Scars

Scars develop through trauma and inflammation. They consist of differences in skin level or colour variation. If they grow above the adjacent skin level they are called hypertrophic scars and keloids. If they are sunken into the tissue they are called atrophic.

Scars can almost never be made to disappear completely; however, they can often be improved

Hypertrophic scars and keloids

This type of scar develops because there is an individual disposition for this kind of scarring. 

Hypertrophic scars are best treated with intralesional cortisone injections into the scar tissue. This makes the scars flatter and softer but often more red through the dilation of blood vessels. These  ‘broken’ vessels can be treated using lasers. At times it may make sense to cut out hypertrophic scars immediately, followed by an X-ray treatment to prevent another hypertrophic scar from developing. It would appear unwise to only surgically treat a hypertrophic scar, because this may increase the size of the scar.

Atrophic scars

Atrophic scars develop as a consequence of acne or chicken pox. They come in various forms:

      Saucer-shaped
Typically they flatten when the adjacent skin is pulled. Unlike previously, when dermabrasion, deep peels or laser skin resurfacings were used to treat these scars, today the gold standard treatment is fractionated laser therapy. We use a medical infrared light laser (Erbium YAG) for this kind of treatment. Its effect is based on the fact that the holes that are ‘drilled’ into the skin are healed by new deposits of collagen which is tighter and hence improves the scars. At the same time skin texture is improved.

Fractionated laser treatments are serial treatments in monthly intervals. Typically 4 – 6 treatments are necessary for an ideal improvement. After a pause of 6 months you will decide whether or not more treatments should follow. There is a 3 – 4 days social down-time associated with this type of treatment.

Saucer-shaped scars may also be filled with biologically degradable hyaluronic acids 
      
Boxcar scars
They have steep edges and a flat bottom. This type of scar is best treated by ablative laser therapy with local anaesthesia (numbing). In this way the edges are flattened and the bottom of the scar is raised. There is a need for skin plaster to be used for about 7 days.

I     Ice-pick scars
They are steep and deep. They are best removed surgically (punch excisions).

The treatment of atrophic scars can be performed step by step (little to no social down-time) or in one or two treatments (social down-time). Often the treatment is a long-term endeavour. Therefore it is our goal to discuss the possibilities realistically with you. Also, it is most important that your expectations meet reality. Atrophic scarring cannot be made invisible but can be improved.

Coulour Changes of Scars

Further information