Treatment options for scars
Jan 28, 2022

There are several types of skin scars that you may want to reduce the appearance of. Think about post-acne scars, surgical scars, injury scars, burns and keloids etc. Each of them requires different or combined treatments, and some treatments may not be suitable at all.

So first, let's explore what a Scar actually is and what causes it.

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When the skin goes through trauma, a natural healing process occurs to mend the skin. Collagen, an essential protein produced by the body, is released, building up around the wound to repair and strengthen it. As the collagen builds up, it makes the skin thicker, maybe even raised and lumpy, its this process that produces what we know to be "A scar." New collagen continues to be built over the following several months.

As time goes by, that collagen breaks down. The scar becomes flatter and smoother, gradually fading over about two years. Although the scar won't wholly disappear, the appearance becomes less noticeable over time. However, we can do things to drastically improve the appearance of scars, even those that have plagued us for many years.

Treatment for scars includes chemical peels, Intralesional steroid injections ( for keloids), PRP injections with Scar revision, Micro-needling, and laser treatments. Let's explore each one in its own right.

Chemical Peels:

Chemical peels remove the outer layers of the skin. Still, with the emergence of Lasers and other scar reducing treatments, chemical peels are not as popular as they once were. Despite alternative therapies, chemical peels still have a place for mild scarring and superficial wrinkles. There are three depths of chemical peels, mild, medium and deep. Common peels include Alpha hydroxy acids, like glycolic, BHA peels, TCA peels, and Phenol peels. You may find mild peels available for home use. However, you still need to be cautious and follow the instructions to the letter because even mild peels can cause permanent skin damage.

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Intralesional steroid injections for keloids and hypertrophic scars.

Keloids and hypertrophic scars are different from other scars as they are raised and excessively thickened at the site of the trauma. Poorly healed wounds, together with genetic factors, can cause raised hypertrophic or keloid scars. If this type of scar develops after surgery, your doctor may recommend up to five steroid injections, taken every 4-6 weeks. The cortisone steroid injections help break up the scar tissue by breaking the bonds between the collagen fibres. The steroid injections have a potent anti-inflammatory action reducing swelling and redness and can help reduce the raised scars. Injections take approximately 15 minutes in an outpatient clinic, and no anaesthesia is required.

Scar Revision surgery

Scar revision involves placing another incision at the site of the original scar, removing previous skin tissue and creating a more refined or more precise scar. Sometimes the original scar may not have healed the way we expect, being overly large or ragged. While scars may be improved by surgery or further surgery, it's essential to know you will be replacing one scar with another and not completely removing it. Using special silicone sheets or gels may improve the skin even more if used as recommended by your doctor. Do not use Silicon until the wound has completely healed.

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A micro-needling device like a dermal roller or Dermapen can improve scars by creating microchannels in the skin, which initiate fibroblast cells to produce new collagen to heal the skin. The Micro-needling effect can be further enhanced by introducing active ingredients into the skin. Certain Mesotherapy products can be beneficial in further creating new collagen and are often used with micro-needling devices. For treating scars, Platelet-rich plasma containing epidermal growth factors together with the fibroblastic activity stimulated by micro-needling create a double effect on healing the skin and reducing the depth of scars.

More unique technology incorporates micro-needling combined with radiofrequency for a better result; UltraCell is one such machine proving very effective in scar reduction.

Laser Treatments

Several types of Lasers are now available to treat many different scars. Some lasers are Ablative, meaning they completely remove layers of skin. Whilst effective for more severe scars, ablative lasers have their drawbacks. Co2 and erbium lasers vaporize dermal tissue to produce new skin. However, the recovery time is long and intense as the skin goes through its healing process.

Newer lasers can produce similar results over time without a lengthy recovery period called micro-ablative lasers.

Fraxel is a well know fractional laser used in scar treatment. Non-ablative or fractional lasers work similarly as Micro-needling, creating channels in the skin. However, lasers also use energy that produces targeted heat, causing collagen remodelling in the skin. Pulsed dye and Q-switched Nd:YAG Lsers can also help reduce the scars' redness.

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Whats now?

Once you have decided to get treatment for your scars, make an appointment to consult with your plastic surgeon or dermatologist to discuss your options. Follow your pre and post procedure recommendations carefully to avoid complications occurring from various treatments.

by Lynda Amani Naji