Scar Revision Guide

How Can I Treat Scars?

Scar revision surgery minimizes the appearance of a scar by making it blend with the surrounding skin tone and texture. Patients often seek the help of a plastic surgeon after they have exhausted non-invasive treatments such as creams, ointments and silicone sheets. Since there are several types of scars, a doctor will need to evaluate the scar to determine which surgical method is appropriate. The treatment will be determined by several factors including:

  • The anatomical location of the scar
  • Type of scar
  • Skin quality
  • Skin type
  • Availability of surrounding tissue
  • Current functional impairment
  • Possibility of decreased functionality after surgery

Scar Revision with Excision

The most common form of scar revision is excision and primary closure. In fact, scar excision is the most effective method to improve deep, wide or long scars. Excision may be necessary if the scar has healed in an unusual way. This method of scar improvement involves cutting the scar out and then rejoining the skin with layered sutures to close the wound. Although it will create another scar, the new scar will be straight and thin and have a chance to heal more discreetly.

In some cases, the closure may require some tissue arrangement. After cutting the scar away, the surgeon will realign the scar with geometric rearrangements such as a z-plasty to elongate or change the direction of the scar. If a patient does not have enough healthy tissue to suitably close the wound, the surgeon may need to use a skin graft. A pharmaceutical tissue substitution can be used to cover a large area, if needed, in cases such as a patient having large scars caused by burns. After healing from scar revision surgery, the patient generally ends up with a scar that is less noticeable than before. It can take six months before the patient sees an improvement and up to a year to see the final results.

Alternative Treatments

There are many methods for treating scars including non-invasive and natural remedies. However, not all scars will respond to minimal treatment.

Laser therapies are often restricted to treating a recent scar, scars that are persistently red in color and light skin resurfacing for scars.

During scar revision with laser treatments, the surgeon uses a laser light beam on the scar and the surrounding skin. The laser removes the outer layer of skin by burning it off and this begins the regeneration of new skin. After it has healed, the new scar will look smoother as well as lighter in color. It may take multiple sessions to gain the desired appearance. Although laser therapy can make mild improvements, it is not an effective solution for most scars. Deep laser resurfacing and dermabrasion may work well for wide, raised scars that are not appropriate for excision.

Follow Post-Op Instructions

Scar revision is about improvement and not about “erasing” a scar since scars can never be completely removed. Furthermore, the lifestyle of a patient after scar revision surgery can impact the long-term outcome. Following post-op instructions and limiting sun exposure can help the scar heal better. Patients should cover the scar or apply sunscreen SPF 30 (or higher) before going outside to maximize the healing process.

-SP

How to Lessen and Remove Burn Scars

Getting Rid of Burn Scars

Scars form thanks to a natural reaction of the body during the healing process after trauma or an accident. One type of trauma that can cause scars is burns on the body. Shallow burns tend to result in light scars while deep burns can cause darker scars. Here are some of the steps patients can take to lessen and remove burn scars from the body:

Moisturizer Works Wonders

Get some moisturizer and massage the scar to increase the amount of circulation to the scar area. By increasing the amount of circulation, patients are also increasing the chances of collagen being distributed evenly throughout the skin at the area of the scar. Plus, increased circulation helps burn scars fade and flatten when performed on a regular basis.

Chemical Peel

Patients can also schedule a chemical peel to get rid of any damaged skin that is located on the outer layers of the skin. The chemical peel eats away at the damaged skin in order to reveal new healthy skin underneath the damaged or dead skin. The type of chemical peel depends on the severity of the burn and/or the scarring.

Eat Healthy

Protecting the skin from the sun is very important each time patients step outside. The UV rays from the sun can make the scars on the body become darker which, in turn, can make them more visible than ever to others. Using SPF 25 (or higher) sunscreen is necessary to protect the skin and prevent the sun from slowing down the healing process.

Food for the Body and Soul

Eating a healthy diet plays a big part in generating collagen for the skin. A well balanced diet also gives the skin the necessary nourishment it needs to heal and grow. Some of the foods patients should look for include those high in zinc and vitamin C such as peanuts, citrus fruits and some vegetables.

