Scarring occurs as part of the natural healing process. As the body tries to repair itself, thick fibrous scar tissue replaces normal tissue and the open wound is held together. As natural as the process may be, frequently we are not happy when a short term injury to the skin results in a lifelong scar, especially if it is on a highly visible area such as the face. Luckily, many scars are correctable with only simple manipulation of the skin. While scar correction may seem a minimal concern to some, it can mean a new face to the world for others.
When discussing scar correction, it is important to determine the type of scar: keloid, hypertrophic, or pitted. A keloid is a scar which forms when the fibrous tissue extends outside the previous boundaries of the inciting injury. They can be caused by even slight damage to the skin, such as an insect bite or even just an ear piercing. Keloids are not only unsightly; they can also itch or even be painful. They can occur in any skin type, but are more common in African Americans. Keloids are effectively corrected in one of two ways. First, a steroid solution can be injected directly into the keloid. Over several weeks, and usually with several treatments, the keloid will begin to shrink. Another faster method is to surgically remove the keloid. With a procedure that only takes minutes, the keloid is completely gone and the patient is left with only a fine line scar. Since keloids can reform even after excision, creams and steroid injections are used to treat them after excision to prevent recurrence.
A hypertrophic scar is a raised scar which remains within the borders of an injury. They are frequently darker or pinker than the natural skin tone. Hypertrophic scars are common after surgery or injury to hte skin, and are typically treated in one of three ways. First, Dr. Kayal highly recommends using a silicone cream called Biocorneum to flatten and reduce the redness of the scar. Second, a series of spot microdermabrasions can be used to soften the scar. Microdermabrasion is an in-office procedure which allows for superficial exfoliation of the scar. The procedure takes only 15 minutes to complete and requires no recovery time. Since microdermabrasion is such a gentle procedure, several sessions are recommended to see significant effects. Just like keloids, hypertrophic scars can also be excised, leaving only a fine line scar.
Pitted scars appear when the healing process causes the scarred skin to form a divot or hole in the skin. These scars are usually caused by acne or chicken pox lesions. Treatments for pitted scars aim to raise the pits to the same level as the rest of the skin. One way to accomplish this is to go underneath the skin with a small needle and release the bands of thick fibrous tissue holding the skin down. This is done under local anesthetic and can even out the skin with only a few small needle pricks. Another option is using a very small cookie cutter-like tool to actually remove the scar from the skin. The remaining hole where the scar was removed is then sewn together with one small suture. This procedure is referred to as subcission. Instead of just closing the hole with suture, the lost volume can be replaced with another procedure called punch grafting. In this procedure, healthy skin from behind the ear is taken to serve as a very small skin graft for the divot created on the face. Down time with any of these procedures is usually just a couple of days. Another solution to reducing the appearance of pitted scars is to inject a small amount of gel filler, such as Restylane, into the divot. While not a permanent result, a quick filler injection can provide months of divot free skin.
For more information on scar correction, contact Kayal’s Dermatology & Med Spa for an appointment with Dr. John Kayal at 770-426-7177.