We all have scars whether from acne, falls, an accident, an operation, illnesses, etc. It should be noted that over time, scars tend to become less visible but never completely disappear. For this reason, in some occasions, some of them too big or in too visible places can cause discomfort, insecurity or great complexes. Because of this, today there is a wide variety of treatments to improve and camouflage them. In more severe cases, surgery may also be an option.
Types of scars
– Hypertrophic and keloid: Hypertrophic scars occur when there is an excessive accumulation of dermal tissue with growth of fibroblasts, elastin fibers and collagen fibers. It is called a keloid scar when the exuberant growth of the scar exceeds the limits of the initial wound.
– Atrophic: They appear when the dermal collagen fibers are broken. They are usually caused by acne or chickenpox. Within the atrophic scars we can also find stretch marks.
– Hyperpigmented: Usually occurs in dark skin when there is a superficial scar.
– Hypopigmented: In this type of scar the skin does not produce melanin due to the trauma that caused it. They tend to be seen more on darker skin.
Treatments to correct scars
Medical treatments should be considered when at least 10 months have passed and the scar has entered a phase of inactivity and rest. In most cases, a combination of several treatments is recommended for optimal results. The following are the most commonly used treatments.
– Fractional CO2 laser: The laser will perform a leveling of the skin by abrasion. It will be particularly effective for the treatment of acne and chickenpox marks or hypertrophic scars. This technique is not recommended for dark skin.
– Radiofrequency: Radiofrequency is characterized by an electromagnetic wave that will heat the tissues to activate the production of collagen and elastin in the skin. Often used as a method to treat skin changes generated by aging, radiofrequency also has a beneficial effect on certain types of scars. Six to eight sessions, one session per week, will be necessary to obtain satisfactory results. Finally, it is important to note that radiofrequency is not suitable for the treatment of keloid scars.
– LED Phototherapy: In phototherapy, LED lights will resonate with the cells in the injured area. This resonance will stimulate the synthesis of collagen and elastin in the skin. The skin will regenerate and the scar will be less visible. LED light therapy is especially beneficial for acne marks, stretch marks or even to activate the healing process of the skin. It will take 6 to 10 sessions to have a satisfactory result.
– Hyaluronic acid injections: Injections will be made directly into the scar, usually in sunken or recessed scars. The filling effect of the hyaluronic acid will fill the scar and make it almost invisible. This technique is recommended for acne or hollow scars (post-surgical or post-traumatic). The results will be visible 15 days after the injections and will last approximately 6 to 9 months.
– Micropigmentation: The specialist will be the one who will decide if the scar tissue is in conditions to be pigmented since 6 to 12 months must have passed in order to perform this treatment. Special care should be taken with keloid or hypertrophic scars. (as this procedure could trigger further generation of hypertrophic or keloid scarring). The patient will not notice changes in the texture of the scar, it will only be camouflaged as the color is matched to normal skin with the micropigmentation pigment. The results will be seen when the redness and swelling subside and it can take up to 30 days for the pigment to set and the definitive color to be seen. This method is valid for stretch marks, scars, etc.
Surgery for scar correction
Sometimes the scars are so large or visible that they affect a person’s self-esteem. In these cases, surgery may be the best option to treat them. It is very important that the scar is not inflamed, is in the inactive phase, has a normal color and is soft. This usually happens after about 12 to 18 months. Generally, surgery is performed under local anesthesia, although if the area is very extensive, sedation or general anesthesia and hospitalization may be necessary. A small scar can be corrected in half an hour but if it is more complex, the procedure can take several hours.
If the scar is wide and has no retraction or elevation and is not keloid, it is a dehiscence. In this case, it is indicated to remove all the scar tissue and sew the scar back together, preferably in planes. This will restart the healing process. In case the scar is not so regular, the surgeon will opt for other techniques such as Z-plasty or W-plasty.
– Z-plasty: The direction of the scar is changed, making it longer and more extensive. Although the scar becomes larger, the skin is more relaxed, which contributes to better healing.
– W-plasty: This technique is used to improve facial scars. It converts a long scar into smaller, consecutive scars for easier concealment.
– Flaps: for larger scars, there are multiple types of flaps depending on the area to be treated.
After treatment
– After a fractional CO2 laser session: In the days following the laser session, the skin may be red and irritated. The most common side effects are redness. In some cases, there may be superinfection, hyperpigmentation or poor healing of the treated area. Creams are usually used after this session.
– After a radiofrequency session: radiofrequency is a non-invasive technique. It has no significant side effects, except for a slight reddening that may appear within minutes after the session.
– After a phototherapy session: being non-invasive and completely painless, phototherapy has no side effects.
– After hyaluronic acid injections: Sometimes a slight edema or bruise may appear at the injection site. The skin will regain a normal appearance within 2 to 3 days after the injections, and the final result will be noticeable in 14-21 days.
– After micropigmentation: The patient should not scratch the treated area or remove the protective layer of skin over the lesion that will form after treatment. After one month the patient will see the specialist again to determine if a touch-up is necessary.
– After surgery: In some cases it may be necessary to wear a bandage for a few days. The scar will have to be healed with specific antiseptics prescribed by the doctor. Generally, the stitches are removed after 15-21 days and, like all scars, they will undergo a process of change until they are inactive for 12 months.
Risks and contraindications
Although the rate of complications in scar correction treatment is usually low, no surgical intervention or medical treatment is free of risk.
In the case of surgery the main complications include:
– Infections.
– Bleeding.
– Abnormal scarring.
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