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Scar Revision

In order to be successful in the treatment of scar revision one requires an observant eye and a creative multi-dimensional approach. Component analysis of the scar is the first step. By treating each of the components of the scar, the overall improvement is greatest.

Cortisone injections, medicated creams, W-plasty, resurfacing lasers, vascular removal lasers, pigment removal lasers and micropigment implantation are techniques which are used in isolation or in combination to improve the appearance of a scar. Multiple treatment sessions are usually required to achieve the best results.

In most cases the ideal time to begin scar revision is 6 to 12 weeks after the wound has occurred. This allows the laser surgeon to direct the body's natural healing process to an improved cosmetic result. In certain cases, re-excision of an old scar is performed prior to laser treatments in order to re-establish the 6 to 12 week window of opportunity for laser scar revision.

Raised Scars
If a scar is simply raised, injecting it with cortisone will cause it to flatten, making it less obvious in appearance.

Linear Scars
Scars which are linear attract attention because we naturally tend to follow a straight line with our eyes. To break up the linearity of a scar a W-plasty is performed where the scar is excised and sutured in a zigzag fashion. This creates an optical illusion so the new scar appears less obvious. Also the new scar is easier to remodel with lasers because the window of opportunity for taking advantage of the body's natural healing process has been re-established.

Thick Irregular Scars
Scars may also be irregular, thick and lumpy. Resurfacing with a carbon dioxide (CO2) laser will smooth out a lumpy scar and blend the edges into the adjacent normal tissue. The CO2 laser uses a very high energy beam of light to heat the water in the scar tissue cells to 100°C, causing them to be vaporized away. The laser light penetrates to a very precise, controlled depth, making the procedure safe and predictable. To achieve the best results this procedure often requires more than one session to gradually remove the layers of scar tissue.

Along with the laser resurfacing, medicated creams containing tretinoin and/or glycolic acid help to realign the collagen building blocks of the skin as well as smoothing out irregular texture which is common to most scarring.

Keloid Scars
Keloid scars are a problematic form of raised, lumpy scarring usually associated with hereditary factors. Keloid forms when the body produces an excessive amount of scar tissue in response to an injury of the skin. It is usually treated with cortisone injections, which flattens the scar, but in some cases keloids may be improved with lasers. Even after the scar has been flattened the body continues to lay down scar tissue. Therefore repeat treatments are usually required.

Depressed Scars
Depressions in the skin may take different forms such as ice pick scars and split pores are common post acne problems where small pits or splits form in place of an oil gland. These are best treated with punch transfers or micro- surgery. Punch transfers involve the removal of the pit with a circular scalpel. A small piece of skin from behind the ear is then transferred into the space where the pit was removed. Micro-surgery is a technique where a very small incision is made around the scar. The scar tissue is removed and the margins of the normal skin are sutured together. Laser resurfacing is often used after the punch transfer or micro-surgery has healed in order to blend the edges into the normal surrounding tissue.

Saucer shaped depressions in the skin require a different approach with implant therapy to elevate the skin. Organic and inorganic implants are available. Organic and inorganic implants each have their pros and cons and the best alternative for an individual is determined through examination and discussion.

We provide the organic implant Juvederm Ultra and Ultra Plus. Organic implants are temporary lasting anywhere from 3 to 12 months and are eventually metabolized by the body, therefore, regular touch ups are required. SoftForm and Artecoll are examples of inorganic matter which can be permanently placed under a depressed scar to elevate it.

Another option for the treatment of saucer shaped depressions is to vaporize the elevations around the depression with a resurfacing laser helping the depression to look less obvious.

Vascular Discoloration
Many scars are very vascular giving a red discoloration to the scar. The vascularity can be removed with one of the target specific vascular removal lasers.

The laser’s wavelength of light penetrates the skin and has a selective affinity for blood vessels ensuring its effectiveness. It passes through the top layer or epidermis of the skin leaving it essentially intact. When some types of laser lights hit the targeted blood vessels it causes a microscopic fragmentation of the blood cells. In the form of a bruise, the dispersed blood cells are then carried away by the body's garbage collecting cells (macrophages) leaving behind normal skin. Other types of vascular lasers seal the blood vessels and do not leave a bruise after the treatment.

Changes in Pigment
Brown discolorations may occur in scars due to an excess amount of melanin or imbedded foreign material such as asphalt into the scar. Brown discolorations can be effectively removed by using a bleaching cream containing hydroquinone in most cases however other cases may require laser treatment.

The intense light from the laser harmlessly passes through the top layer of the skin and is selectively absorbed by brown, black or blue pigment in the skin. The energy emitted by the laser light when it is absorbed breaks the melanin or foreign materials into minuscule particles which are removed by the body's immune system.


 

Definition:
A scar may be linear, raised, thick, depressed, uneven, vascular, hyperpigmented (brown discoloration) or hypopigmented (devoid of color).


 
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