Scars whether due to trauma, injury or surgery will gradually improve over time. After about one year, however, the majority of scars have completed their maturation, and do not significantly improve. If the scar continues to be disfiguring or more visible than desired, it may benefit from scar revision treatment.
Some scars, especially traumatic scars, may improve by converting them to a precise surgical scar. Other scars need to be reoriented to blend in with the natural skin creases and lines. A technique called z-plasty can benefit these scars. Sometimes the scar does not require further surgery, but needs to be blended into the surrounding skin through dermabrasion, derma sanding, or fractional laser resurfacing. Scars that remain red can be treated with a vascular laser to reduce the number of blood vessels and the blood flow to the scar.
Depressed scars, as seen as the result of severe acne, can be treated with skin fillers, subscision, popup grafts or skin grafts followed by dermabrasion.
Keloid scars and Hypertrophic scars are a special type of scar tissue in which the skin has not controlled the normal healing process and continues to make an excess of collagen. If a new wound is created, even more scar tissue will form. These scars are best managed with cortisone injection (to turn off the exaggerated healing), and lasers to shrink the blood vessels.
The last category of “scars” is when there is a permanent alteration of the skin’s pigment or color. Dark scars or “hyper- pigmented scars,” can be a normal part of the healing process and will naturally fade over time. This can often be hastened with good sun protection, bleaching creams, and occasionally lasers or IPL. White scars, or “hypopigmented” scars, are due to a loss of melanocytes that manufacture pigment. This loss is usually permanent, but can sometimes be improved by fractional laser resurfacing, which allows some of the pigment cells to migrate back into the lighter-colored skin areas. Alternatively, micro punch grafts of normal skin can be placed into the skin devoid of pigment to assist with the repigmenting process. This procedure is usually followed by laser resurfacing or dermabrasion.
Scar Revision Treatments
- Fractional laser resurfacing
- Skin grafting
- Vascular lasers
- Bleaching creams