| PROCEDURES: Minimizing Scars
The Scars of Yesteryear
You Don’t Have to Live with Them Forever
If you’ve been living with a scar you feel self-conscious about, I have good news. In the past 10 years we’ve come up with a number of new techniques for lightening or hiding such scars as:
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- Keloids from a surgery
- A Caesarean section scar that prohibits wearing low-rise pants
- Acne or chicken pox scars
- Gashes from accidents on otherwise attractive legs or arms
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Insurance Will Pay For It
Although there is no way to remove scars completely, we can improve the appearance of most scars either by disguising, relocating or minimizing their prominence. These procedures are normally covered by insurance, so there’s no reason to sit around waiting and hoping. Just get it handled! Your wardrobe choices will expand, and you’ll feel more confident all-around.
Different types of scars respond to different plastic surgery techniques.
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Keloids
Keloids and hypertrophic scars are excessive tissue growth in response to skin trauma. You don’t have to have a large wound in order to form a keloid. It takes just a minor scratch, acne bump or pierced ear for a keloid to form.
The main difference between a keloid and a hypertrophic scar is size. Keloids can be overwhelmingly large, occasionally becoming baseball-size. Fortunately, this excess is not the norm. Keloids are thick, raised and rubbery.
While keloids have been stereotyped as only affecting people of color, anyone can develop a keloid. Men more commonly make keloids than women. And the upper body, especially the back and chest, may form thickened, raised scars. |
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Steroid Injections
We can minimize the appearance of a keloid by injecting a concentrated steroid solution directly into the scar. Usually the treatment is repeated every six weeks. Plan on at least 3 rounds of injections. While the steroid solution doesn´t erase the scar from view, the keloid does shrink down and flatten.
If you’ve had any pain or itching associated with the scar, it’s often resolved with this type of treatment.
Topicals
Some patients who have heard about the healing effects of steroids try to get similar results using topical steroid preparations. These can be effective for thin scars, but I have never been impressed with the results of these creams or ointments on thicker keloids. They just cannot penetrate deeply enough to be therapeutic. Steroid impregnated tapes (I can give you a prescription), can be more helpful. However, the ideal approach is through local injection.
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Silicone
What if steroid injection isn´t successful? I do often recommend silicone gels and sheets, but their applications are generally limited to areas where they can be applied under a compression dressing simultaneously. I use them mostly on extremities, and most often for burn scars (or their equivalent).
We also can try laser surgery, followed by injection with a steroid and/or application of a silicone formulation or sheeting.
Each scar is different, and each patient’s body chemistry will determine which of these therapies might work best. During a consultation I can offer you the benefit of my experience and suggest how to proceed.
Ice Pick, Pock Marks, Saucer-Shaped and Depressed Scars
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Deep jagged ice-pick scars are often the result of severe cystic acne. While acne can result in more saucer-shaped depressed scars, ice-pick scars are going to be different in management.
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Most depressed scars will respond to one of several methods of treatment.
- We can fill them with a human-derived collagen material known as Dermalogen or Cymetra
- We can fill them with another injectable tissue known as Fascian
- Restylane is a hyaluronic acid filler agent
- A series of laser or IPL treatments can stimulate fibroblasts to make collagen. Keep in mind it takes several sessions to see results.
- Fat transfers have shown good results as a filler, too.
Fairly superficial depressed scars may also respond to a series of microdermabrasions, true dermabrasion and/or chemical peels.
Ice-pick scars
Often these have to be surgically cut out and stitched back together, leaving a fine line scar instead of the deep, thickly walled, jagged skin defect. These are relatively small excisions, just large enough to get around the scar. Then microdermabrasion or another procedure can be used to make the linear scar less visible if necessary. Ice-pick scars do not tend to fill well, due to the continued visibility of the edges.
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Help Is on the Way
There’s no longer any reason to limit your wardrobe or feel self-conscious just because of an old scar. Modern medicine, using a palette of different techniques, has made that a thing of the past. |
