It’s amazing and wonderful that our skin can repair itself, fusing back together after a surgical incision or traumatic injury. But the scars that are often left behind are not so wonderful.
While many scars fade over time, some appear as permanently raised, discolored marks. The way a scar heals depends on several factors, only a few of which are within our control. “You need to treat your skin like you would a fine garment that’s been mended,” says Dr. Tina Tarantola, a dermatologic and cosmetic surgeon with Washington University Physicians. “It’s important to keep an incision or wound out of the sun while it heals, and follow post-operative care instructions.” Yet she admits that even the most cautious care still doesn’t always prevent noticeable scarring.
Most patients who seek scar revision, in which an existing scar is treated to make it less obvious, have facial scars caused by some sort of traumatic injury or accident, such as an automobile accident or sports injury, says Dr. Brock Ridenour with Ridenour Plastic Surgery. Treatment depends on the scar’s degree of pigmentation, contour and relation to nearby structures, such as the lips or eyebrows.
“The approach is very individually case-dependent,” he says. However, he describes laser as the “treatment work horse.” The type of laser used again depends on the scar itself. A pulsed-dye laser can reduce redness, while a resurfacing laser can be very helpful for mild surface scarring with no distortion or major contour problems. “Lasers can work wonders at the surface,” Ridenour notes.
Tarantola agrees. “The laser field continues to advance, and the way we can alter the skin is incredible. In the future we’ll have more types of lasers in our arsenal to treat multiple skin issues, including texture, pigment, volume loss and scarring.”
In addition to laser treatments, scars can be revised through excision, a surgical procedure in which the scar’s orientation is altered or the scar is broken into shorter segments designed to be less apparent. Facial fillers, steroid injections, chemical peels or microdermabrasion also may help reduce the appearance of some scars. Yet Tarantola says that patients should have realistic expectations and seek a plastic surgeon experienced in scar revision when considering treatment.
The most effective over-the-counter treatment currently available is silicone sheeting products that are worn over the area like a bandage, says Dr. Leroy Young of BodyAesthetic Plastic Surgery. “Patients should ask their surgeons about using these products. There’s good evidence that they can have a positive effect.”
Young, the president-elect of the Aesthetic Surgery Education and Research Foundation, is researching a new type of topical therapy that is showing promise in early clinical trials. “We’re using molecular biology as the basis of our studies, and we’re beginning to develop new techniques for understanding which genes are turned on and off in the healing process. Progress is being made,” he says.
Until a breakthrough occurs, scar revision continues to be an inexact science, yet there is hope for those who no longer want to bear the visible scars that life can inflict. LN