While prevention - especially in the case of acne - is best, there are effective treatments available to minimize or eliminate scars.
One of the most frequent reasons that people consult dermatologists and plastic surgeons is for the treatment of scars due to surgery, injuries, acne or infections. Broadly speaking, there are three ways of treating scars: topical products, surgical revisions or laser treatments. Each of these has its own risks and benefits and is associated with its own degrees of success.
Scar Prevention
Obviously, the best way to treat a scar is to avoid getting the scar in the first place. This may mean prompt and definitive care of scarring acne or consideration for reconstruction following
skin cancer surgery. Dermatologists can make a huge difference in the degree of scarring from acne and I try to be as aggressive as the patient and the parents will allow. This means using isotretinoin, lasers, photodynamic therapy and good topical products in addition to oral antibiotics.
I will combine modalities if needed. Unfortunately, many of the patients I see present after dealing with acne for years, when the damage has been done.
Surgical Scar Revision
Post-surgical scarring — Surgical revision of scars is frequently performed following a surgical procedure, such as open heart surgery, skin cancer surgery or cosmetic surgery. In many of these cases, the scars are painful and treatment is sought for comfort.
Acne scars are probably the most common reason people present for scar revisions. (For a great book on this, look at Tosti’s text on acne scar treatments (Acne Scars: Classification and Treatment by Antonella Tosti (Editor), Maria De Padova (Editor), Kenneth Beer (Editor)).
Varicella and other infections may also cause significant scarring.
Scars caused by healing process — Irrespective of the etiology of the injury, in some people, the healing process results in a scar that is cosmetically problematic. For some, excising the scar after a period ranging from several months to 1 year can sometimes improve it by changing the shape or direction. For instance, a Z-plasty will frequently improve the appearance of a scar by making it less distorting. Replacing a contracted scar with one that releases the fibrous band will also improve the appearance. The major caveat for surgical revision of scars is that some people will form thick scars (hypertrophic scars or keloids). For these people, excising the scar will typically result in a more prominent scar.
Topical Products
Topical products to treat scars range from folk remedies to over-the-counter products. One topical product that is frequently touted by patients is vitamin E. Although many patients swear that it helps, the data does not support its efficacy. Topical treatments such as Mederma and Kelocote are more thoroughly researched and there is data to demonstrate that they are effective in surgical scars. My impression is that these products can help and they do no harm, so I tell my patients to use them whenever they are concerned about scarring.
Lasers
Lasers are changing the way I treat scars.
Pulsed dye lasers (PDL) — For years, dermatologists have been using pulsed dye lasers to treat scars that are red or pink. Typically, these involve several treatments, and the scar becomes softer and less prominent.
Fractionated lasers — More recently, we have begun to use fractionated lasers to drill microscopic holes into the scar. This treatment enables the body to remodel at a more controlled rate and frequently can be used to improve the appearance. The depth of these holes can be
controlled and there are two basic lasers that are used: ablative and non ablative. Ablative lasers are used to make deeper holes into the skin, and they require a longer healing process, which can be as long as 1 to 2 weeks. Non-ablative lasers — the most popular of which is the Fraxel — can be used to drill more shallow holes that are good for superficial scars. Both may be used for acne scars and stretch marks, but the physician needs to adjust the energy settings and choose the appropriate device based on the scar and skin type of the patient.
Cortisone Injections
Less sophisticated approaches to scar management include injections of cortisone. These have been used for decades and they tend to work well. However, care must be taken to avoid leaving dents and white marks at the injection site.
Conclusion
Scarring is an unfortunate part of life. Whether from acne, chicken pox, surgery or trauma, the damage that a scar causes is life-long and can be profound. With the advent of new treatments, there is new hope for scars and more appears to be in the pipeline.
Dr. Beer is in private practice in West Palm Beach, FL. He’s also Volunteer Clinical Instructor in Dermatology at the University of Miami, a Consulting Associate in the Department of Medicine at Duke University, and Director of The Cosmetic Bootcamp meeting.
Disclosure: Dr. Beer is an owner of Theraplex LLC, and consults, speaks or performs clinical trials for Medicis, 3M, Sanofi Aventis, Bioform Medical, Allergan and Stiefel. He is also a Director
of the Cosmetic Bootcamp meeting.
