Professional Cosmetic Surgery and Healthy Ageing Clinic
In an appearance conscious society any marks or scars are more conspicuous and noticed. Over the counter scar management treatments are rarely useful except in the case of minor blemishes. Most moderate to major scars require stronger treatment available from medical practitioners only.
Depending on the type of scar and certain other individual considerations, treatment should be tailored to individual needs. It is important to get good advice from an experienced practitioner prior to having treatment for the same.
Types Of Scars
Flat Scars :Flat scars formed as part of the normal healing process, in most cases fades with time but on occasion might need surgical intervention for correction.
Keloid and Hypertrophic scars : Keloids are formed of scar tissue that extends beyond the confines of the original wound by pushing outward. Hypertrophic scars while confined to the original wound increase in size by pushing outward
Atrophic Scars : Acne scars and pox scars are examples of localised, exaggerated dermal and subcutaneous atrophic scarring.
Hypertrophic and Keloid scars may develop even after the most minor skin wounds such as insect bites, larcerations, tattoos, vaccinations, burs or blunt trauma. In most cases of Keloids a family history is observed. Localised wound healing can also affect the formation of keloids; when wounds are located along lines of relaxed skin tension there is a reduced occurrence of keloids. Abnormal function of the hypothalamus, thyroid and parathyroid glands can cause a pre-disposition to keloid formation
- Silicone Gel Sheath
- Laser Surgery
- Argon Laser
- Nd:Yag Laser
- Pulsed Dye Laser
- Intralesional cortocisteroid
Surgery can be performed to improve small keloidal scars in areas with minimal skin tension. A simple excision with extra care to remove any residual sources of inflammation including hair follicles, sinus tracts etc and re-orientation of scars to parallel lines of skin tension will produce good results with reduced chance of recurrence. For larger scars tension relieving procedures which may necessitate skin flaps and grafts need to be considered.
The surgery is performed under local anaesthetic on an out patient basis. It can between upto 30 minutes. Following the surgery a pressure dressing is applied on the treated area for atleast 24 hours. Corticosteroid injections are applied at the time of suture removal and followed up with periodic injections till the keloid is resolved. You are advised to return if there is any pain or any recurrence of the keloid for further injections.
Silicone Gel Sheeting
Silicone gel sheet is used for its scar hydrating effects. The sheet is 3.5mm thick and is a soft, adherent, semi-occulsive covering that is fabricated from medical grade cross-linked silicone polymers. Silicone gel sheath acts through scar hydration by reducing the evaporative water loss from the skin to half the normal amount. This increased hydration results in decreased capillary flow with decreased circulation.
A silicone gel sheath is trimmed to fit the dimensions of the scar and is applied to the scar for atleast 12 hours daily. If the sheeting does not adhere to the scar the use of stick tape is recommended to hold it in place with minimal skin irritation. The same sheet can be reused a number of times. In most cases this method of treatment will only provide relief from the symptoms of keloid and not affect the actual appearance of the keloid scar.
Advantages include no down time and easy care
Lasers produce tissue evaporation with minimal coagulation. These can be used to vaporise small scars and excise larger ones. There is a choice of a number of lasers for this treatment. Among them the Co2 laser is commonly used and can be most effective.
The procedure takes upto 20 minutes and is performed on an out patient basis under local anaesthetic. The area to be treated is cleaned with antiseptic solution; eyes are protected with metal shields or goggles depending on the area being treated to avoid accidental exposure/damage to laser light. The laser is applied along the periphery of the scar and then at the centre to vaporise as much of it as possible. Once fully vaporised the char is removed with a saline soaked cloth. Cold compress is applied and cleaning with cold compress 2 to 3 times a day following the procedure following the procedure, for the first 24 hours. Aqueous cream application is required for the first 3 to 5 days.
Possible side effect include blistering, infection, pigmentation changes, milia, acne flareup and scar hypertrophy
Advantages include excision one of the effective means of removal and results seen immediately in the case of large scars
The cosrtocosteroid injections are the first- line of treatment for keloids. They work by inhibiting fibroblast growth and macroglobulin, resulting in collagen degradation. The cortosteroid is injected directly into the scar. This method of treatment alone may not be effective in eliminating the scar and in most cases will only act to reduce its size. Combining with other methods of treatment may produce maximal results.
Possible side effects of of this method of treatment are skin atrophy, pigmentation changes at the treatment site, Ulceration, white deposits (subepidermal) that resolve with time.
Advantages include quick procedure, no down time and in the hands of an experienced doctor efficient means of treatment.
Atrophic scarring is a consequence of acne and varisella infections. Trauma, other infection and long standing epithelial cyst formation are processes that can also lead to atrophic scarring. Atrophic scarring is caused by fibrotic scar tissue formation. The dermal nature of the scar produces a bound down, often angular scar with an indented or inverted centre. The shape of the scar may differ but the underlying etiology is the same.
In most cases the desire to prevent acne stems from the possibility of scarring and inspite of well tested means of prevention millions of people suffer from acne scarring. There are 3 types of acne scars the box scar, the ice pick scar and the rolling scar. The most common is the crater-form box scar. The ice pick scar appears as a narrow deeply pitted scar. Rolling scars are soft, distensible with a lightly superfially wrinkle appearance.
- Subcision (for rolling scar)
- CO2 laser
- Erbium Yag Laser
- Dermabrasion and microdermabrasion
Co2 Laser : used to treat mild to moderate superficial rolling and box acne scars and very superficial ice pick scars. The results are achieved by precise, controlled, layer by layer vaporisation with minimal thermal damage to underlying normal skin.
Erbium Yag Laser : Is used by itself on in combination with Co2 laser for treatment of depressed scars. Milder than co2 laser with lesser possibility of complications such as pigmentation changes, blistering, Milia, hypertrophic scarring and acne flare-up .
Dermabrasion and micro dermabrasion : there are a number of recognised means of microdermabrasion that can effectively treat mild to moderate atrophic scars. The commonly used ones are salt peel . As the depth of penetration is not as deep as lasers the complications are much lesser if carried out by an experienced professional.