Scars treatment

Scars can be classified according to their form of treatment:

Hypertrophic scars

Manifested by prolonged redness and increasingly annoying induration. Such scarring occurs in areas where the entire thickness of the skin is suffering, and creates a disproportionate fibrotic response. Used to initiate preventive laser treatment all patients with closure with sutures intervene because it can also occur in surgical wound closure without tension. After laser sessions local infiltration is initiated at sites where there is mass dose and frequency according to the reduction obtained with each session.

Scar after abdominal lipectomy
Before	Results at month 10, 4 Photoderm Sessions

Keloid scar

They are really what we know as tumor of scar, which extend beyond the original injury. They may occur spontaneously and not be related to the intensity of the initial trauma. Usually they do not go away without treatment. Some grow so early that they are already observed at the time of suture removal. The timely management with injections can control some of them. In other cases, it is necessary to cut them with CO₂ laser and infiltrate.

Before	Results within 12 sessions of 5-fluorouracil

Atrophic scars

Depressed scars are due to non-recovery of skin structures after trauma. They can be:

Superficial atrophic scars: Are those with very faint depressions which retain the texture of the skin in the bed. With gestures bands show no traction what differentiates them deeper. When they are old show no discoloration. They may be pigmented and red for months or even years. In the early stages they respond to Fraxel redness and Q-Switched Nd-YAG. When edges are notoriously profiled, level with Erbium-YAG laser is required.

Before
1 month after Fraxel®
6 months after Fraxel®

Deep atrophic scars: Those that show sinking due to atrophy of the dermis. They produce no complete recovery of dermal structures.

Ice pick scars
Before	After 5 Fraxel® sessions

The most common of these are the sequelae of acne which can be:

1 Ice pick scars: The correction will focus individually on each lesion: With primary closures to the deepest, with dermabrasion to the shallowest point, with sub-incisions showing adhesions and fractional Fraxel/CO₂ lasers throughout the affected area.

2 Valley scars: Depressed scars remain longer and larger lesions. The most noticeable flaws are corrected and filled sub-incisions when possible. When skin is extremely thin this technique is not possible due to the Tyndall effect will cause the filler.

3 Skin Bridges / pimples / cysts / large pores: These are injuries that leave explicit anatomical changes permanently. Microsurgical corrections of these defects are possible with primary closure techniques and CO₂/Erbium-YAG laser procedures.

Post-operative scars

We consider here two very common types of scars that occur after surgical closure: The widening of the surgical scar caused by tension forces in the primary closure and subsidence due to loss of subcutaneous fat and / or adhesions to the deep planes. They are independent of the conditions of the patient's healing and they are due to difficulties from surgical closure. This makes treatment arises on the mechanical aspect.

Dilated postoperative scars: They are generated due to stress at the edges of the suture. When the tension is stabilized, the ends widen the scar. They may have parts with atrophic and hypertrophic zones. They remain long, red, and sometimes hyper-pigmentated. When they are very wide, they usually lack pigmentation. Their ideal is the surgical correction provided to ensure a tension-free reclosure. The laser can correct defects in pigmentation and redness, also creates a more homogeneous collagen remodeling smoothing the surface. Fillers supplement some well-defined defects.

Postoperative sunken scars: They result from the adhesion of the suture line to the deep planes. Adhesions can be released with subincisiones considering that you must fill the resulting space to prevent further adherence to deep level. Wide spaces resulting in excess skin inhomogeneous influence the choice of a scar revision.

 

 

Stretch marks

They are dilated scars without surgical history. Given that increased stress conditions its appearance, evolution set the stage for treatment. When they are in phase erythema should be noted that end up being atrophic and Fraxel ® laser stimulation is important to avoid major sinks while reduces redness. When they are old the defect is of two types: For low pigmentation and / or sunken. We have had more result in these cases leveling the initial stimulation of CO₂ fractional laser with manual technique for later use Fraxel ®. It should be noted that responses to stimulation treatments take years to be noticeable and are better in shallow stretch marks.

Striae forearm
Striae forearm treated in 2007	Long-term follow-up in 2009	Long-term follow-up in 2010

 

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