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Scar treatment


Scarring occurs in a variety of forms with various differing characteristics. Scarring affects all skin types, regardless of ethnicity, and can appear anywhere on the face and body. Types of scarring include keloid, hypertrophic and atrophic.

Scars can cause considerable problems such as psychological distress, restricted movement (especially larger scars that stretch over joints), itching or discomfort. Global figures are unknown but are likely to be much higher. People with abnormal skin scarring may face physical, aesthetic, psychological, and social consequences that may be associated with substantial emotional and financial costs.

Types of scars


Atrophic scarring

An atrophic scar can occur anywhere on the body, although most of my patients decide to have facial or more noticeable atrophic scars treated. The characteristics of atrophic scars are irregular with jagged edges and a pitted, sunken, chicken-pox-like appearance. They are generally caused by damage to the underlying tissue of the skin. This tissue damage is caused by a loss of muscle or fat and the lack of sufficient collagen production in the area resulting in a sunken, depressed structure. A few examples of causes include: severe acne, chicken-pox, surgery or accidents that cause trauma to these underlying structures. Atrophic scars can be treated in a number of ways, with one of the most common being fractional laser or selective waveband technology (SWT), Fractional Radiofrequency ( Morpheus 8) and other medical options available include subcision, hyaluronic acid fillers to raise the scar, chemical peels, microneedling or medical micropigmentation.

Hypertrophic scarring

Hypertrophic scars are usually raised and darker in colour than the surrounding skin and, unlike a keloid scar, they remain within the boundaries of the wound and can continue to thicken for up to six months. A hypertrophic scar is inflexible and can restrict movement.
Hypertrophic scarring occurs after thermal and/or traumatic injury concerning the reticular dermis. Hypertrophic scar can take up to approximately two years to improve in appearance/heal fully. If there is no improvement within a year, the scar could potentially be a keloid scar. Treatments include: micropigmentation, silicone sheeting gel, scar revision surgery, steroid injections and electrosurgical excision.

Keloid scarring

Keloids are benign, dermal, fibroproliferative tumours characterised by excess collagen at the site of previous skin injury. Common causes include surgical procedures, piercings, vaccinations, lacerations, and burn injuries. Please see detail in Keloid treatment page.

Treatments


Electrosurgery and steroid injections

At the London Keloid Clinic we use a device that aims to rapidly and selectively destroy tissue by the passage of an electric current, which works to burn off the tissue in We would then follow the treatment with steroid injections. This treatment has minimal pain and scarring; however, due to it initially leaving an abrasion wound, the correct aftercare (saline wash, an antibiotic ointment and the correct dressings) is recommended to all patients to avoid potential infection. Inflammation and swelling in the treated area may occur, however this resolves itself within a few days.

Corticosteroid injections

Approximately 50-100% of keloids respond to the injection of a corticosteroid as it suppresses inflammation and mitosis while increasing vasoconstriction in the scar.6 Injections are given every two to six weeks until improvement is seen. This may cause subsequent side effects such as a network telangiectasia due to the thinning of the scar tissue or due to trauma to the area. These do subside as the scar tissue thickens, however we usually recommend a laser/SWT session to my patients to reduce or permanently remove telangiectasia.

Pigment change can also occur in the treated area. This is temporary and usually returns back to normal once the injections are reduced or stopped. If hyperpigmentation occurs, Doctors usually prescribe a 4% hydroquinone-based product to lighten the area and to treat post-inflammatory hyperpigmentation.

Fractional laser resurfacing

Fractional laser resurfacing is a popular treatment utilised for the treatment of atrophic scarring, surgical scarring and striae. At the London keloid scar Clinic we use a fractionated non-ablative laser that delivers a large number of very small spots per square centimetre of the skin. These columns of energy create a heat reaction in the dermis, which works on the principle of injury and repair leading to reversible necrosis resulting in collagenases, angiogenesis and structural changes within the dermis and scar tissue. Treatments are performed at six-week intervals and a course of three treatments is recommended. A topical anaesthetic such as EMLA or LMX 4 is applied prior to the application of the laser to reduce any discomfort. There is little to no downtime associated with this procedure, the patient will usually feel a mild sunburn sensation and there will be mild to moderate erythema present, depending on the sensitivity of the patient.

SWT (Selective Wavelengths Technology/IPL)

For any residual redness such as post-acne inflammation, post-surgical scarring the laser treatment aims to diminish the redness of a flat scar. This can be performed as soon as three weeks after surgery for optimal results, providing sutures have dissolved/been removed. SWT will treat the very light salmon-coloured scars using the sub millisecond pulse.10 Practitioners should be trained thoroughly on the administration of SWT and take care to ensure that the appropriate energy levels are delivered safely with the most suitable pulse duration used.

Surgery

Surgery can improve the appearance of scars, change the shape of the scar and release a tight scar that is close to a joint in order to improve movement. Scar revision is a process of removing scar tissue. After the excision the new wound is usually closed in order to heal by primary intention, instead of secondary intention. Deeper cuts need a multi-layered closure to heal optimally, otherwise depressed or dented scars can result. Surgical excision of hypertrophic or keloid scars is often associated with other methods such as steroid injection, pressotherapy or silicone gel sheeting. Be aware that performing surgery on a scar will leave a new scar and I have found that may take up to two years to heal. There is also an increased risk of further keloid and hypertrophic scarring following surgery. After surgery the recurrence rate for keloid scarring is approximately 50-80%.

Dermal fillers

Dermal filler injections can be used to “plump up” pitted, athrophic and indented scars. Treatments provide instant results and the results usually last 1-2 years. Repeat treatments are needed to maintain the effect. There is very little discomfort and downtime. Commonly Hyaluronic acid dermal filler are used. It is the substance that naturally found in our skin and dissolveable. Sometimes Subcision procedure may be performed prior the injection to release the scar tissue first.

Skin pen microneedling

Skin needling, which involves rolling a small device covered in hundreds of tiny needles across the skin, can also help improve the appearance of scars. But repeat treatments are often needed to achieve an effect, and results vary considerably.

Fractional Radio Frequency (Morpheus 8)

The FDA approved Morpheus8, the powerful and deepest Subdermal Fractional micro-needling Radio Frequency (RF) technology. It’s renowned treatment to achieve collagen and elastin production and even smoothing down under-skin. ` The Morpheus 8 microneedles can go deeper than any RF microneedling device on the market to date, up to 4 mm.

Microneedling fractional radiofrequency is efficacious for the treatment of moderate and severe acne scars.

“My team share my passion for the aesthetics industry and only through this passion are we able to provide our patients with a truly outstanding experience.”

Dr Salinda Johnson

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