It is common for patients to request improvements of scars of the face and body. These could be from post-acne scarring, trauma such as cuts and burns or wounds from previous surgery.
In general, the aim would be to improve the colour and the contour of the patient’s scars.
Improvement of the Colour of a Scar
If a scar is fresh and red, this is usually due to the presence of small blood vessels which are part of the natural healing process. These early scars can be treated with creams to reduce redness such as Centellase or Mederma.
If the scar is dark due to the presence of melanin, then a depigmenting agent such as hydroquinone can be used together with sunblock SPF 50 to improve the colour of the scar.
For the scars with more stubborn discolouration, light based therapies such as lasers or Sciton BBL (broadband light) can be used. The light output and colour can be tuned to improve redness and also to improve discolouration due to melanin.
Improvement of the Contour of a Scar
Scars can either be depressed or raised. This is due to atrophy in the area of a scar or hypertrophy of the scar. A severe form of scar hypertrophy is known as a keloid- in this, the scar tissue spreads beyond the margins of the original scar.
Depressed scars can be treated with light based therapies. These include erbium lasers, which have a “sandpapering” effect to smoothen scars. Better still, we use a mixture of erbium and fractional laser therapy using the Fraxel Duo laser. This has the additional effect of strong collagen stimulation. The laser treatments are done 4-6 weeks apart and the two lasers are used alternately. This is done at the laser centre. There is a 3 day downtime after an erbium treatment but very little downtime with the Fraxel. A patient would be pre-treated with cosmeceuticals for 1 month prior to the treatment to minimize the risk of post-inflammatory hyperpigmentation.
For broader based depressed scars, a technique called subcision is used. This is where the base of an acne scar, for example, is released with a needle and filler used to raise the overlying skin. This will improve the depressed nature of the scar thus making it less obvious. There is a 24 hour downtime and the subcision sites are red and swollen initially.
Raised keloidal scars can be smoothened with pressure therapy, serial injection of steroids into the scar or revised as described below.
Finally, wide or raised scars can be excised individually and stitched according to plastic surgery principles to improve isolated scars. These are good for broad and discoloured scars including those from previous surgeries. Although the procedure itself does leave a scar, the purpose of this scar revision would be to make one that is less obvious. Depending on the size and position of the scar, these procedures will be done in clinic or operating theatre under local or general anesthesia.