Easing the scars of war

Washington Tina Alster, MD, had one big worry about treating Ayad al-Sirowiy, a 13-year-old Iraqi boy who was severely scarred by shrapnel when a "bomblet" from a US cluster bomb exploded in his face.

"My biggest concern with treating Ayad," she says, "was that this was explosive material (embedded in his skin). I had to make sure I didn't end up creating little craters in his face."

But, according to her peers, if anyone could tackle this high-profile job it was clearly Dr. Alster, the founding director of the Washington Institute of Dermatological Laser Surgery-the first facility of its kind in North America. After all, the pioneering physician was one of the first to use dermatologic lasers.

Dr. Alster first saw Ayad's photo in a March 2004 New York Times article outlining the plight of the boy, who also was blinded in one eye by the bomb blast that a cow accidentally set off on his family farm in April 2003.

"I turned to my husband and said: 'I could fix him,' " Dr. Alster says.

So when Easley contacted her several months later, "It was providence," she says. "I immediately agreed to it."

Laser selection

Because of the language barrier, Dr. Alster was not able to glean more information on Ayad's condition before meeting him in July, when she immediately did a test on his ear and an injured hand. Her laser of choice: a Q-switched alexandrite by Candela, used with a 3 mm spot size and a 50 nanosecond pulse duration.

"When you're using a pigment-specific laser like that, with the very short pulse durations, you end up really blasting that tattoo granule. If there had been incendiary material, there would have been a little explosion," she says. "In that case, I would have opted to do a Fraxel (Reliant Technologies) treatment instead."

But luckily, the test proved successful, Dr. Alster says. She now believes the carbon-based particles probably came from the encasement from the bomb and other flying debris.

Youth is also on Ayad's side, according to Dr. Alster.

"In the original photo, the particles were bigger and darker, but over the course of almost a year and a half, his body has worked to break them down. Kids clear things away fast," she says, noting the biggest particles now measure the size of a pea.

Dr. Alster used intravenous anesthesia on Ayad during the one-hour procedure, which was filmed by the British Broadcasting Corp.

"If Ayad had been a little calmer, I may have been able to do topical," she says, adding that the actual treatment time was only about 30 minutes. "It went very quickly. I treated his entire face, his ear, and his hand. But I had to keep stopping for filming."

Dr. Alster waived her charges, which would have totaled about $1,500 for the anesthesia and $2,000 for the treatment.

"This is the same tattoo removal system that has been around for the last 10 years," she notes, adding that in 1995 she wrote a pioneering article about traumatic tattoos. "But I get people coming to me from all over the country because there aren't a lot of people who are familiar with this application - I suppose because we don't live in a war zone."