Patients unsure about how to implement the steps listed above should consult with a board-certified doctor. A medical professional can lead patients in the right direction and offer them advice and support when it comes to dealing with scars caused by burns on the body.

-MA

Effective Ways to Say Good-Bye to Scars

Get Rid of Scars

Do you have an unsightly scar you want to get rid of? Are you about to have a procedure and are concerned about how the scar will look afterwards? Scars not only look unappealing but they can also be painful, itchy and restrict natural motion. Thankfully, there are numerous scar treatments to remove or reduce the appearance of scars. However, there are several types of scars including hypertrophic, keloid, acne and atrophic and each may respond better to certain treatments. While some scars may be treated with topical ointments or natural remedies, other scars may need a little more help. The type of treatment will be based on the location of the scar, cause of the scar, its appearance and the type of scar. Let’s look at some effective treatments to say “good-bye” to scars:

Injections

Cortisone injections are one of the quickest and easiest ways to treat a raised or thick scar like a keloid or hypertrophic scar. Either injection can help reduce the production of collagen which causes scars to thicken. Over time, the scar will lighten and flatten out. Injections to treat scars can also calm itchiness, pain and redness associated with these types of scars. Depending on the scar, a series of injections may be needed to attain the desired outcome.

Pulsed Dye Laser

Although the redness in most scars will reduce as time passes, pulsed dye lasers (PDL) can remove the redness from the scar and the surrounding skin. Pulsed dye lasers help to blend the scar with the color of the surrounding skin while also flattening a raised scar. In addition, pulsed dye laser treatments can be performed in combination with injections. However, multiple treatments may be required to obtain the best results.

Non-ablative Laser

This type of laser treatment involves making microscopic injuries to the skin which allows new collagen to form in the area. Over time, non-ablative laser treatments can help raised scars become softer and flatter. This treatment can also be used to help fill-in acne scars and indented scars. Non-ablative laser treatments are safe to use on all skin types but multiple treatments will be needed and should be scheduled about a month apart. Patients can expect their skin to look a little puffy and red and it may take 5 days or more for the skin to return to its normal appearance.

Ablative Laser Treatments

Ablative laser treatments are generally used on dense scars. This method of scar removal usually involves fewer treatments than others but the healing time is lengthier. Healing from ablative laser treatments can take 7 to 14 days because small areas on the top layer of skin are removed during this treatment. Due to the nature of the treatment, this procedure carries greater risks and downtime than other laser treatments. Ablative laser treatments can also be combined with injections for the most optimal outcome.

Micro-needling

Micro-needing works to treat acne and atrophic (sunken) scars. It can also treat raised scars in conjunction with injections or topical treatments. Micro-needing treatments consist of using a small handheld device to distribute numerous fine needles into the skin to stimulate collagen formation. The doctor sets the depth of penetration per the thickness or flatness of the scar. Patients can expect pinpoint bleeding, redness and swelling which should heal within 2 to 3 days. This treatment can be repeated monthly until the desired improvement is made.

Radiofrequency Micro-needling

This treatment is like micro-needling except the device uses micro-needles to distribute heat at various depths. Small areas of coagulated collagen are formed and then progressively replaced with new collagen to fill-in the scars and improve their appearance. This treatment requires multiple sessions and the number of treatments depends on how severe the scars are being treated. Recovery time varies depending on the depth and strength of the radiofrequency treatment. However, patients can expect 2 to 5 days of redness with swelling and bruising.

-SP

Are Scar-less Wounds Possible In The Future?

No Scar Incision

Have you ever stopped to think about how miraculous the human body really is? Each component in the body works in different ways to heal itself, sustain functionality and maintain its own lifecycle. The skin can heal the most horrific wounds leaving only scar tissue after it heals. Although it is effective mechanism, scar tissue is not visually appealing. Luckily, the possibility of scar-less wounds is making headlines thanks to to a recent study by The Perelman School of Medicine at the University of Pennsylvania

The University conducted a study using mice and human skin samples to do what was previously believed to be impossible. The team of scientists is confident that they discovered a means that allows skin to regenerate using fat cells. “Essentially, we can manipulate wound healing so that it leads to skin regeneration rather than scarring,” stated George Cotsarelis, MD, the Milton Bixler Hartzell Professor of Dermatology at Penn and chief investigator of the project.

