An Overview of the Mechanisms of Fractional CO2 Laser in Scar Treatment

This review aims to investigate the mechanisms underlying the application of ablative fractional CO2 laser in scar treatment and analyze its effects on inflammatory responses, cell proliferation and collagen remodeling during wound healing. It focuses on how the fractional CO2 laser promotes skin repair by modulating molecular mechanisms, thereby effectively improving scar appearance. This review summarizes numerous clinical and experimental studies on ablative fractional CO2 laser treatment, focusing particularly on its regulatory effects on immune cells, fibroblasts, matrix metalloproteinases (MMPs), transforming growth factor-β (TGF-β), heat shock proteins (HSPs), microRNAs (miRNAs), and basic fibroblast growth factor (bFGF) at various stages of repair. The findings demonstrate that ablative fractional CO2 laser significantly improves scars through precise thermal damage and modulation of the tissue repair. Specifically, by precisely regulating key factors such as MMPs, TGF-β, HSPs, miRNAs, and bFGF during the tissue repair phases, it promotes re-epithelialization, neovascularization, and the synthesis and orderly deposition of collagen, thereby balancing antifibrotic and pro-repair effects to improve scar texture and function. The fractional CO2 laser is an effective modality for scar treatment that promotes scar resolution and wound healing through dynamic regulation. It demonstrates significant clinical efficacy for both atrophic and hypertrophic scars, offering new perspectives and approaches for future scar management.