be life-changing." Procedures also apply to civilian population Fractional laser surgery has been developed in recent years by Hivnor and Cmdr. Peter Schumaker, chief of dermatology at Naval Medical Center San Diego, among others, to treat wounded warriors. Their findings, including Hivnor's recommendations on botulinum toxin A injections, were recently presented to the American Academy of Dermatology to help promote the use of these kinds of treatments on civilians with scars from motorcycle accidents, dog bites, fires or the like. Different lasers, fillers can achieve a variety of results Hivnor has treated patients with various types of lasers, including pulsed dye lasers and fractional lasers. "No single laser is going to do everything. It takes a combination of lasers," he said. His research, however, focuses primarily on carbon dioxide fractional lasers, which he has found particularly effective. At the same time, he approaches each patient as an individual who may require a variety of dermatological treatments to achieve optimal results, including lasers, fillers and botulinum toxin A. "There's a lot more that's left to be figured out," said Hivnor, who plans to continue to treat service members at the ambulatory surgical center at Joint Base San Antonio Lackland, where he was previously program director of the dermatological residency, while also maintaining a private practice in San Antonio. "We're really at the tip of the iceberg when it comes to the ramifications." Related Article Air Force Doctor Uses Laser Skin Treatment to Heal Burn Victims