• laser treatment was performed using ( DEKA SmartXide DOT, Italy). Treatment parameters included power (18-20W), dwell time (800-1000µs), spacing (500-600µm, 13% density), micro spot size (120µm), and 2-3 stacks, adjusted depending on scar height

• For eye protection, eye goggles were used during the sessions. Patients were instructed to apply a full-spectrum sunscreen regularly. Topical antibiotic cream was applied twice per day for 5 days following the session, and emollients twice daily for two weeks

• Immediately following laser treatment, Botulinum toxin type A (Botox Allergan, Irvine, CA; 100U vacuum-dried powder reconstituted in 2mL of sterile, preservative-free 0.9% saline to a concentration of 5U/0.1mL) was injected intralesionally into the scar tissue for Section 1.

  • A 24-gauge needle (0.3mm × 0.8mm) was used, and the injection was continued until slight blanching was visible. The dose was adjusted to 2.5 U/cm³ of the lesion, not exceeding 100 units per session

Fractional CO2 laser treatment was performed using ( DEKA SmartXide DOT, Italy). Treatment parameters included power (18-20W), dwell time (800-1000µs), spacing (500-600µm, 13% density), micro spot size (120µm), and 2-3 stacks, adjusted depending on scar height For eye protection, eye goggles were used during the sessions. Patients were instructed to apply a full-spectrum sunscreen regularly. Topical antibiotic cream was applied twice per day for 5 days following the session, and emollients twice daily for two weeks

• Fractional CO2 laser treatment was performed using ( DEKA SmartXide DOT, Italy). Treatment parameters included power (18-20W), dwell time (800-1000µs), spacing (500-600µm, 13% density), micro spot size (120µm), and 2-3 stacks, adjusted depending on scar height (Tawfic et al., 2022). For eye protection, eye goggles were used during the sessions. Patients were instructed to apply a full-spectrum sunscreen regularly. Topical antibiotic cream was applied twice per day for 5 days following the session, and emollients twice daily for two weeks.
• Immediately following laser treatment, Botulinum toxin type A (Botox Allergan, Irvine, CA; 100U vacuum-dried powder reconstituted in 2mL of sterile, preservative-free 0.9% saline to a concentration of 5U/0.1mL) -• Immediately following laser treatment for Section 3, topical Botulinum toxin (prepared at the same concentration 2.5 U/cm³ of the lesion as for intralesional injection and adjusted to 2.5 U/cm³) was applied to the treated area topically

Fractional CO2 laser 10, 6000nm

The Patient and Observer Scar Assessment Scale (POSAS) include a 6-item Patient Scar Assessment Scale (score range 6-60) and a 5-item Observer Scar Assessment Scale (score range 5-50). Each item is scored from 1 (normal skin) to 10 (worst imaginable scar). Total scores are calculated by summing item scores. The primary endpoint is the change in POSAS total score (patient and observer components) from baseline to 3 months after the last treatment session for each of the three scar sections.

The VSS evaluates four scar characteristics: pigmentation (0-2), vascularity (0-3), pliability (0-5), and height (0-3). Total VSS score ranges from 0 to 13, with higher scores indicating more severe scarring. The outcome is the change in total VSS score between baseline and 3 months after the final treatment session.

•Scar elevation (height above surrounding normal skin) will be measured in microns using the Antera 3D camera (Miravex, Dublin). The same region of interest (ROI) is analyzed at baseline and follow-up using the software's alignment/synchronization feature. The outcome is the change in mean elevation value (µm).