There are different types of scars that can occur on the face and body. Most scars are caused by trauma to the skin or surgery. Specialists classify scars based on their thickness and level of skin discoloration.
Scars can be treated using several effective methods that are chosen based on whether a particular scar is darkened, thickened, or widened. In our clinic scar revision is performed using the Nd- Yag laser, topical creams, subcision surgery, or scar excision and revision. Some deeper scars can be corrected using fat grafting or fillers.
Most of the procedures can be done on day care basis under local anaesthesia.
The goal of scar treatment for acne scars and depressed scars is to build new collagen at the scar base so that the skin depression can be filled naturally and recontoured. The stimulation of collagen and elastin is performed through scar subcision, scar surgery, or laser scar revision, all of which stimulate scar fibroblasts to produce collagen in the designated area of scarring. After the collagen is built, the scar resumes a normal contour and configuration relative to the surrounding tissue.
There are many reasons why patients choose to undergo scar revision. Scars can occur on any part of the body as a result of trauma, surgery, accidents, and acne. Scars can be permanent as a result of a violation of the dermis and deeper layers of the subcutaneous tissue. As a result a scar may develop that influences the overall contour of the soft tissue. Scar revision techniques include laser, chemical peels, dermabrasion, subcision, or electrodesiccation.
Scar Revision (Layered Closure)
Embryologically, the skin and soft tissue develops in specific parallel layers. Skin trauma, lacerations, and surgical incisions can sometimes destroy the positioning of these soft tissue layers, creating tethered, indented, or discordant scars that do not look visibly attractive or normal. A technique known as layered closure attempts to recreate the normal soft tissue layering by excising a scar and releasing its fibrous attachments and then resuturing the scar so as to reapproximate the different soft tissue layers. This scar revision procedure is very common on the face and abdomen in order to improve surgical scars. The most common tissue layers that are approximated include the fascia, fatty subcutaneous layer, deep dermis, and superficial dermis. Once a layered closure is complete, a combination of external sutures, steri-strips, laser, and application of Silicon gel can help modulate scar recurrence.
Microdermabrasion for Scars
Microdermabrasion can improve skin quality overlying scars and keloids. Superficial skin discoloration and epithelial slough can accumulate on the surface of a scar, causing it to become visible. In our clinic, we use microdermabrasion and PRP to remove surface impurities on the skin and reduce skin pigmentation overlying a scar. Microdermabrasion can work well to improve skin quality of scar tissue.
Soft Tissue Fillers
In the last decade, there have been major advancements in the use in stimulatory and volume fillers for scar revision. These fillers are primarily used for volume-deficient or atrophic scars in patients who have surgical or traumatic scars. Soft tissue fillers can be autologous and can be comprised of your own purified fat; or can be commercially-available fillers such as Restylane, Juvederm, Radiesse, Sculptra, Perlane, Voluma, and Belotero. These fillers are often made of hyaluronic acid or collagen and last for about one to two years. The most recent advancements in filler scar revision have been to correct major rhinoplasty scars and deformities with hyaluronic acid fillers.
Watch Dr Nithya Raghunath speaking about various treatment options for scars at the SCAR FORUM
Dr Nithya Raghunath & Dr Sreekar Harinatha’s cited research papers published on Scar Treatment
1. Keloid and hypertrophic scar distribution according to Fitzpatrick skin phototypes in Indian population- A hospital based study,
Sreekar Harinatha, Nithya Raghunath, Ravi Reddy, Ashwin Hebbar, Sreeharsha Harinatha,
Revista Brasileira de Cirurgia Plástica, 2014;29(2):309-10. (Link)
2. A randomized controlled trial comparing the efficacy of intralesional 5-fluorouracil versus triamcinolone acetonide in the treatment of keloids,
Avinash Prabhu, Sreekar Harinatha, Rajesh Powar, VM Uppin,
Journal of Scientific Society, 2012;39:19-25. (Link)
3. The role of Bleomycin in management of hypertrophic scars and keloids – A clinical trial,
Ravi Reddy, Sreekar Harinatha, Nithya Raghunath.
Our Dermatol Online. 2015;6(4):1-3. (Link)
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