There are many types of scars and each requires specific treatments. Generally, scars are classified according to the cause of the injury or the type of scars. Scars are difficult to erase completely – most treatments are to improve the appearance
Treatment of scars
Treatment of scars depends on the aetiology and type of scars. Sometimes a combination of treatments are needed to treat a single scar
Treatments available to treat scars
- Prescription creams: to improve the colour and the texture
- Corticosteroid injection/tape/ointment
- Non steroid injections: 5FU, interferon, bleomycin, neurotoxins
- Chemical peels
- Chemical reconstruction of skin scars (TCA CROSS)
- Cryotherapy: liquid nitrogen
- Light therapy : IPL, LED
- Fractional Laser scar resurfacing : CO2laser, Fraxel laser, YouLaserMT
- Fractional Radiofrequency
- Jet volumetric remodelling (Enerjet )
- Thermo- mechanical remodelling (Tixel Pro)
- Surgery: subcision, punch excision, punch elevation, scar revision
- Dermal filler injections
Treatment of superficial scars with chemical peels
Chemical agents are applied on the scars to improve the colour or the texture of superficial scars. Sometimes several sessions are needed
Treatment of pitted scars with chemical reconstruction of skin scars (TCA CROSS)
A strong chemical (usually trichloroacetic acid) is applied to the apex of the scars. The chemical removes some of the scar tissue and stimulate new collagen below the scars. Several treatments at 4-8 weeks are done till the scars are flat. Sometimes TCA CROSS is done before scar resurfacing or remodelling by the Youlaser MT or Enerjet or Tixel Pro.
Advantages of TCA CROSS
- Simple, safe and effective treatment
- Minimal downtime
Treatment of keloid or hypertrophic scars with cryotherapy( liquid nitrogen)
Liquid nitrogen is sprayed onto keloid or hypertrophic scars to soften the scars before intralesional injection. Sometimes a probe is inserted into the scar to deliver liquid nitrogen to shrink the scar
Treatment of coloured or superficial scars with light therapy
Certain wavelengths of lights are applied onto scars to improve the red or brown scars and also to improve the texture. The lights can be a broad band light (IPL) or a specific wavelength (LED light).
Advantages of light therapy
- Non-invasive and effective for certain scars
- No downtime
Treatment of scars with fractional laser scar resurfacing
Fractional lasers can resurface both depressed and raised scars.
- They can be either the ablative lasers (CO2laser, Erbium-YAG laser) or the non-ablative lasers (Solta Fraxel Dual) or the combined ablative and non-ablative lasers (YouLaser MT, Sciton Halo).
- Thousands of microscopic laser columns penetrate deep into the scars, to remove old and damaged cells.
- The adjacent skin between the lasered columns is kept intact – this allows for better and faster healing and minimal side-effects. Eventually this scar too is replaced with new tissue
Treatment of scars with fractional radiofrequency
Fractional radiofrequency (RF) works by passing a current through the scar and surrounding dermis at a pre-set depth to produce small thermal wounds in the scar and surrounding skin which in turn, stimulates dermal remodelling to produce new collagen and soften scar defects. Combining RF with microneedling allows the RF energy to penetrate deeper into the scars and gives a better result
Treatment of scars with Jet Volumetric Remodelling (JVR): Enerjet Pro 2.0
- The Enerjet Pro uses Jet Volumetric Remodeling (JVR) technology – a high-pressure jet technology to simultaneously produce micro-trauma and introduce hyaluronic acid or any healing agents deep into the dermal layer of the skin and scar.
- The synergy between the two effects sets in motion a cascade healing process, resulting in scar remodelling and skin hydration
Treatment of scars with Thermo-Mechanical Remodelling (Tixel Pro)
- The Tixel Pro uses thermal mechanical ablation to transfer heat energy to the scars and surrounding skin.
- A template with cones is heated (at 400 degree celsius) and this is stamped onto the scars and skin to create tiny microscopic columns.
- This heat stimulates the skin to generate collagen and elastic fibres and hence improve skin surface and scar texture.
Treatment of scars with surgery
There are many different surgical procedures to improve scar. Among them are:
- Subcision: This is a minor surgical procedure to release the attachments of deep fixed scars from the surrounding skin. Once the attachments are released, new collagen is able to slowly elevate the scars
- Scar excision: The scars are either punched out or excised and replaced with a linear surgical scar. This scar can eventually be resurfaced with a laser
- Scar elevation: The scars are partially excised and then elevated to be flush with the skin surface
- Scar revision: The scar is often excised and revised to improve the cosmesis of the scar. Scar revision is also used to reduce tension in a scar
Treatment of scars with dermal fillers
- Dermal fillers are injected below the scar to elevate the scars initially and to stimulate collagen and elastin to remodel the scars.
- The fillers can be hyaluronic acid, growth factors or other healing agents.
- Fibrotic scars are subcised before the injection of dermal fillers.
- Dermal fillers improve scars within a short period while waiting for the other procedures to work
Scars can be classified according to the causative factors and each type of scars may require specific treatments
Types of scars commonly seen in our clinic
- Acne scars
- Keloids and hypertrophic scars
- Post-inflammatory scars
- Traumatic scars
- Post-surgical scars
Acne scars
Acne scars can be present during the active acne phase or when acne is healing. Some are temporary and improves on their own while others remain permanent and require treatments
Types of acne scars
- Flat brown scars
- Red healing scars
- Depressed and pitted scars
- Raise soft scars on the nose
- Keloids scars
Treatment of acne scars
- Prescription creams
- Chemical peels
- Red scars: Treatment with pulse dye V beam laser, Excel V laser, BBL light treatment
- Brown scars: Picoway laser, Fraxel Dual laser
- Laser scar resurfacing: CO2laser, Fraxel laser, YoulaserMT, Picoway Resolve Laser
- Jet volumetric remodelling (Enerjet )
- Thermo- mechanical remodelling (Tixel Pro)
- Chemical reconstruction of skin scars (TCA CROSS)
- Surgery: subcision, punch excision, punch elevation, scar revision
- Depressed scars:dermal filler injections
Keloid and hypertrophic scars
Keloid and hypertrophic scars are caused by skin injury and irritation and the subsequent abnormal wound healing
Causes of keloid and hypertropic scars
- After skin injury and burns
- After skin surgery
- After skin infection: acne, folliculitis, chickenpox
- After skin inflammation: insect bites
- After vaccination
Treatment of keloid and hypertrophic scars
- Corticosteroid injection/tape/ointment
- Non steroid injections: 5FU, interferon, bleomycin, neurotoxins
- Cryotherapy
- Compression therapy
- Stabilisation therapy: silicone tape and dressings
- Laser treatment: V beam, Fraxel laser, YouLaserMT
- Jet volumetric remodelling (Enerjet )
- Surgery to reduce skin tension
Post-inflammatory scars
Post-inflammatory scars occur after skin inflammation or skin treatment. It can be hypopigmentation or hyperpigmentation scars
Treatment of post-inflammatory scars
- Prescription creams
- Chemical peels
- Light and laser treatment
Traumatic scars
Traumatic scars are formed as a result of skin injury and they arise after physical, mechanical or thermal injury (eg burn scars)
Treatment of traumatic scars
- Prescription creams
- Light and laser treatments for the red and early phase scar
- CO2 laser for burn scars and contractures
- Scar resurfacing with lasers: Fraxel, YouLaserMT
- Scar remodeling with Tixel Pro and Enerjet
