Scars

If a scar is simply raised, injecting it with cortisone will cause it to flatten making it less obvious in appearance.

Scars which are linear attract attention because we naturally tend to follow a straight line with our eyes. To break up the linearity of a scar a W-plasty is performed where the scar is excised and sutured in a zigzag fashion. This creates an optical illusion so the new scar appears less obvious. Also the new scar is easier to remodel with lasers because the window of opportunity for taking advantage of the body’s natural healing process has been re-established.

Scars may also be irregular, thick and lumpy. Resurfacing with a carbon dioxide (CO²) laser will smooth out a lumpy scar and blend the edges into the adjacent normal tissue. The CO2 laser uses a very high energy beam of light to heat the water in the scar tissue cells to 100°C, causing them to be vaporized away. The laser light penetrates to a very precise, controlled depth, making the procedure safe and predictable. To achieve the best results this procedure often requires more than one session to gradually remove the layers of scar tissue. 

 

Regular use of medicated creams containing tretinoin and/or glycolic acid are often used in combination with laser resurfacing. These creams help to realign the collagen building blocks of the skin as well as smoothing out irregular texture which is common to most scarring.

Keloid scars are a problematic form of raised, lumpy scarring. The tendency to form keloid scars is often hereditary. Keloid forms when the body produces an excessive amount of scar tissue in response to an injury of the skin. It is usually treated with cortisone injections, which flattens the scar, but in some cases keloids may be improved with lasers. Even after the scar has been flattened the body continues to lay down scar tissue. Therefore repeat treatments are usually required.

Depressions in the skin may take different forms. Ice pick scars and split pores are common post acne problems where small pits or splits form in place of an oil gland. They are best treated with punch transfers or micro-surgery. Punch transfers involve the removal of the pit with a circular scalpel. A small piece of skin from behind the ear is then transferred into the space where the pit was removed. Microsurgery is a technique where a very small incision is made around the scar. The scar tissue is removed and the margins of the normal skin are sutured together. Laser resurfacing is often used after the punch transfer or microsurgery has healed in order to blend the edges into the normal surrounding tissue. 

 

Saucer-shaped depressions in the skin require a different approach. To elevate the skin, dermal fillers are generally the treatment of choice.

Another option for the treatment of saucer-shaped depressions is to vaporize the elevations around the depression with a CO2 resurfacing laser. This helps the depression to look less obvious.

Many scars are very vascular giving a red discoloration to the scar. The vascularity can be removed with one of the target specific lasers, such as the V-Beam laser. 

 

These lasers are effective because the wavelength of light that penetrates the skin has a selective affinity for blood vessels. It passes harmlessly through the top layer or epidermis of the skin leaving it essentially intact. When it hits the targeted blood vessels, the Vbeam Laser causes a microscopic fragmentation of the blood cells. The dispersed blood cells, in the form of a bruise, are then carried away by the body’s garbage collecting cells (macrophages) leaving behind normal skin. The Help G laser seals the blood vessels and does not leave a bruise after the treatment.

Brown discolorations may occur in scars due to an excess amount of melanin or imbedded foreign material such as asphalt into the scar. In some cases this can be effectively removed by using a bleaching cream containing hydroquinone and/or kojic acid. In other cases laser treatment may be necessary. 

 

The state of the art PicoWay laser works in a similar fashion to the dye laser. The intense light from the laser passes harmlessly through the top layer of the skin and is selectively absorbed by brown, black or blue pigment in the skin. The energy emitted by the laser light when it is absorbed causes the melanin or foreign material to break into miniscule particles that are removed by the body’s immune system.

Hypopigmentation or the lack of color in a scar can be very difficult to change. It may be improved by the meticulous injection of flesh colored pigment into the scar with a technique known as micro-implantation. The other option is simply to cover the scar with cosmetics such as Derma Color.

In most cases the patient is responsible for the payment of Scar Revision Therapy. The cost varies according to the extent of the scarring and the treatment modalities used. GST applies. Treatments are charged on a per session basis. 

 

In some cases a private insurance plan may pay for the treatment. This must be arranged by the patient.