Scars

The way a scar forms is influenced by an individual’s age and the location of the trauma on the body or face. Younger skin makes strong repairs and tends to “over heal,” resulting in larger, thicker spots on the skin. Skin over a jawbone is tighter than skin on the cheek and will make the scarring easier to see. If the spot is indented or raised, irregular shadows will be seen in certain light conditions, 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 naturally occurring line.

Any one of these factors—or a combination of them—may result in a scar that could be improved by treatment. Scars can sometimes improve on their own, but there are several techniques that can minimize the mark. Most of these are performed routinely by licensed dermatologists, such as Dr. Ellen Turner, who offers scar treatments as part of the general dermatology services at her practice.

Only severe scarring, such as burns over a large part of the body, may require general anesthesia or a hospital stay as part of the repair process. The most important step in scar treatment is careful consultation between the patient and the dermatologist, finding out what bothers a patient most about the marks, and deciding upon the best options for treatment.

One method of improving surgical, acne, hyperpigmentation, injury, burn, 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.

Marks that are left from acne breakouts or other indented (atrophic) scars can be improved with laser skin resurfacing such as Halo^® by Sciton. Hypertrophic (thick, raised) scars or keloids typically need two or more pulsed dye laser treatments. Certified laser technicians at the Dermatology Office may also use radiofrequency microneedling such as Secret^® by Cutera or a picosecond laser depending on the color of the scar. Sun protection will be critical before and after any kind of laser-based treatment as there is a higher risk of a serious burn or discoloration if you arrive for your treatment with a tan or sunburn.

Various injectable fillers are available to elevate indented, soft patches of skin. The amount of material injected will vary with the size and firmness of the mark. Improvement will be seen right away, but is temporary, and injections often need to be repeated. The patients’ own fat or injectable donated fascia can be used in full-thickness, deep, depressed marks. Dr. Turner will discuss the available dermal fillers and help you decide which is best for you. Research is continuing to develop more long-standing substances to inject into these skin lesions.

Punch grafts are small pieces of healthy skin used to replace scarred skin. A tiny circular “cookie cutter” is used to cut a hole in the skin and remove the lesion. The area is then filled in with a matching piece of unscarred skin, usually taken from the area behind the ear, where its removal will not be easily noticed. 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 excisions form scars of their own, they provide a smoother skin surface, which is less visible than depressed lesions. Deep or “pitted” acne marks are best treated by punch grafts or excisions.