Treatment of Scars
An unattractive scar on a readily visible body site often makes a patient feel deformed, unattractive and may even impair his or her ability to form and maintain relationships! Scars can be the result of an injury, an operation or even following inflammatory skin diseases such as acne or bacterial abscesses. Once the scars have developed, regardless of their cause, they can affect not just the skin but also the soul. A smooth, regular and unmarked skin is taken as a sign of attractiveness, youthfulness and health. Correcting a scar can not only improve the physical appearance of the lesion but also improve the self-image and attitude of the patient. Unfortunately, it is an illusion to believe that any treatment can make scars completely disappear and become invisible!
There are many methods of scar correction. The choice of therapy must be individualized depending on the type of scar, how long it has been present, the age of the patient, the location and the extent of the scar. These are some of the possible conservative, minimally-invasive and surgical methods which I employ.
Scars following surgery or injury may benefit from prophylactic treatment. Possible approaches include silicone gels or sheets, as well as creams containing onion extract or urea. These approaches improve the circulation in the tissue and increase the skin moisture content by enhancing the skin barrier function. They must be used 1-2x daily for many weeks. In addition the regular use of high-potency sunscreens (SPF 50) is recommended in order to reduce the likelihood of darkening of the scar through exposure to sunlight.
Solitary dehiscent (stretched), sunken or wide scars are often best approached by surgical excision. Re-excision with a scalpel, perhaps coupled with re-adjusting the scar configuration to reduce tension, and careful, multi-layered closure often leads to a less obvious fine scar.
Many dehiscent scars and stretch marks (striae distensae) after pregnancy or marked weight change, as well as some acne scars, can be improved using modern devices to deliver fractionated laser therapy. The scar and the surrounding skin become more similar in texture and color after repeated treatments. In addition, the synthesis of collagen is stimulated which improves the structure of the scar or stretch mark and surrounding tissue. Dilated vessels and brown discoloration in scar tissue can be treated with high-intensity pulsed light (IPL) devices.
Hypertrophic scars are scars which have proliferated in the original incision or trauma site. They often look like an “earthworm” on the skin surface. They are not only unattractive, but tend to continue to grow and may be itchy or painful. Their growth can often be arrested with cryotherapy (freezing with liquid nitrogen spray) or intralesional injection of cortisone and /or cytostatic agent with a fine needle directly into the lesion. Repeated treatment should level out the raised scar or even produce a sunken scar which can be managed as discussed above. The surgical excision of hypertrophic scars with the intention of producing a fine linear scar is reasonable; but even when optimal surgical techniques are used, the risk of a recurrence is considerable.
Keloids are scars which have extended beyond the boundaries of the original incision or trauma site. They should not be re-excised as the risk of recurrence or even worsening is extremely high. Keloids are not only unattractive, but usually itchy or painful. They also continue to grow. Thus they are a great challenge for the treating physician. Therapeutic approaches include tangential excision (shaving off the tumor at the level of skin surface), repeated cryotherapy and intralesional injection of cortisone and/or a cytostatic agent. All of these can be combined. Fortunately keloids are uncommon, but there are some body sites where they are more likely to appear after surgery, trauma or inflammation. Patients must be aware of the increased risk of keloid formation following operations on the neck, ear lobes, décolleté, breasts or back.
When acne heals, it can leave behind a wide variety of scars which may create a considerable emotional burden for the patient. The possibilities for scar correction after acne are discussed under Acne / Rosacea.
Deep broad scars are better treated with subcision. After incising the strands of connective tissue at the base of the scar, it is possible to elevate the scar. Using a sharp Strauss cannula the surgeon penetrates the skin at just one point and then working in a „windshield wiper“ pattern, fans out to undermine and free up the broad scar. In addition, injections of autologous fat or hyaluronic acid can help to level out the skin profile; these injections usually must be repeated several times. Subcision is also used in treating cellulite.
In a personalized consultation, I will be happy to discuss with you which approaches are best for your scar or scars.