While prevention - especially in the case of acne - is best, there are effective treatments available to minimize or eliminate scars.
One of the most frequent reasons that people consult dermatologists and plastic surgeons is for the treatment of scars due to surgery, injuries, acne or infections. Broadly speaking, there are three ways of treating scars: topical products, surgical revisions or laser treatments. Each of these has its own risks and benefits and is associated with its own degrees of success.
Scar Prevention
Obviously, the best way to treat a scar is to avoid getting the scar in the first place. This may mean prompt and definitive care of scarring acne or consideration for reconstruction following
skin cancer surgery. Dermatologists can make a huge difference in the degree of scarring from acne and I try to be as aggressive as the patient and the parents will allow. This means using isotretinoin, lasers, photodynamic therapy and good topical products in addition to oral antibiotics.
I will combine modalities if needed. Unfortunately, many of the patients I see present after dealing with acne for years, when the damage has been done.
Surgical Scar Revision
Post-surgical scarring — Surgical revision of scars is frequently performed following a surgical procedure, such as open heart surgery, skin cancer surgery or cosmetic surgery. In many of these cases, the scars are painful and treatment is sought for comfort.
Acne scars are probably the most common reason people present for scar revisions. (For a great book on this, look at Tosti’s text on acne scar treatments (Acne Scars: Classification and Treatment by Antonella Tosti (Editor), Maria De Padova (Editor), Kenneth Beer (Editor)).
Varicella and other infections may also cause significant scarring.
Scars caused by healing process — Irrespective of the etiology of the injury, in some people, the healing process results in a scar that is cosmetically problematic. For some, excising the scar after a period ranging from several months to 1 year can sometimes improve it by changing the shape or direction. For instance, a Z-plasty will frequently improve the appearance of a scar by making it less distorting. Replacing a contracted scar with one that releases the fibrous band will also improve the appearance. The major caveat for surgical revision of scars is that some people will form thick scars (hypertrophic scars or keloids). For these people, excising the scar will typically result in a more prominent scar.
Topical Products
Topical products to treat scars range from folk remedies to over-the-counter products. One topical product that is frequently touted by patients is vitamin E. Although many patients swear that it helps, the data does not support its efficacy. Topical treatments such as Mederma and Kelocote are more thoroughly researched and there is data to demonstrate that they are effective in surgical scars. My impression is that these products can help and they do no harm, so I tell my patients to use them whenever they are concerned about scarring.
Lasers
Lasers are changing the way I treat scars.
Pulsed dye lasers (PDL) — For years, dermatologists have been using pulsed dye lasers to treat scars that are red or pink. Typically, these involve several treatments, and the scar becomes softer and less prominent.
Fractionated lasers — More recently, we have begun to use fractionated lasers to drill microscopic holes into the scar. This treatment enables the body to remodel at a more controlled rate and frequently can be used to improve the appearance. The depth of these holes can be
controlled and there are two basic lasers that are used: ablative and non ablative. Ablative lasers are used to make deeper holes into the skin, and they require a longer healing process, which can be as long as 1 to 2 weeks. Non-ablative lasers — the most popular of which is the Fraxel — can be used to drill more shallow holes that are good for superficial scars. Both may be used for acne scars and stretch marks, but the physician needs to adjust the energy settings and choose the appropriate device based on the scar and skin type of the patient.
Cortisone Injections
Less sophisticated approaches to scar management include injections of cortisone. These have been used for decades and they tend to work well. However, care must be taken to avoid leaving dents and white marks at the injection site.
Conclusion
Scarring is an unfortunate part of life. Whether from acne, chicken pox, surgery or trauma, the damage that a scar causes is life-long and can be profound. With the advent of new treatments, there is new hope for scars and more appears to be in the pipeline.
Dr. Beer is in private practice in West Palm Beach, FL. He’s also Volunteer Clinical Instructor in Dermatology at the University of Miami, a Consulting Associate in the Department of Medicine at Duke University, and Director of The Cosmetic Bootcamp meeting.
Disclosure: Dr. Beer is an owner of Theraplex LLC, and consults, speaks or performs clinical trials for Medicis, 3M, Sanofi Aventis, Bioform Medical, Allergan and Stiefel. He is also a Director
of the Cosmetic Bootcamp meeting.
