Cosmetic - Scars

Scar Revision

Scars are an abnormal healing response of the skin to injury. There are many types of scars: atrophic scars, hypertrophic scars, and keloids. While atrophic scars are skin depressions, hypertrophic and keloid scars are elevated or raised. No matter what type of scar is present or where it is located, there are many treatment options that can significantly reduce its appearance.

Atrophic scars often result from imbedded material or injuries that removed a significant amount of tissue. Acne scars are a very common type of atrophic scar. This type of scar can benefit from a number of non-invasive treatments. For acne scarring and other widespread scarring, the fractional resurfacing laser treatments are the most effective treatment. While both the non-ablative and ablative resurfacing lasers can be used and are effective, the fractional CO2 laser gives the most impressive result on scars, particularly large deep scars such as burns.

Scars with uneven surfaces, such as bumps or ridges, can also be smoothed using certain lasers that vaporize the elevations of the scar and flatten them to produce a smoother surface. The pulsed dye laser and IPL can minimize the red color and dark pigment within some scars. Some scars require treatment by a combination of lasers.

Other treatments for acne scarring include surgical excisions of scar tissue, surgical subcision and dermal fillers. Surgical ‘punch’ excisions of scar tissue are the treatment of choice for so called ‘ice pick’ scarring. Small 2-4mm pieces of scar tissue are removed and tissue is stitched together. This is done in the office under local anaesthesia and often paired with laser resurfacing done at suture removal.

Surgical subcision can be used in larger areas and for certain types of scars where there is scar tissue underneath the skin. Under local anaesthesia, the deep scar is “broken apart” and separated from the overlying skin using a large needle. This often gives temporary bruising, but can raise larger scarred areas and make less laser treatments necessary.

Dermal fillers can also be used to elevate indented, soft scars. Improvement is immediate, but the trade-off is that it is not permanent. Injections typically need to be repeated every 6-10 months.

Lasers can also be used to reduce the appearance of hypertrophic scars. Pulsed dye lasers and IPL have been the standard treatment for hypertrophic scars and keloids. Usually combination therapy is needed to treat hypertrophic scars and keloids since the response can be variable. In order to flatten the scar, intra-lesional steroid injections are frequently used in addition to topical therapies worn daily. IPL is used more to reduce its red appearance, and improve the itching and burning sensations commonly associated with them.

While hypertrophic and keloid scars can be treated at any time, the best results occur when they are treated as early as possible.

Recovery times vary depending on the procedure and/or combination of treatments.

To learn more about available treatments or to schedule an appointment, please complete the form below or call the office at 860.243.3020.

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