Management of Scars
Introduction
Injury to the skin will result in scar formation if it extends into the deeper dermal tissue and is of sufficient volume. Skin needling for example will not cause scarring despite penetrating through the skin profile as the injury volume is very low.
After injury the repair processes result in new collagen formation within the skin, and if this process is disorderly or chaotic a notable scar will result.
Early on in scar formation the presence of new vascular tissue and inflammation is visible as redness in the area. Over time this settles and scar tissue will take on a pale or depigmented appearance. In darker skin types and on the legs brown pigmentation will often accompany scar formation.
Scars in younger people are often more visible, and certain areas tend to scar more, especially where the healing tissue may be stretched such as on the back.
Improving Outcome in Scars
Scar formation is best addressed as soon as possible. If it is due to surgery, having a wound which is not under stretch or tension is important. When stitches or sutures are removed, supporting the scar with tape is useful. Silicon dressings or gels keep the scar hydrated and are also helpful for some months. Massage of a scar may also help as well as application of anti-inflammatory oils such as Rose Hip Oil, Bio-Oil or Lavender oil.
Remodeling treatment for scars can be started early – for surgical wounds within weeks of suture removal, and for traumatic injuries within months of the injury. Acne scars are also best treated in the first six months.
Red Scars
Redness in scars can sometimes persist for many months after the initial injury. This can be treated with Intense Pulsed Light (IPL) or the vascular laser if capillaries are present and visible.
This requires a series of treatments over some weeks.
Remodelling Scars
Improving scar texture, size and shape can be assisted by remodeling treatments including fractional laser (Fraxel Laser, fractional Erbium or CO2 laser), and skin needling. These treatments gradually improve scars over a series of treatments.
Other therapies such as PRP/PRF injection, and LED light treatment are quite weak in our experience.
Improving Older Scars
Scars which are older than 1 – 2 years are less amenable to remodeling treatments. The options for treating older scars include:
- More aggressive laser treatment with ablative erbium or CO2 laser. Fractional ablative laser can still assist many years after the scarring event.
- Surgical revision of scar – in some cases surgical excision of the scar followed by Fraxel laser of the new scar bed is possible.
- Filler treatment of the scar – this can be very useful in depressed/atrophic scars and is a quick and safe procedure with results lasting 1 – 2 years.
Keloid Scars
Keloid scars are a particular type of scar where overgrowth of scar tissue gives a scar very much larger than the original injury. They are more common in darker skin types and in younger people. We most commonly see them on the ear related to piercings, but also on the shoulder, chest and beard area in men.
Cryotherapy (or freezing) of keloid scars is a good first line treatment, and if done judiciously gives excellent cosmetic results. Injecting the scar with a cortisone-like substance is commonly performed, and can be combined with cryotherapy. Surgery alone is to be avoided as scars often come back worse. There are several other treatments available in resistant cases such as injections with chemotherapy agents and radiotherapy.
By Dr David Main
