Topical Treatments
Topical treatments involve gels, tapes or external compression, which can help in wound closure and healing and even reduce the ability of skin to produce a regular pigment. These products are useful for treating existing surface scars and discoloration, but may also be used to aid in the healing of scar revision procedures.
An example of a product used at our office to achieve this is Embrace. It is a combination of a silicone sheet placed over the incision. This product compresses and concomitantly diminishes the tension across the incision.
Dermabrasion
Dermabrasion is in essence a method of controlled scraping off the top layers of the skin. Using a handpiece similar to a sander. Through this method one can soften the sharp edges of surface irregularities, helping the skin to appear smoother as it heals.
This method is most often used to improve facial skin which has been scarred by accidents, previous surgery, deep acne scars, or to improve facial wrinkles. It can be used on a small patch of skin or over the entire face.
Chemical Peels
Chemical peels help to smooth and improve the texture of your skin by removing the top layer of your skin. As you heal your skin will tighten, much in the same way after a sunburn.
Although most commonly used on the skin of the face it is also useful improving the appearance of the skin on the neck and hands. It can be used in skin damaged by sun exposure, acne, or wrinkles and spots that occur as we age.
Dermal Fillers
Dermal fillers are injectables used to improve facial wrinkles and restore the facial volume one loses as they age. Due to this volume loss the muscles in our face work closer to the skin surface, enhancing the smile lines and Crow’s feet. They can also be used to enhance shallow contours thereby improving the appearance of scars which are recessed.
Steroid Injections
Steroid injections have been used to improve the appearance of hypertrophic and keloid scars. This works by decreasing the synthesis of collagen and glycosaminoglycan’s, the inflammatory process, and fibroblast proliferation within the wound. Therefore the appearance of the scar is improved by inhibiting the excessive fibrosis in the wound.
Laser Resurfacing
Also known as a laser peel, this procedure can reduce facial wrinkles, scars and blemishes. The newer laser technologies give the plastic surgeon better control in the resurfacing process. They are able to have more precision. They are very commonly used to improve scars from acne or chickenpox, enlarged oil glands on the nose, age or sun damaged skin, and fine lines and wrinkles on the forehead her mouth.
Punch Grafts
These are small skin grafts that can be used to replace scarred skin. During this procedure a whole is punched around the scar. After removal of the scar it is then replaced with unscarred skin, typically from the back of the earlobe or other areas that are easily hidden. This technique is very helpful in treating deep scars left by acne.
Surgical Scar Revision
Some scars will require a removal with layered closure, when they extend below the skin. The closure begins in the subcutaneous tissue below the skin and the surgeon continues to close in layers until the incision is fully approximated. In this way one can create a less obvious scar. Although this technique will improve the appearance of the scar, it is important to understand that a scar cannot be completely erased. More complex scars may require the rearrangement of surrounding tissue, also known as a flap procedure.
Skin Grafting
Skin grafting is the process in which a defect that could not be sutured is closed by a portion of skin taken from another site. This procedure is typically reserved for large areas of scar, such as in burn patients. The scars, especially when across joints, may limit the mobility of the patient. If this occurs the scar is excised, freeing the joint from its restriction, and it is replaced by a skin graft.
Tissue Expansion
This procedure can be substituted for skin grafting. A tissue expander, an inflatable balloon, is placed under the skin near the area of scar. It is then slowly filled with sterile solution, stretching the area of healthy skin. Once the skin has been stretched sufficiently, the scar is removed and the stretched skin is moved in to replace the scar tissue. It is not unusual that multiple surgical stages are needed in order to achieve the final result.
Autologous Fat Transfer
During this procedure fat is taken from another site on your body and is injected beneath the surface of the skin. It can be used to refill lost volume caused by deep scars, such as deep acne scars, or to elevate scars which are more superficial in nature and are slightly depressed, such as atrophic scars. The fat may be reabsorbed by the body and therefore the procedure may need to be repeated.