Adipocytes are fat cells which are normally found in the skin but are lost when wounds heal as scars. Consequently, the most common cells found in the tissue during wound healing are myofibroblasts which are thought to only create scar tissue. Researchers also know that scar tissue does not have any hair follicles which gives it an atypical appearance from healthy skin. The research team used these distinctive features as the foundation for their thesis to manipulate the myofibroblasts into fat cells that won’t cause scarring. “Typically, myofibroblasts were thought to be incapable of becoming a different type of cell,” Cotsarelis stated. He went on to add that “our work shows we have the ability to influence these cells and that they can be efficiently converted into adipocytes.”

During the study, the researchers found that they must influence the tissue to regenerate within a specific time period after the wound occurs. Otherwise, they lose the opportunity and a scar will form. To determine the window of opportunity, researchers had to discover where the signals were coming from. Eventually, they determined that Bone Morphogenetic Protein can instruct the myofibroblasts to convert into fat. They also found that the key is to regenerate hair follicles first and then the fat will regenerate in response to the signals from those follicles. In other words, the study showed that fat and hair develop separately but cannot develop independently. The hair follicles form first but the fat will not form without the new hairs. Converting the surrounding myofibroblasts by regenerating the hair follicles is crucial to creating fat cells. Once the new fat cells are formed, they are identical to the pre-existing fat cells. This discovery has opened the door to the possibility of scar-less wounds. Adipocyte loss, or fat loss, is a natural result of aging which results in saggy skin, gauntness and wrinkles. The loss of adipocytes is also a known side effect of certain medical conditions and treatments including HIV treatments.

The study is still in its earliest stages and was merely used to demonstrate proof of the concept. The experiment has not reached the point of successful hair follicle growth from a wound on a living human. Until then, doctors and patients can still use various types of scar treatments including injectable fillers, laser treatments and dermabrasion.

-SP

Scar Treatment Options

Types of Scar Treatments

Almost everyone has had a scar on their body at one time or another. Scar tissue appears on areas of the body that have been injured and protects the injured section. While it does protect the injured area, many patients consider scar tissue to be less than pleasing to the eye. Some scars heal naturally with few issues in fading and becoming less noticeable. Two of the most common types of scars include:

  • Hypertrophic scars which are scars that are larger than normal that tend to have a lumpy appearance.
  • Keloid scars are scars that become raised and spread beyond the wound due to the overgrowth of collagen.

While some scars fade and are hard to notice on the skin, other scars are not able to be completely removed after they form on the body. However, there are various forms of treatment for all types of scars to make them less noticeable in appearance. Depending on the extent of the scarring, the method of treatment might take weeks, or even months, to make a difference in the appearance of the scar. The following are some of the more common methods used for treating scars:

  • Applying pressure to a scar or placing silicone sheets over it can often improve the appearance of the scar. These treatment options tend to flatten any raised scars and also make them paler.
  • Surgery can be performed on some scars to remove them. It should be noted that the surgery might leave a new scar. However, the new scar might look better in appearance than the older scar.
  • Laser surgery can remove the raised surfaces of keloid or hypertrophic scars.
  • Skin grafts can cover scars created by burns.
  • A doctor may choose to inject corticosteroids, which is a cortisone-like medicine, into the area of a raised scar. The medicine serves to reduce inflammation as well as limit the synthesis of collagen that may have been the cause of the raised scarring in the first place.

Before deciding to undergo any kind of treatment for scars on the body, patients should consult with a doctor. Some scars can be easily treated while others might be considered permanent because they are too hard to remove. Meeting with a board-certified doctor will help a person determine the proper scar treatment to undergo in order to achieve the desired results.

Dangers of Using Accutane

One of the most effective acne treatments for patients who suffer from severe acne scarring is Isotretinoin AKA Accutane. In general, it takes 4 to 5 months for the medication to eliminate cases of acne severe enough to warrant the use of Accutane after all other treatment options have failed. It is also useful in treating acne that has not shown a complete response to creams or antibiotics. Accutane was approved by the FDA in 1982 for use as an acne medication. The American Academy of Dermatology has reported that 85% of patients who use Accutane have results that range from long-lasting to a complete reduction of acne.

