Laser Therapy (PDL and Fractional)

It depends on the laser. Pulsed dye laser can be used across skin tones with careful settings but still carries a real risk of post-inflammatory hyperpigmentation in Fitzpatrick IV-VI. Ablative fractional CO2 at aggressive settings is higher risk in darker skin; many practitioners prefer non-ablative fractional lasers (1550 nm or 1927 nm), longer cooling, and lower fluences. Always ask for a test spot in an inconspicuous area and wait 4-8 weeks before committing to a full treatment. If the clinic won't do a test spot or can't show experience with skin types IV-VI, find a different provider.

LADD uses a fractional ablative laser to punch microscopic channels into the scar, then applies topical or intralesional triamcinolone or 5-FU immediately over the same area. The open channels let the medication reach far deeper and more evenly than a standard needle injection, which matters most for thick, plaque-like keloids where needle injections struggle to distribute the drug. Published trials consistently show LADD outperforms either laser or injection alone, and it's become the standard approach for resistant or large keloids in many dermatology clinics.

Different tool, different purpose. Medical lasers are high-intensity, precisely targeted devices that cause controlled tissue damage (PDL targets vessels, fractional lasers vaporize tissue) to trigger remodelling. Red light therapy (photobiomodulation) is low-intensity LED light that feeds cellular energy production without tissue damage. Laser is a clinical procedure with downtime and recurrence risk; red light is a daily at-home adjunct with no downtime. They're often used together — laser in the clinic every few weeks, red light at home every day to support recovery and extend the anti-inflammatory effect.

Most protocols run 4-6 sessions for PDL at 4-6 week intervals, or 3-5 sessions for fractional ablative at 6-8 week intervals. Response is usually assessed at the halfway point; if the scar is clearly improving, the schedule continues. Thick or long-standing keloids often need more sessions and combination with LADD or injections. If cost is a barrier, pairing a smaller number of laser sessions with consistent at-home silicone and red-light therapy is more cost-effective than pushing for more laser visits alone.

Ablative fractional (CO2, Er:YAG): 3-10 days of redness, swelling, pinpoint bleeding, and crusting, with pink skin lasting 2-4 weeks. Avoid sun exposure strictly during this window and wear high-SPF sunscreen for at least 3 months post-session to prevent hyperpigmentation. Non-ablative fractional and PDL: usually 1-3 days of redness and mild swelling with no crusting. Bruising from PDL (purpura) can last up to a week at higher fluences. Plan sessions with at least a week of low social exposure if you can.