While prevention - especially in the case of acne - is best, there are effective treatments available to minimize or eliminate scars.
One of the most frequent reasons that people consult dermatologists and plastic surgeons is for the treatment of scars due to surgery, injuries, acne or infections. Broadly speaking, there are three ways of treating scars: topical products, surgical revisions or laser treatments. Each of these has its own risks and benefits and is associated with its own degrees of success.
Scar Prevention
Obviously, the best way to treat a scar is to avoid getting the scar in the first place. This may mean prompt and definitive care of scarring acne or consideration for reconstruction following
skin cancer surgery. Dermatologists can make a huge difference in the degree of scarring from acne and I try to be as aggressive as the patient and the parents will allow. This means using isotretinoin, lasers, photodynamic therapy and good topical products in addition to oral antibiotics.
I will combine modalities if needed. Unfortunately, many of the patients I see present after dealing with acne for years, when the damage has been done.
Surgical Scar Revision
Post-surgical scarring — Surgical revision of scars is frequently performed following a surgical procedure, such as open heart surgery, skin cancer surgery or cosmetic surgery. In many of these cases, the scars are painful and treatment is sought for comfort.
Acne scars are probably the most common reason people present for scar revisions. (For a great book on this, look at Tosti’s text on acne scar treatments (Acne Scars: Classification and Treatment by Antonella Tosti (Editor), Maria De Padova (Editor), Kenneth Beer (Editor)).
Varicella and other infections may also cause significant scarring.
Scars caused by healing process — Irrespective of the etiology of the injury, in some people, the healing process results in a scar that is cosmetically problematic. For some, excising the scar after a period ranging from several months to 1 year can sometimes improve it by changing the shape or direction. For instance, a Z-plasty will frequently improve the appearance of a scar by making it less distorting. Replacing a contracted scar with one that releases the fibrous band will also improve the appearance. The major caveat for surgical revision of scars is that some people will form thick scars (hypertrophic scars or keloids). For these people, excising the scar will typically result in a more prominent scar.
Topical Products
Topical products to treat scars range from folk remedies to over-the-counter products. One topical product that is frequently touted by patients is vitamin E. Although many patients swear that it helps, the data does not support its efficacy. Topical treatments such as Mederma and Kelocote are more thoroughly researched and there is data to demonstrate that they are effective in surgical scars. My impression is that these products can help and they do no harm, so I tell my patients to use them whenever they are concerned about scarring.
Lasers
Lasers are changing the way I treat scars.
Pulsed dye lasers (PDL) — For years, dermatologists have been using pulsed dye lasers to treat scars that are red or pink. Typically, these involve several treatments, and the scar becomes softer and less prominent.
Fractionated lasers — More recently, we have begun to use fractionated lasers to drill microscopic holes into the scar. This treatment enables the body to remodel at a more controlled rate and frequently can be used to improve the appearance. The depth of these holes can be
controlled and there are two basic lasers that are used: ablative and non ablative. Ablative lasers are used to make deeper holes into the skin, and they require a longer healing process, which can be as long as 1 to 2 weeks. Non-ablative lasers — the most popular of which is the Fraxel — can be used to drill more shallow holes that are good for superficial scars. Both may be used for acne scars and stretch marks, but the physician needs to adjust the energy settings and choose the appropriate device based on the scar and skin type of the patient.
Cortisone Injections
Less sophisticated approaches to scar management include injections of cortisone. These have been used for decades and they tend to work well. However, care must be taken to avoid leaving dents and white marks at the injection site.
Conclusion
Scarring is an unfortunate part of life. Whether from acne, chicken pox, surgery or trauma, the damage that a scar causes is life-long and can be profound. With the advent of new treatments, there is new hope for scars and more appears to be in the pipeline.
Dr. Beer is in private practice in West Palm Beach, FL. He’s also Volunteer Clinical Instructor in Dermatology at the University of Miami, a Consulting Associate in the Department of Medicine at Duke University, and Director of The Cosmetic Bootcamp meeting.
Disclosure: Dr. Beer is an owner of Theraplex LLC, and consults, speaks or performs clinical trials for Medicis, 3M, Sanofi Aventis, Bioform Medical, Allergan and Stiefel. He is also a Director
of the Cosmetic Bootcamp meeting.