Accutane Dangers

How It Works

Accutane belongs to the retinoid medication class which includes drugs that are used in cancer treatments. In fact, the drug was originally marketed as a chemotherapy drug. Accutane works by controlling the oil located in the sebaceous gland and is most often used to treat acne with nodules that are 5-mm or larger in diameter. The dosage of Accutane taken by a patient depends on his or her body weight. As mentioned above, it can take up to 4 or 5 months for the treatment to eliminate the acne.

Side Effects

As effective as Accutane is for treating severe acne, it is also known to cause side effects that range from mild to severe.

Some of the milder, and most common, side effects include:

  • Nosebleeds
  • Dry eyes
  • Cracked/Peeling skin
  • Pain in the back, joints and muscles
  • Fatigue
  • Headaches
  • Dizziness
  • Swollen or Bleeding gums

There are also a number of serious side effects associated with Accutane and they include:

  • Psychiatric disorders such as depression, aggressive behavior and suicidal thoughts
  • Inflamed bowels
  • Pancreas inflammation
  • Pseudotumor cerebri (a buildup of pressure in the skull that mimics a brain tumor)
  • Bone loss

Birth Defects

Accutane has been known to cause birth defects in women. As far back as 1985, the FDA added a black box warning telling pregnant women (or women who hope to become pregnant) not to use Accutane because of possible birth defects including fetal deformities and potential fetal death. These potential birth defects can happen even if Accutane is only taken for a short period of time by a woman who is pregnant. Some of the serious birth defects that can occur include:

  • Eye and ear abnormalities
  • Cleft palate
  • Problems with the heart and brain
  • Facial dysmorphia
  • Central nervous system malformations
  • Fetus death

Interactions with Other Drugs

Anyone who uses Accutane should be aware of how it interacts with other drugs. Patients need to consult with a board-certified physician before making the decision to actively use Accutane. While the label on the medication informs patients of the lengthy list of interactions, here are some of the most common interactions associated with Accutane:

  • Vitamin A – Toxicity can be the result if used with Accutane
  • John’s Wort – Taking this product while also using Accutane can decrease birth control effectiveness and lead to pregnancy
  • Tetracycline – When combined with Accutane, the risk of pseudotumor cerebri increases
  • Phenytoin – Since this drug can cause low mineral density in bones and Accutane can cause bone loss, the two should not be taken at the same time

Why Scars Heal Differently on the Body

Have you ever noticed that you can have scars on different parts of your body and they look dissimilar? When an injury breaches the layer of the skin, the skin cells and blood vessels become damaged and the body sends excess collagen to quickly repair the region. This is the body’s way of forming a barrier to protect it from bacteria and germs. Depending on the amount of collagen sent, it can cause the wound to heal differently and result in scar tissue that looks and feels unlike the rest of the skin. Other factors that impact how a scar heals include:

  • Genetics
  • Age
  • Lifestyle
  • Size and depth of the wound
  • Treatment methods
  • Location of the wound

Abdomen Scar healing process

Here is a rundown of different areas of the body and how scars normally heal in these regions:

  • Knees and Elbows

The knees and elbows are prone to heavy scarring since they are constantly being stretched. Therefore, the skin cannot properly regenerate and heal. The scar tissue may constrict mobility over the joints since the tissue becomes tight and less pliable. Severely limited mobility or pain may require scar revision surgery to improve functionality.

  • Chest and Shoulders

Per the National Institutes of Health, the chest and shoulder regions have the poorest results when it comes to extensive scarring because areas of tension produce thicker scars which appear more noticeable.

  • Legs

Scars tend to be thicker and more prominent on the legs since the skin is normally tighter and tougher than other parts of the body. Scars on the legs are inclined to be hypertrophic scars. Hypertrophic scars can be red in appearance and are raised above the surface of the skin.

