Effect of CO₂ fractional laser intervention versus hyaluronidase injection in early scar treatment: a randomized controlled study

Early intervention for scars is a vital focus in dermatologic surgery, with various treatment options showing potential in enhancing the appearance and texture of scars. This randomized controlled study evaluated the effectiveness of fractional CO₂ laser treatment compared to hyaluronidase injection in managing early scars. Sixty patients with recent scars were randomly assigned to receive either fractional CO₂ laser treatment (n = 30) or hyaluronidase injection (n = 30), with 56 patients completing the study. Treatments were conducted over 4-6 sessions, followed by a 6-month follow-up. The CO₂ laser group showed significantly better results, achieving a 45.3% reduction in scar volume compared to 32.7% in the hyaluronidase group (p < 0.001). Improvements in the Vancouver Scar Scale were also significantly higher in the CO₂ laser group (52.4% ± 15.6% vs. 38.9% ± 14.2%, p < 0.01). Histopathological analysis indicated better collagen organization, improved elastic fiber networks, and lower type I/III collagen ratios in the CO₂ laser group, nearing values typical of normal skin. Both treatments had favorable safety profiles, but the CO₂ laser group needed fewer treatment sessions. These results provide strong evidence that fractional CO₂ laser is a preferred option for early scar management, especially when treatment begins in the third week after scar formation.