Scars and Acne Scars: Description and Treatment
What is a scar?
Scars form as the skin repairs wounds caused by accidents, diseases (such as acne) or surgery. They are a natural part of the healing process. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar. Typically, a scar may appear red and thick at first, and then gradually fade. Many actively healing scars that seem unsightly at three months may heal nicely if given more time.
The way a scar forms is affected by an individual’s age and the location on the body or face. Younger skin makes strong repairs and tends to over heal, resulting in larger, thicker scars. Skin over a jawbone is tighter than skin on the cheek and will make a scar easier to see. If a scar is indented or raised, irregular shadows will be seen, giving the skin an uneven appearance. A scar that crosses natural expression lines, or is wider than a wrinkle, will be more apparent because it will not follow a natural pattern, nor look like a natural occurring line.
Any one, or a combination of these factors, may result in a scar that may be improved by treatment. Some scars may improve on their own, but there are several techniques that can minimize a scar. Most of these are done routinely by licensed dermatologists, such as Dr. Ellen Turner. Only severe scars, such as burns over a large part of the body, may require general anesthesia or a hospital stay. The most important step in the treatment of scars is careful consultation between the patient and the dermatologist, finding out what bothers a patient most and deciding upon the best options for treatment.
Laser Resurfacing and Laser Scar Revision
One method of improving surgical, acne, chicken pox and other scars is laser scar revision. High-energy light is used to remove or remodel unwanted, damaged skin. Patients can usually return to work or regular activity within one week, but skin may stay pink for several weeks or months, particularly after skin resurfacing with a carbon dioxide (CO2) laser. Several different lasers are available depending on the skin defect requiring improvement. Acne scars or other indented (atrophic) scars can be improved with laser skin resurfacing such as Fraxel®. Hypertrophic (thick, raised) scars or keloids typically need two or more pulsed dye laser treatments every two months.
Soft Tissue Fillers (Juvéderm®, Restylane®, hyaluronic acid or fat injections)
Various injectable fillers are available to elevate indented, soft scars. The amount of material injected will vary with the size and firmness of the scar. Bovine or human collagen may be used. Improvement is immediate but is not permanent, and collagen injections often need to be repeated. Hyaluronic acid injections often need to be repeated. Hyaluronic acid injections typically last a little longer. The patients’ own fat or injectable donated fascia can be used in full-thickness, deep, depressed scars. Dr. Turner will discuss the available dermal fillers and help you decide which is best for your scar. Research is continuing to develop more long-standing substances to inject into scars.
Punch Grafts and Punch Excision
Punch grafts are small pieces of normal skin used to replace scarred skin. A tiny circular “cookie cutter” is used to cut a hole in the skin and remove the scar. The area is then filled in with a matching piece of unscarred skin, usually taken from the skin behind the ear. The “plugs” are taped into place for five to seven days as they heal. Punch excisions, on the other hand, involve the use of stitches to close the holes produced by the tiny skin punch. The stitches are removed in five to seven days. Even though the punch grafts and excision form scars of their own, they provide a smoother skin surface, which is less visible than depressed scars. Deep or “pitted” acne scars are best treated by punch grafts or excisions.
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Cortisone (steroid) injections or tape are effective in softening very firm scars (or keloids), causing them to shrink and flatten. This treatment is popular (along with pulsed dye laser) for hypertrophic scars and keloids.
Surgical Scar Revision
Based on the ability of the skin to stretch with time, surgical scar revision is a method of removing a scar and rejoining the normal skin in a less obvious fashion. The surgical removal of scars is best suited for wide or long scars, those in prominent places or scars that have healed in a particular pattern or shape. Wide scars can often be cut out and closed, resulting in a thinner scar, and long scars can be made shorter. A technique of irregular or staggered incision lines, rather than straight-line incisions, may be used to develop a broken-line scar, which is much more difficult to recognize. Sometimes, a scar’s direction can be changed so that all or part of the scar that crosses a natural wrinkle or line falls into the wrinkle, making it less noticeable. This method can also be used to move scars into more favorable locations, such as into the hairline or a natural junction (for instance, where the nose meets the cheek). Best results are obtained when the scar is removed and wound edges are brought together without tension or movement (pull) on the skin.
Dr. Turner prides herself on outstanding patient care. She is very diligent about listening to concerns and choosing appropriate therapies for each patient. You can expect your consultation with her to be comfortable, informative and respectful. To schedule a visit with Dr. Turner to discuss therapeutic options for your scars, you can book an appointment online or call the office to make an appointment at (214) 373-7546.
How much does a scar treatment cost?
The cost will vary based on the type and extent of treatment recommended by Dr. Turner.