  • Abdomen and Stomach

Scars on the abdomen and stomach generally heal well leaving a thinner, flatter scar. Surgical scars can usually be placed below the waistline or bikini line and are rarely seen while wearing everyday clothing. Additionally, this placement keeps the scar protected from the sun for optimal healing and to avoid hyperpigmentation.

  • The Mouth

When it comes to scars, the inside of your mouth is the best at healing. The intraoral tissue stays moist and can regenerate quickly. However, it is critical to keep the area clean to avoid infection. An infection will slow down scar formation and may generate a larger, denser scar.

  • Ears

A scar on the ear is generally thick and more prominent than others. This type of scar is generally a keloid scar. Keloids can be found on any part of the body but are common after an ear piercing. Like hypertrophic scars, keloids are red and raised. Unlike hypertrophic scars, keloids extend beyond the edges of the wound. Keloid scars can be minimized with pressure and topical scar treatments.

Preventing and Treating Scars

To keep scars at bay, you should keep the wound clean and moist until it has healed. Serious burns or deep cuts should be evaluated and treated by a doctor. Post-op instructions should be followed as directed to help minimize scarring. Silicone scar treatments can minimize scarring or reduce scars that have already formed. There are many different types of scar treatments available and each type of scar may respond differently to certain treatments. Consult with your doctor about which treatment might be right for your scar.

SP

Don’t Be Ashamed Of Your Scar

Be Proud of Your Scar

Everyone reacts differently to having a scar. Some people simply accept having a scar as part of their appearance while others work to find ways to treat or remove it. One thing everyone should realize is that there is no reason to be embarrassed about having a scar. The current hit song, “Scars To Your Beautiful,” addresses this very issue.

Don’t believe there is nothing to be ashamed of when it comes to having a scar? Here are 5 reasons you should not be ashamed of having a scar:

  1. The story they tell

Scars interest others and leave them wanting to know more about you. They are a daily reminder of your journey in life. The scar can be from an accident or even a birth mark scar you’ve had your entire life. Look at the scar as a way that your body shares your history with others.

  1. Scars can encourage others

Scars can raise awareness for a number of issues and causes. In fact, scars that are related to an illness can often give others the encouragement they need as they battle the same disease.

  1. They show the passage of time

Many scars tend to fade and change color as they heal. The appearance of your scar shows others how long you’ve had it as well as how far you’ve come in life since the scar first appeared.

  1. A scar can be educational to others

While you might not like to discuss the reason you have a scar, some people just can’t help asking questions about it. Talking about your scar can help others learn more about certain diseases or situations and even make them more open-minded.

  1. They make you unique

Scars can add character to your body as well as your personality. They make you just a little bit different than others and help you stand out in a crowd. Embrace your unique status and show others that you are someone to be noticed.

How the Sun Affects Scars

Sun and Scar

Did you know the sun can affect the appearance of scars both during the healing period and after they have healed? After the skin has been damaged and scar tissue forms, the new skin is very sensitive. Exposure to the sun can cause further inflammation in the tissue and create a multitude of side effects. Avoiding the sun helps with patient recovery by reducing the swelling, avoiding potential skin burns, minimizing tissue damage and scarring.

The sun plays a big part in how noticeable your scars will appear. It can darken a scar long after it heals and this is especially true for people who already have a dark skin tone. Many people believe tanning helps even out the skin tone between healthy skin and scar tissue to make the scar less noticeable. However, the UV rays of the sun can have a damaging and lasting effect on sensitive scar tissue. Healthy skin produces more melanin, or dark brown to black skin pigment, while tanning. The pigment absorbs the UV radiation and protects the skin cells from damage.

Scar tissue does not produce melanin which makes the scar tissue, as well as the surrounding skin, more susceptible to sunburn after a surgery or injury. Furthermore, scar tissue can sunburn more rapidly than healthy skin and alter the pigmentation of the scar tissue resulting in a discoloration or darkening of the scar. It can also cause the scar to thicken which creates the possibility of tissue damage.

The damage from UV rays can be permanent and the skin discoloration may never lighten to match the tone of the healthy tissue. Patients should completely avoid the sun for at least a week after surgery and limit any exposure thereafter.

