Synergistic Integration of Multimodal Lasers and Bioactive Substances for Severe Post-traumatic Facial Sequelae and Traumatic Tattooing: A Case Report

Traumatic tattoos (TTs) with chronic scarring present a complex dermatological challenge, often requiring protocols to optimize pigment clearance and skin texture. This case report evaluates the synergy between a picosecond laser (Nd:YAG 1064 nm), a fractional CO₂ laser, and biostimulants. A 33-year-old female presented with a facial TT and scarring resulting from a 10-year-old injury. The lesions were located on the right forehead and the periocular area, the latter involving an underlying titanium plate. Management began with a fractional CO₂ laser combined with platelet-rich plasma (PRP) for initial scar remodeling, followed by a picosecond laser for deep pigment removal and scar refinement. Tropocollagen injections concluded the treatment. Results after six months showed appreciable clinical regression and scar blurring. However, the periocular area demonstrated greater challenges, including prolonged erythema and swelling, due to thermal interaction with the metallic implant. This case report provides valuable data on an effective and safe alternating laser treatment regimen for complex TTs while simultaneously highlighting the necessity for meticulous parameter selection and intensive post-treatment care when dealing with underlying metallic structures.