Skin Club by DermaGenesis

Scar is an exaggerated response by the skin to an inflammation. It can develop as the result of acne, trauma, infections, chicken pox or surgery. Fractional CO2 laser has revolutionized scar revision procedure by reducing the scars and smoothening the skin in just few months.

Early intervention may affect the way a scar remodels itself and may minimize its appearance. The treatment for scar depends on the type of scar. Simply put, there are hypertrophic (raised) scars or atrophic (depressed) scars. Atrophic scars are the most common and ranges from having the appearance of an ice pick to a wide saucer.

Scar formation

Scar formation is part of the healing process that occurs following an inflammation. The triggering factors of an inflammatory reaction may be acne, chicken pox, infection, trauma or surgery. During an inflammatory reaction, the underlying collagen structure within the dermis is disrupted. The disruption of collagen network is reflected as a depressed (sunken) part on the surface of the skin. Some scars are small in diameter but deep, while some scars are wide and shallow. These are known as atrophic scars. Atrophic scars, though they are caused by an inflammatory reaction, ironically, they are also treated by deliberately inducing a controlled dermal inflammation. inflammation increases blood flow within the dermis which promotes the release of Fibroblast Growth Factor (FGF). FGF is a potent stimulator of new cell growth from both axis (horizontal and vertical). Over time when the procedures are repeated the new collagen growth reduces the scars gradually.
On the other hand, hypertrophic or keloid scars occur due to the same triggering factors (inflammatory reaction). However, in hypertrophic scars, the disrupted collagen network is replaced by an overgrowth of dense fibrotic tissue; giving it the elevated, brownish, thick “cord like” scar tissue.

Types of scar

There are few types of scar. The choice of treatment depends on the type and severity of the scar.

Ice pick scars
Common after chicken pox, acne or forceful extraction or pinching of acne. Ice pick scars are deep-pitted scars that make the skin look like it had been jabbed with an ice-pick. Best treated with subcision, followed by Fractional CO2 laser resurfacing.

Rolled scars
Common after acne. Most often multiple “saucer like” scars coalesce together to from an irregularly shaped patch of scars. Best treated with NALR and Fractional CO2 laser. Depressed scar area can be filled with Dermal Filler.

Fibrotic scars
Combination of fibrotic and rolled scars, coalescing together and causing obvious disfigurement. Most often these type of scars are genetically influenced. Steroids are used to weaken the scar, followed by smoothening the skin with NALR or Fractional CO2 laser.

Hypertrophic scars

Though a rare type, hypertrophic scars are more obvious and dificult to conceal. These patients have a tendency for keloid and have to be treated cautiously. TAC (corticosteroid) injections are used to flatten the scar, followed by smoothening the skin with IPL or Fractional CO2 laser.

Post traumatic scar
These scars occur following surgery or trauma. They appear as a fine thickend line which may or may not be discolored. TAC (corticosteroid) injections are used to flatten the scar, followed by smoothening the skin with IPL or Fractional CO2 laser.

Scar revision procedures

Based on the skin type, type of scar and its severity, the physician may recommend either one or combine any of the following treatment modalities. It is important for patients to realize that the appearance of scar can be significantly reduced with these treatments, but cannot be restored to the original skin condition. In addition to medical treatments, a healthy lifestyle and a positive mindset is equally crucial.

Scar revision - Fractional CO2 laser

Fractional CO2 laser is the latest in skincare technology and is considered to be the gold standard for scar revision. Fractional CO2 laser creates numerous microscopic laser punctures, which help promote microcirculation and new cell genesis. Regular treatments will help to replace the scar tissue with newer healthier cells. Over time, the scar reduces and the skin appears healthier.

Immediately after the treatment the skin will appear red and in rare cases, minimally swollen. There may be numerous microscopic dots on the treated area, which will develop into fine scabs within a day or two. The scabs will disappear within 3 - 4 days; after which the skin is smoother and clearer. The entire recovery process takes about 3 - 5 days. During this time, patients are advised to apply more moisturizer and sun block to soothe the skin and stay away from excessive sun exposure. An individual may require 4 – 7 treatments done once in 2 - 3 weeks. The actual number of treatments will depend on the severity of the skin condition, skin type and lifestyle. Fractional CO2 laser can be used for skin rejuvenation or skin resurfacing. Fractional CO2 laser rejuvenation procedure is done for mild scars while Fractional CO2 laser resurfacing procedure is done for moderate to deep scars. Fractional CO2 laser resurfacing is an intense treatment which may not be suitable for certain skin types. Click here to know more about Fractional CO2 laser.