It can take a full year for scar tissue to finally settle down. During this time, take precautions to protect the scar from harmful UV rays. Whenever possible, shield yourself from the sun to avoid exposure. Stay in the shade or cover up a scar with clothing. Sun hats and dresses are great for providing some protection but don’t forget to use sunscreen on a regular basis. This is especially true if the scar is on an area which can’t be covered easily. You should apply sunscreen each day before you go outside.

Be sure and use an SPF that will protect your scar from sun damage. An SPF number means the sun protection factor and an SPF of 30 or higher is recommended for the best results.

Different Methods for Removing Facial Scars

Facial Scar Removal

Having a visible scar is bad enough but when a scar is located on the facial area, it can cause self-esteem issues as well as take a toll on your professional and social confidence. Scars can be embarrassing especially when they cannot be hidden.

Scars can form as a result of an injury, acne, insect bite, cut or scrape. They can also form due to an autoimmune disease such as psoriasis or lupus. Although scarring may not be preventable in some cases, there are several options for improving the look, color or size of a scar. Some methods of scar revision include natural remedies as well as invasive and non-invasive techniques. It is important to understand that some methods may work better for certain types of scars than others.

Aloe Vera

is one of the oldest natural remedies used to treat injuries and scars. It is a great moisturizer and gentle on the skin. Apply 100% Aloe Vera gel to your face as a topical treatment to promote healing and fade a scar. Be sure to choose an Aloe Vera, which does not contain alcohol as alcohol can irritate a scar and dry the surrounding skin.

Nutmeg and honey

Make a great combination when used to reduce the look of scarring. Mix approximately 1/2 teaspoon of nutmeg with 1/4 teaspoon of honey until it becomes a paste. Wash your face and apply the mixture like a mask onto the affected areas and leave it on for approximately 20-30 minutes. A little stinging is normal and this means it is working. After 20-30 minutes, wash it off. Aloe Vera can be used afterwards as a moisturizer and to help boost the effectiveness of the treatment.

Vitamin E

Great for regenerating damaged tissue as it has been shown to penetrate layers of the skin and also reduce the formation of free radicals that interfere with healing. Vitamin E also promotes collagen production.

Scar removal

Creams such as Mederma and Revitol Scar Cream may help to remove or lessen the appearance of scars. Be sure that the scar cream is gel or serum-based and contains a medical-grade silicone as the primary/active ingredient.

Soft tissue injections

Provides almost immediate results. These are injected into the scarred area and then plump the skin and smooth the scars. Some of the most popular fillers include collagen, Radiesse and Restylane. However, these fillers are not permanent and require touch-up treatments every 6 months to 2 years in order to maintain smooth-looking skin.

Excision

A surgical procedure used to treat deep scars, wide scars or scars which healed in an unusual way. This method involves cutting out the poorly healed scar and using layered sutures to properly close the wound. The patient will still have a scar but the objective is to have a tighter and less apparent scar.

Laser resurfacing

A way of gently vaporizing the damaged or acne-scarred skin to reveal fresh skin from underneath. The surgeon directs an energy beam onto the scar and its surrounding area. The laser beam burns off the outer layer of skin, which begins the regeneration of new skin. In addition, the heat from the laser stimulates the production of collagen underneath the skin. The patient will have smoother and tighter skin once it heals.

Microdermabrasion

A gradual and gentle scar removal technique,this approach vacuums micro crystals across the skin to remove damaged scar tissue. It is described as a superficial skin polishing technique. Since this treatment is designed to be gentle on the skin, patients will need to go in for weekly sessions to achieve their desired look.

Dermabrasion

This technique allows the doctor to sand down the scarred area with a diamond burr or wire brush after the skin is injected with a local anesthetic. The results from this treatment are not immediate as it takes approximately 6 weeks for a new layer of fresh skin to regenerate. However, it is an effective means to smoother skin and less scars.

Chemical peels

A chemical solution is applied to the facial area and creates a controlled wound as it burns the top layers of skin away. The new skin can take 3 days to 3 weeks to regenerate depending on the aggressive nature of the treatment. Mild peels can be repeated a few weeks later in order to achieve the desired look. Medium-depth, and deeper, peels can be repeated in 6-12 months if desired by the patient.