Scar Treatment

What are scars?

Scars are the marks that are left on the skin after an injury is healed. Scars can be caused by trauma, cuts, burns, acne, and skin related diseases like vitiligo or chickenpox. Scars are thicker, and shinier than normal skin and can appear anywhere on the body. They are usually red or pink in colour. Scars do not immediately disappear but fade in time. To make a scar as invisible as possible requires extra effort from both the patient and the surgical practitioner.

What are the different types of scars?

• Keloid scar: These are thick, raised, and are often red or dark in colour. They are caused by the over production of collagen that grows beyond the wound.
• Hypertrophic scars: These are also thick, red, and are raised. But unlike keloid scars they do not grow over the wound but instead remain within their boundary.
• Contractures: This occurs when the elastic nature of the skin is replaced with fibres which make the skin more rigid losing the ability to stretch and restricting movement. This can occur with burns or with the loss of a large area of skin from injury.

What are the non-surgical treatments for scars?

• Creams or lotions: Vitamin A, Vitamin E, or retinoic acid can be applied to the scar to improve the appearance and surface of the scar. Anti-mitotic agents (5-fluorouracil or bleomycin) prevent the cells from dividing in the scar region so that the scar will not spread. These anti-mitotic agents are not used in pregnant women.
• Laser therapy: This treatment is more advanced and works very effectively. Light is emitted from a light source and the radiations emitted through this light are directly passed on the scar. Lasers use thermal (heat) energy to heat and destroy the targeted tissue.
• Silicon and collagen injections: These injections are used for treating scars that have deep cavities and holes with the goal of leaving behind an unnoticeable scar. A numbness cream is applied before the treatment. Collagen requires a skin test before use to assess for reaction and sensitivity. Silicone, FDA approved for ophthalmologic use, has been used in an off-label manner for over 25 years. It is permanent and requires multiple sessions to achieve results. Silicone is injected in droplets to help in the growth of collagen.
• Dermabrasion: This technique is also a widely used skin treatment to remove scarring and imperfections. This technique uses a hand-held electronic tool with a wire brush and sanding tool. Sand-like particles are applied on the skin to scrape off the scarred outer layers so new skin can grow in its place.

What are acne scars?

Acne is a common skin condition that about 80% of people develop in their teenage years. Often, acne may resolve itself without leaving behind permanent marks on the skin; however certain individuals may get displeasing acne scars. If any skin defects remain even after 1 year, it is considered to be a permanent defect or scar.

What are the types of acne scars?

Acne scars can be classified into two major types based on the response of the tissues to the inflammation as follows:

• Scars formed by increased tissue formation–Hypertrophic or Keloid scars
• Scars formed by loss of tissue
  • Ice-pick scars
  • Boxcar scars
  • Rolling scars
  • Depressed fibrotic scars
  • Superficial and deep soft scars
  • Atrophic macules

How are acne scars treated?

There are several surgical and non-surgical techniques available for acne scar revision and your Cosmetic Surgery Practitioner will discuss the most suitable option for your particular situation. The non-surgical techniques include:

• Chemical peel: This technique involves applying a high-potency acid to remove the top layer of the skin. New skin forms within 15 days. It is helpful to treat small scars. It is necessary to protect your skin from the sun exposure after a chemical peel is done to prevent further irritation.
• Dermabrasion: This procedure is performed at your doctor’s office under local or general anesthesia. Your doctor will abrade the top layer of your skin with a handheld device which moves in a back and forth or in a circular motion over the skin. Cold compresses are used to control bleeding and the area will be covered with a sterile dressing.
• Laser resurfacing of scars: This is a newer technology used to treat depressed acne scars. The tissue penetration power of a YAG laser helps to improve the scars and the infrared beam of the carbon dioxide laser may be used to elevate depressed scars by tightening the collagen fibres. After the treatment, antibiotics will be prescribed to help healing and a surgical dressing is applied. You can resume normal activities within 2 weeks.
• Soft-tissue augmentation: This technique is used to treat scars caused by loss of tissue. Your doctor may inject fat fillers such as collagen, hyaluronic acid, or polymethylmethacrylate (PMMA) into subcutaneous fat below the scars to elevate the scar to skin surface level and give your skin an even surface. Repeated treatments may be recommended.
• Intralesional steroid injection: Steroids are directly injected into the scars. This helps to improve keloid scars.

It is important to remember when undergoing any treatment for acne scars that improvement is the goal. Several treatments may be necessary to achieve optimal correction. Combining these different procedures may be needed to better address individual problems. Additional sessions to treat other areas or to retreat previously addressed areas can be scheduled at monthly intervals.