Scar Revision

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If you have a troubling scar, there are options available for improving its appearance. Scars occur as the result of an injury, including burns, lacerations, or surgical procedures. Scars can also result from skin conditions like acne or infections like chickenpox. Treatment of acne scars or other facial scars that have resulted from infections like chicken pox are among the most commonly requested reasons for scar revision or treatment.

During the healing process, a scar forms as the body repairs a wound and new tissue grows to fill a defect in skin or other damaged tissue. Although scars are composed of collagen, just as normal skin, the alignment of collagen in a scar occurs in a single direction, unlike the random pattern in normal tissue. The structural differences in scar tissue result in functional changes in skin, and loss of skin elements like hair follicles or sweat glands. As a wound heals, an area of fibrous skin grows over a wound that is often thicker than your normal skin. The most effective way to minimize scarring after an injury is good wound care, including prevention of infection and avoidance of smoking, which slows wound healing.Conditions like diabetes are known to impair wound healing.

Formation of a scar depends upon several characteristics, including the size of the wound, the location of the wound, the age of the patient, and genetic predisposition to scarring. Scars generally involve the dermis of the skin, which is a thick layer lying underneath the superficial epidermis. Most scars fade over time, but they don’t disappear. In some cases, troublesome scars can be disfiguring or bothersome, prompting patients to seek solutions.

Some individuals produce excessively stiff and proliferative scar tissue, resulting from overproduction of collagen in the wound healing response. This results in keloid scarring and hypertrophic scarring. These scars are raised about the normal skin surrounding the healing wound. Keloid scars occur most commonly in individuals with dark skin. They are characterized by scarring outside the original wound area and can form large masses that, although unsightly, are benign. However, they can sometimes cause itching or discomfort. Other individuals may produce an inadequate amount of collagen during wound healing, resulting in sunken scars, which are known as atrophic scars. Atrophic scars are often associated with acne or the skin lesions of chickenpox.

During wound healing, redness is common and does not constitute scarring. It occurs as part of the inflammatory process during wound healing, and may takes days to months to dissipate. Scars are most likely to occur when wound healing is delayed. In normal wound healing, a layer of epithelial tissue will fill in a wound within two weeks, preventing overproduction of collage. After the initial phase of inflammation, cells produce and modify collagen within the wound. The final phase of wound healing may take up to a year, during which the body remodels the collagen fibers that have been deposited in the wound, increasing the strength of the tissue.

There are a number of effective treatments available to improve the appearance of scarring. People with acne scarring or scars left from chicken pox frequently request treatment to improve the appearance of scarring, particularly on the face. In additional to the use of application of topical products, like silicone gels, creams, or salves, scars with areas of depression can be filled with dermal fillers very successfully. Raised scars can often be treated with laser resurfacing or cryotherapy. Some patients with keloid scarring undergo excision of the keloid tissue with injection of steroids to minimize continued scarring after excision.

Patients who have a history of keloid scarring benefit from application of silicone gels or self-adhesive sheets in the event of a wound. Dermabrasion can be useful for reduction of mildly elevated scars, but are not recommended for true hypertrophic or keloid scarring. Laser therapy, which limits damage to the underlying dermis, is very effective for reduction of prominent scars. Although infection rates are low, patients may experience some redness, swelling, or itching after therapy.

Topical retinoids applied to the skin are sometimes effective as a resurfacing treatment. Chemical peels range in strength and include salicylic acid and glycolic acid solutions. Studies have shown that chemical peels are very effective in improvement of the appearance of pitted scars. For depressed or contracted scars, injection of dermal filler can be used to elevate the skin and make the area less prominent, a particularly effective technique for improving the appearance of pitting acne scars. Fillers include collagen and filler materials like Juvederm or Restylane, which provide temporary correction. Permanent options are available, but the likelihood of significant adverse effects is much higher.

Patients should have realistic expectations when deciding on scar revision treatments, so a consultation with a professional experienced in treatment of scarring is important before deciding to undergo therapy. If you are troubled by scarring and considering options to minimize the appearance of unsightly scars, call us for a consultation with a cosmetic dermatologist at one of our convenient locations in Beverly Hills, Encino, or Glendale.

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