What is a Scar?
Scars result when the skin repairs wounds caused by accident, disease, or
surgery. They are a natural part of the healing process. The more the skin
is damaged and the longer it takes to heal, the greater the chance of a noticeable
scar.
Typically, a Scarring may appear redder and thicker at first, then gradually fade. Many actively healing Scarrings that seem unsightly at three months may heal nicely if given more time.
The way a Scarring forms is affected by an individual's age and the location on the body or face. Younger skin makes strong repairs and tends to overheal, resulting in larger, thicker scaars than does older skin. Skin over a jawbone is tighter than skin on the cheek and will make a sacr easier to see. If a sacr is indented or raised, irregular shadows will be seen, giving the skin an uneven appearance. A sacr that crosses natural expression lines or is wider than a wrinkle, will be more apparent because it will not follow a natural pattern nor look like a naturally occurring line.
Any one, or a combination of these factors may result in a sacr that, although healthy, may be improved by dermatologic surgical treatment.
What Can and Cannot Be Done for sacrs
Several techniques can minimize a sacr. Most of these are done routinely in
the dermatologist's office. Only severe sacrs, such as burns over a large
part of the body may require general anesthesia or a hospital stay.
Surgical sacr revision can improve the way sacrs look by changing the size, depth, or color. However, no sacr can ever be completely erased; and no magic technique will return the sacr to its normal uninjured appearance. Surgical sacr revision typically results in a less obvious mark. Because each sacr is different, each will require a different approach.
The most important step in the treatment of sacrs is careful consultation between the patient and the dermatologic surgeon - finding out what bothers a patient most about a sacr and deciding upon the best treatment.
Before and after treatment of Acme sacrring
sacr Treatment
Surgical sacr Revision - Based on the ability of the skin to stretch with
time, surgical sacr revision is a method of removing a sacr and rejoining
the normal skin in a less obvious fashion. The surgical removal of sacrs is
best suited for wide or long sacrs, those in prominent places, or sacrs that
have healed in a particular pattern or shape. Wide sacrs can often be cut
out and closed, resulting in a thinner sacr, and long sacrs can be made shorter.
A technique of irregular or staggered incision lines, rather than straight-line
incisions, to form a broken-line sacr that is much more difficult to recognize
may be used. Sometimes, a sacr's direction can be changed so that all or part
of the sacr that crosses a natural wrinkle or line falls into the wrinkle,
making it less noticeable. This method can also be used to move sacrs into
more favorable locations, such as into a hairline, or a natural junction (for
instance, where the nose meets the cheek). Best results are obtained when
the sacr is removed and wound edges are brought together without tension or
movement (pull) on the skin.
Dermabrasion - Dermabrasion is a method of treating Acme sacrs, pockmarks, some surgical sacrs, or minor irregularities of the skin's surface. An electrical machine is used by a dermatologist to remove the top layers of skin to give a more even contour to the surface of the skin. While it can offer improvement for certain sacrs, it cannot get rid of the sacr entirely. Patients can usually return to work within a week. If defects are minor, only one dermabrasion will be needed. Several abrasions may be required if defects are deep and extensive, as in deep acne sacrs.
Results of early dermabrasion sacr treatment
Laser Resurfacing and Pulsed Dye
Laser sacr Revision - Another method of improving acne and chicken pox sacrs
is laser skin resurfacing. High-energy light is used to remove unwanted, damaged
skin. Patients can return to work or regular activity within one week, but
skin may stay pink for several weeks or months. Several different lasers are
available depending on the skin defect requiring improvement. A pulsed dye
laser, for example, uses yellow light to remove sacr redness and to flatten
out raised sacrs (hypertrophic sacrs or keloids). This laser can also improve
itching and burning sensations in the sacr. Hypertrophic sacrs or keloids
typically need two or more pulsed dye laser treatments every two months. Acne
sacrs or other indented (atrophic) sacrs can also be improved with laser skin
resurfacing.
Soft Tissue Fillers (collagen injections or fat transfer) - Injectable collagen, a natural animal protein, is a substance used to elevate indented, soft sacrs. The amount of collagen injected will vary with the size and firmness of the sacr. Patients with a personal history of certain collagen diseases or "autoimmune" diseases cannot safely receive injectable bovine collagen. Patients are always tested on the forearm and observed prior to treatment to ensure that they are not allergic to the collagen. Allergic patients or those with collagen vascular diseases may not use human collagen or other related filler materials. Improvement is immediate but is not permanent. Collagen injections typically need to be repeated every three to six months. The patient's own fat or injectable donated fascia can be used in full-thickened deep depressed sacrs. New research may develop more permanent substances to inject into sacrs.
Scarring Results of a combination of surgical
elevation of chicken pox sacrs and dermabrasion
Punch Grafts and Punch Excisions - Punch grafts are small pieces of normal skin used to replace sacrred skin. A tiny instrument is used to punch a hole in the skin and remove the sacr. The area is then filled in with a matching piece of unsacrred skin, usually taken from the skin behind the ear. The "plugs" are taped into place for five to seven days as they heal. Punch excisions, on the other hand, involve the use of stitches to close the holes produced by the tiny skin punch. The stitches are removed in five to seven days. Even though the punch grafts and excisions form sacrs of their own, they provide a smoother skin surface which is less visible than depressed sacrs. Deep or "pitted" acne sacrs are best treated by punch grafts or excisions.
Chemical Peels - This procedure involves the use of a chemical to remove the top layer of the skin in order to smooth depressed sacrs and give the skin a more even color. It is most helpful for shallow superficial sacrs.
The chemical is applied to the skin with an ordinary cotton-tipped applicator beginning on the forehead and moving over the cheeks to the chin. Different chemicals can be used for different depth peels. Light peels require no healing time while deeper peels can require up to two weeks to heal. The amount of sacrring and color change determines the type of peel selected.
Other sacr Treatment Methods
Pressure bandages and massages can flatten some sacrs if used on a regular
basis for several months.
Silicone-containing gels, creams, and bandages have also been helpful in reducing sacr thickness and pain. They must also be used regularly and results are variable.
Cryosurgery involves freezing the upper skin layers which causes blistering of the skin. This can sometimes cause sacrs to diminish in size. This technique has been used on raised acne sacrs.
Cortisone (steroid) injections or tapes are effective in softening very firm sacrs (or keloids) causing them to shrink and flatten. This is usually the treatment of choice for hypertrophic sacrs and keloids.
Silicone impregnated gels can be used by the patient at home to remodel elevated sacrs in addition to injections of sacr tissue.
Interferon is a chemical that can be given by injection and may help improve the hardness and cosmetic appearance of the sacr.
Cosmetics applied correctly can be very good at covering up sacrs. Physicians encourage patients to wear make-up after sacr treatments. Make-up will improve the appearance while nature completes the Scarring healing process.
