Scar treatments


What is in a scar?


Scars are the result of the skin’s repair of wounds caused by accident, disease, or surgery. This is a natural part of the healing process. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar.

Typically, a scar will become more prominent at first, then gradually fade. Many actively healing scars which seem unsightly at three months may heal quite satisfactorily if given more time.

A scar’s appearance will depend on its color, texture, depth, length, width or location. How the scar forms will also be affected by an individual’s age and location on the body or face. Younger skin makes strong repairs and tends to over heal, resulting in larger, thicker scars than on older skin. Skin over a jawbone is tighter than skin on the cheek and will make a scar easier to see. If a scar is depressed, it will make skin seem shaded, and if it is higher than surrounding skin, it will cast a shadow. A scar that crosses natural expression lines will be more apparent because it will not follow a natural pattern, and a scar that is wider than a wrinkle will stand out because it is not a naturally occurring line.

 Any one, or a combination, of these factors may result in a scar that, although healthy, may be improved by treatment.

 

Types of scars:                                           Medical Name:

Raised and thickened                                   Hypertrophic and keloid

Red                                                               Erythematous

Dark                                                              Pigmented

Thinned/sunken/hollow                                 Atrophic

Ice pick                                                          Ice pick

Crater                                                            Punched out

 

What can and cannot be done for scars

Several techniques can minimize a scar. Most of these are done routinely in the dermatologist’s office with local anesthesia. Only severe scars, such as burns over a large part of the body, require general anesthesia and a hospital stay.

Surgical scar revision can change the length, width, or direction of a scar; raise depressed scars, or lower elevated scars. However, no scar can ever be completely erased; and no magic technique will return skin to its uninjured appearance. Surgical scar revision can provide improvement in the appearance of the skin, while leaving another—though less obvious—mark. In addition, a scar’s color cannot be altered; as it gets older, it usually fades and can often be hidden with make-up, but a certain difference in pigmentation will usually remain.

The most important step in the treatment of scars is careful consultation between patient and dermatologist—finding out what bothers a patient most about a scar and deciding the best treatment. Physicians stress that each scar is different, and each requires a different approach.


SPECIFIC TREATMENTS


Despite claims to the contrary, you can’t eliminate scars altogether but, with the latest treatments, you can reduce them. You don’t want to over treat a scar and cause any more damage. 

Some of the most frequently used methods of scar reduction are:


Tretinoin or Tazarotene Gel   Vitamin A prescription creams and gels that increase new collagen production under some scars.   If scar is on sun exposed skin, protect with daily sunscreen.

Best for:  Minor scars.

Disadvantages:  Some people may experience skin irritation, and results can be subtle.

 

Silica patches and tapes   Small plaster-like cushions that sometimes contain silicone (said to accelerate the healing of thick scars).

Best for: Small early raised scars, according to manufacturers.

Disadvantages:  Experts haven’t seen much evidence that they work very well.  But they can’t hurt and compared to something costly like laser surgery they are cheap enough to try out for yourself.   May be used in addition to the other treatments.

 

Cortisone cream, injections  and tape  One of the most common ways to reduce a scar.

Best for:  Hypertrophic (red, raised) scars, but also effective in shrinking and flattening very firm scars (keloids).

Disadvantages:  Over time, cortisones can cause a chronic thinning of the skin.


Flurouracil injections

Best for:  Hypertrophic scars and keloids.

Disadvantages:  Several sessions needed.


Scar Subcision and Elevation 

Best for:  Saucer shaped sunken scars.

Disadvantages:  Risk of temporary bruising. Often needs to be repeated.  Further surgery.

 

Vascular Lasers   This process targets blood vessels feeding the scar, leading to flattening and lightening of the scar.

Best for:  Works best on red, raised, thick and keloid scars, active acne and flat red scars.

Disadvantages:  Will need multiple treatments.

 

Fraxel Lasers (Dual and Restore)   These lead to renewal of the top layers of skin and may help reduce appearance of scars.

Best for:  Improving minor skin irregularities, such as sunken acne scars and ‘rolling’ type of scars. Discoloured scars.

Disadvantages:  Several treatments are needed.

 

Fraxel (Carbon dioxide) Laser  More powerful for effective skin ‘impact’.

Best for:  Severe scars

Disadvantages:  7-10 days healing time.  Possible ‘whitening’ of skin.

 

IntraCel    Combining micro-needling and radio frequency.

Best for:  ‘Hollow’ sunken scars, ‘icepick’ scars. Helps some acne spots.

Disadvantages:  Several treatments are needed.

 


Microdermabrasion, DermaSweep & mild chemical peels.  Superficial skin abrasion or an acid solution is applied to the skin, removing the top layers of the skin.

Best for:  Small superficial scars, diminishing smooth, sunken scars and evening out skin tone.

Disadvantages:  Light peels require very little healing time, but deeper ones may require up to two weeks to heal and may cause redness and irritation.  Not suitable for deeper scars.

 

Filler Injections.  These are injected into the scar site.

Best for:  Raising soft, sunken scars such as those from acne. Results can be long lasting.

Disadvantages:  Repeat treatments are sometimes required.

 

Surgical Revision.  The scar is cut away and the skin is rejoined in a less noticeable fashion.

Best for:  Wide or long scars, and scars that are the product of plastic surgery procedures.

Disadvantages: further surgery, larger scar may return.



Atrophic Scar, Ellanse Filler

Scar treatment combine treatments with Botox, HA Filler & RF Microneedle

Atrophic Scar, HA Filler & Tretinoin cream

Keloid scar before and after radiofrequency & injections

Scar treated with Vascular laser