Whenever the skin is injured, a scar will occur. Fortunately for us, most scars will flatten, soften and lighten in color simply by giving them time to mature. This can be upwards of six months to a year. Remember, you will always be able to find old scars from prior injuries or surgeries, but we want to create one that the casual eye is not drawn to at the first moment.
Natural Scar Mutration
For most patients, I recommend Kelocete Scar Gel to be applied very sparingly to the surface of the scar. No one knows why silicone speeds the natural process of scarring, but it seems to in most scars.
Red and Hypertrophic Scars
Some scars remain red or swollen over long periods of time. Sometimes individuals even develop hypertrophic scars — thicker, redder and often more symptomatic scars which either itch intensely or have little “lightning bolt” pains in them when struck or stroked upon.
For these cases, we often use a combination of laser or BBL treatment to treat the redness of the scar. A combination of treatment of red as well as injection of a strong steroid suspension will create a smoother, flatter and more skin-colored scar.
A small subset of scars which occur in darker races and expand way beyond the site of the original injury, becoming quite unsightly, painful and large. They are due to an abnormally aggressive repair mechanism that creates a risk for even more keloid formation if anyone attempts to remove the keloid. I usually leave keloid excision and follow-up to my plastic surgery colleagues.
Uneven or Elevated Scars
Scars which are uneven, that have an elevated edge or what we call “shoulders”. These are often a nuisance as these mature scars catch the light in just a way that they create a visible, abnormal shadow. They can often be easily improved by using an erbium laser to literally sand down those sharp margins creating the shadows, followed by some blending passes to smooth and blend the site with surrounding skin. Getting rid of the “shadow” is what makes this system work so beautifully.
Acne Scarring and Larger Scars
A combination of unevenness, thin and atophic patches of skin. Often after a burn, a skin graft or a wound that was not possible to repair with clean closures. We need to look at a treatment modality that addresses all of these issues.
Up until a few years returning the skin to normal appearance was virtually impossible. We now have the Sciton Profractional FX erbium laser which allows us to approach this kind of scar in a totally novel and brilliant technology! Instead of “sanding down” skin, we are literally drilling microscopic holes into the scarred skin. By removing upwards of 50% of abnormal skin, the remaining skin wants to repair and return to more “normal” appearance and texture. Recovery is fast because of all the surrounding healthy skin able to move in.