Scar revision - Non Ablative Laser Rejuvenation

Non Ablative Laser Rejuvenation (NALR) using carbon peel is a new technique of using medical grade Lasers for skin rejuvenation. This technique uses the Q switch NdYAG laser at 1064 nm. A layer of carbon is first applied onto the skin. The carbon acts like a ‘magnet’ and adheres to the dead cells, both on the skin surface and the walls of the open pores. The laser is fired onto the carbon. The carbon absorbs most of the laser energy and is fragmented along with the dead cells, resulting in a perfect skin exfoliation. Simultaneously, the laser energy is distributed as heat into the dermis without affecting the outer layers of the skin (the epidermis). The heat energy stimulates new collagen / cell growth which helps to fill up the depressed scars. The scar tissue is replaced by new healthier cells. An individual may require 4 – 7 treatments done once in 2 - 3 weeks. The actual number of treatments will depend on the severity of the skin condition, skin type and lifestyle. Click here to know more about NALR.

Scar revision - Intense Pulse Light

Intense pulsed light (IPL) is useful to treat scars that are associated with uneven skin discoloration, especially the reddish colored acne scars. IPL does NOT help to treat fibrotic scars. IPL treatment distributes light energy as heat beneath the skin's layers without affecting the outer layers of the skin (the epidermis). A layer of cold gel is applied onto the skin. The gel keeps the epidermis cool while the heat is distributed into the dermis. The IPL energy produces heat energy beneath the skin which stimulates new cell growth and help to reduce the scar. The light energy also helps to even out the skin discoloration.
Immediately after the treatment, the skin may appear red. Very rarely, there may be scab formation, which disappears within 3 - 4 days. During this time, patients are advised to apply more moisturizer and sun block to soothe the skin and stay away from excessive sun exposure. An individual may require 4 – 7 treatments done once in 2 - 3 weeks. The actual number of treatments will depend on the severity of the skin condition, skin type and lifestyle. Click here to know more about IPL.

Scar revision - Subcision

Subcision is a simple procedure that helps to treat fibrotic ice pick scars. In ice pick or fibrotic type scars, the base of the scar (at the dermal layer) is normally anchored by fibrous bands (see type of scar image above). Lasers might not help in reducing the scars until the fibrous bands are released. During subcision, the skin is first anaesthetized with a cream. Under sterile practices, a needle is used to release the fibrous bands. This procedure also induces an inflammatory and healing process which helps to stimulate collagen growth and reduce the scars. It is an almost painless procedure with zero downtime, so you can resume your activities immediately. For best results, subcision should be followed by a series of collagen stimulation procedures such as Fractional CO2 laser or Non Ablative Laser Rejuvenation.

Scar revision - Dermal Filler

Soft tissue augmentation with injectable filler (implants) is another option for some of the shallower (hypotrophic / atrophic) scars. Depending on the depth of the scar, dermal fillers of different molecular weight are selected as implants. These fillers are injected beneath the scar using tiny needles. Initially, the injected fillers work by plumping up the injected site and reduce the depth of the scars. After a few weeks to months,injected fillers attract new collagen growth around the implant if followed by laser rejuvenation or resurfacing. The new endogenous collagen growth helps to reduce the scars further. Click here to know more about Dermal Filler.

Cost

The cost of treatment for scar (for the facial area) using Fractional CO2 or NALR laser rejuvenation ranges from RM 600 - RM 700 per treatment, while Fractional CO2 laser resurfacing for scar (facial area) costs about RM 1100 - RM 1300 per treatment. Dermal fillers (implant) cost depends on the amount of filler that is used. For example, hyaluronic acid dermal filler normally costs about RM 1200 - RM 1400 for 1 (one) ml of dermal filler. Scar revision normally requires 2 - 3 ml of dermal filler.

Photo gallery

Pictures of scar treated using a combination of treatment. Click on the thumbnail for larger image.
(Pictures are copyright protected and are the property of DermaGenesis (Australia) Pty Ltd. Unauthorized use or reproduction is strictly prohibited.)