Combined Laser Strategies for Scar Treatment: A Comprehensive Review of Synergistic Protocols

Skin scars represent a complex therapeutic challenge, with significant functional, aesthetic and psychological implications. Despite advances in laser therapy, monotherapy has significant limitations, particularly in complex scars with atrophic, hypertrophic, vascular and pigmentary components. The combined use of multiple laser sources, in sequential or simultaneous mode, allows selective targeting of different tissue targets and improves clinical efficacy while maintaining a good safety profile. This narrative review critically analyses the available evidence on combination therapies for atrophic, hypertrophic, keloid, post-surgical and burn scars. Protocols combining ablative lasers (CO₂, Er:YAG), non-ablative lasers (1540–1550 nm), vascular lasers (PDL, Nd:YAG) and intense pulsed light (IPL) are reported. Possible integrations with adjuvant techniques, such as radiofrequency, PRP and laser-assisted drug delivery, are also mentioned as areas for future development. Available data suggest a promising role for multimodal strategies, but the literature remains limited by small cohorts, heterogeneous protocols and short follow-up periods. Further prospective and multicentre studies are needed to define standardised protocols and consolidate the role of combination therapies in the management of scars.