SKIN PROBLEMS AND TREATMENT

5.3 Treatment of the Scars

Types of Scars:

(1) 'Hypertrophic' Scars: These are the result of excessive healing process and are raised above the level of surrounding skin, reddish in color and may be painful to pressure.

(2) Atrophied Scars: These are thin scars. Often the area is slightly depressed.

Is it possible to eliminate the scar completely?

No, once the scar is formed it may remain forever, though it can be improved with the laser treatment and may become almost invisible. Scar is always scar; it cannot be eradicated cent percent but it can be eradicated up to 90-95% & its appearance can be made more pleasing or cosmetically acceptable.One often needs combination of techniques. Every technique has its advantages and limitations.

Various techniques to make scar less visible or invisible:

Surgery in scar excision, scar excision with tissue expander, skin grafting on the scar, fat grafting under the scar.

Ablative laser skin & scar resurfacing SCAARFXTM and DeepFxTM Ultra-Pulse® fractional CO2 laser skin Resurfacing, Fractional Er:YAG laser skin resurfacing

Non ablative laser scar rejuvenation with use of long pulse Nd:YAG laser, Pulse dye laser, Q-switch Nd:YAG laser.

Dermabrasion

Micro needling/RF micro needling

Chemical peels

Medical Treatment: Silicon gel sheet, application of silicon cream, keloid like cream.

Scar formation: Everybody has some scars on the face or body. Some scars on face & other part of the body (e.g-burn scar) make face less attractive. Some scars affect facial expressions. Development of the scar and its effects are highly individualistic. Patient's attitude towards the scar is variable. As people are not aware that scar can be reduced or its appearance can be improved by taking laser treatment or cosmetic treatment they do not ask treatment.

After scar formation, one may allow to pass a period of one year after injury. Or one may start preventive laser treatment immediately after healing So wound scar contracts further. As wound heals puckering of surrounding skin layers takes place. The muscles and tendons of underlying layers are affected by contraction of scar layers. In hypertrophic scar, collagen production remains in the boundaries of scar area. So, the area becomes thick and develops unsighty scar. It one feels that scar area shows thickening before one year then one can take local injection or local Ultra-Pulse® fractional CO2 laser (SCAARFXTM ) resurfacing or ablative/non ablative laser treatment to reduce thickening & to improve appearance of scar surface.

Preventive treatment on these scars : If person thinks that scar appearance should be minimum or if person has tendency of hypertrophic scars then 2-4 weeks after wound healing one should take treatment of LP Nd: YAG laser, pulse dye laser or fractional 'DeepFXTM' or 'SCAARFXTM' Ultra-Pulse® fractional CO2 laser.

Treatment of old scars: As mentioned above there are various methods to treat scars. To improve the scar appearance effectively, in most of the cases one may require more than one procedure and more than one technique or technology & more than one sitting.

a) Scar excision: (i) If scar is small it is excised fully in one sittings. If scar is of bigger size it is excised in 2 to 5 stages & finally one fine line remains. Number of sittings depend upon location & size of the scar. The remaining fine line of scar can be made less visible by using laser therapy.

In cosmetic scar excision technique wide scar tissue is excised and incisions are closed with fine invisible stitches which results into less prominent scar. That remaining fine lines of scar can be made less visible with laser treatment. (ii) If scar is of big size (burn scar, road accident scar) it can be fully excised with serial excision techniques. The remaining scar is like a fine line. (iii) Z-plasty technique: In this technique, scar from one area is moved to the other area i.e. nature fold or crease of the skin to reduce its visibility. Thus, it does not remove all scar signs but it makes scar less visible. Scar is surgically revised. The small thin line of new scar is laserised to make it less visible. In last two photo graphs CO2 laser scar resurfacing & non ablative laser skin rejuvenation was done respectively. (iv) In flap technique of removal of the scar, its entire tissue is excised. Then, skin flap from adjacent healthy skin is lifted & it is moved over the area of this new wound.(v) If scar is very big in size then additional skin surface area is increased and this additionally increased skin is used to cover scar surface. Additional increase of skin surface can be done by using tissue expander under the skin. Such tissue expander is kept for 1-3 months under the skin then that expanded skin is shifted over scar on the skin.

Skin grafting: In skin graft technique, section of the tissue of the skin from one area is taken and it is transferred to wound area from where the scar is excised. If scar is of bigger size then it can be reduced in 2-4 sittings. After each scar excision of scar reduces to minimum single line size satisfactorily. This technique is preferred in limited size of burnscar, road accident scar etc.

After facial scar excision, avoid all physical activities and facial expressions which places undue stress on the axis of the incision. Ask your surgeon about activities which should be avoided. After surgery, patient may feel some pain or discomfort. Due to natural process of healing, swelling, bruising and redness may develop locally. Keep patience till wound heals. Internal healing maturity process may continue for few months and so appearance improves gradually.

b) Ablative laser skin & scar resurfacing:SCAARFXTM and DeepFXTM Ultra-Pulse® fractional CO2 laser skin Resurfacing:

In this renewed and effective technique CO2 laser rays enter in deep layers of the scar. Ultra-Pulse® fractional CO2 laser of Deep Fx and SCAAR Fx enters 4mm depth in the scar tissue. So scar partially shrinks three dimensionally. So surface of the scar become more smooth & better in appearance. Size of the scar reduces to some extent. If there are dark layers on the surface of the scar thickness on these can be reduced by use of ActiveFXTM Ultra-Pulse® fractional CO2 laser skin resurfacing. One may need 2-5 sitting at interval of 6 to 12 weeks.

c) Non ablative laser scar rejuvenation:Scars can be made better in appearance without causing any visible injury by using non ablative long pulse Nd: YAG laser or pulse dye laser or erbium YAG Glass laser. 1340nm laser, 1450nm laser, etc. These lasers improve in fine-ness of mild scars, texture of the scar, LP Nd:YAG laser improves darkness and redness of the scars. This technique is use to improve results of other technique and in mild scars. This technique is also used when one wants mild changes or mild improvement. This technique is often used after scar excision surgery or ablative CO2 laser resurfacing of scars. Results are better if scar is reddish in colour or if person takes 6-12 sittings.

In era of cosmetic surgery, it is unjustice not to treat the scar & tolerate if for whole life on the face.

(C) LASER SURGERY OF DEPRESSED SPOTS, DEPRESSED, DEPRESSED HEALED SCARS WOUNDS

Laser surgery of depressed spots, depressed scars, depressed healed wounds can be done by 'DeepFXTM'& 'SCAARFXTM' mode of surgical Ultra-Pulse® fractional CO2 laser skin resurfacing. Treatment with the help of Ultra-Pulse® fractional CO2 laser machine heals wound faster & it is the latest and the most effective treatment to reproduce smooth & scarless skin. Patient does not need any admission. Bigger sized scars can be reduced with cosmetic scar excision surgery.To elevate depressed surface one need subcision followed by tissue grafting, fat grafting or filler rejection.

Reduction of scars with combine used of ablative & non ablative laser:This combination of Ultra-Pulse® fractional CO2 laser scar resurfacing and long pulse Nd:YAG laser/ pulse dye laser/ Q-switch Nd:YAG Laser is often used for effective results. Ifsome persons do not like to undergo any stitch procedure to reduce scar,then this combination is used.

Fat Grafting under the scar: It improves appearance of scar. Fat tissue has stem cells which improve cosmetic appearance of skin and scars of the skin. This is very effective method to improve cosmetic appearance of the face.

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