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Scarring

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Scarring results from how the skin heals after injury. The main skin scarring that we treat is scarring after Acne and scarring from trauma, be it accidental injury or scars from surgical operations. Stretchmarks can be regarded as a specific type of skin scarring and we treat these as well. Scarring from burns is a special type of scarring that is best treated in a dedicated Burns Centre that specialises in this area.

About the condition

A scar reflects how injured skin heals and it is important to understand that scar formation is normal for any injury that extends into the deep dermis layer of the skin. Early scars are formed in 7 – 10 days after injury at which time they have only about 5 – 10% of the original skin strength. Over the next 6 – 12 months the wound continues to undergo remodelling to form a mature scar which eventually has about 80% of the original skin strength.

Skin wounds sometimes heal with excessive scarring to form Hypertrophic scars or Keloid scars. The reason for abnormal scarring is not fully known but factors involved are numerous and include skin type, genetics, site and size of wound, presence of tension on healing site, secondary infection, foreign material and hormonal status.

Types of Scars

A scar is devoid of skin markings and appendages such as hair follicles and sweat glands and there are various ways to describe scars:

Scars may be skin coloured, hypo pigmented (white) or hyper pigmented (brown).
Scars can be flat with the skin’s surface, depressed below the surface or raised above the surface.
Acne scars can cause various types of indentations in the skin such as rolling undulations (rolling scars), punched out depressions with sharp vertical edges (boxcar scars), deep scars with loss of subcutaneous tissue (deep divots) and deep small holes in the skin (ice pick scars).
Raised scars can be may be either Hypertrophic when they are enlarged but confined to original area of trauma, or Keloid when the scarring extends beyond the original area of trauma.

Scarring - About the condition

Treatment options

Surgical Scars: Range of options depending on age and appearance of scar:

Local treatment such as steroid injections can help flatten raised scars
Topical silicone based gels such as STRATADERM or DERMATIX can be beneficial to minimise scar formation in the first instance and then also help flatten established scars.
To promote skin healing and help prevent excess scar formation after surgery LED treatment with red light is helpful.
Laser based treatments can help with scar remodelling and choice of laser is largely based on scar colour. Surgical scars are initially red and then whiten over time. Treating new red surgical scars is done with Vascular lasers whilst older white surgical scars achieve better results with either FRAXEL or INFINI treatment.

Acne Scarring: It is important that any active Acne is controlled so new scarring is still not developing. The treatment of choice for acne scars will depend on the type and severity of the acne scars as well as response to other treatments.

Flat brown discolouration after acne is more an issue of pigmentation than textural scarring and can be treated with topical depigmenting creams such as hydroquinone or superficial peels. Resistant macular scarring often requires laser based treatments in particular the FRAXEL laser which can target both pigmentation and scarring at the same time.
Very superficial scarring can be treated with Peels, Laser peels and Microdermabrasion.
Superficial to moderate scarring will need laser based treatments to stimulate collagen such as Picotoning which is a particularly good option in Asian and darker skin types.
Moderate to deeper acne scarring requires more aggressive laser treatments such as the FRAXEL laser or use of radiofrequency skin microneedling (INFINI).
Certain types of severely depressed acne scars may require surgery, such as subcision which aims to release depressed scars from underlying structures, or fat grafts to fill very deep scars that have lost supporting tissue.

FAQs

How many Laser treatments are needed to treat Acne Scarring?

Multiple treatments are needed as Collagen remodelling takes time. The exact number will depend on the type of scar, the severity of scarring and the level of improvement required. Depressed Acne scars typically take a series of at least 6 treatments.
How much improvement in Acne Scars can be expected?

The aim is significant improvement but it is important to understand that the skin will never look 100% again after scarring has formed. With Acne scarring we have an expectation of at least a 50% improvement and obviously we aim for much better.
How soon can a surgical scar be treated?

There has been an increasing trend to be proactive with surgical scars to try and prevent a large scar developing rather than wait until an unsightly scar has developed then have to treat a bad scar. This is particularly when a patient is having surgery with a greater risk of scarring or has a history of scarring in the past.

The use of LED light can commence immediately after any surgery. For scar reduction after general surgical procedures we wait until stitches are removed before Vascular laser treatments, so usually at about 2 weeks. After plastic surgical procedures performed by a plastic surgeon (eg. like a breast augmentation or facelift) we wait to start any laser treatment until the plastic surgeon has given post-operative clearance, which is usually at about 6 weeks after surgery.

Before and after

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Before and after images are presented purely as a reference point of the results that can be achieved. Everyone is unique and outcomes will vary and realistic expectations need to be discussed on a case by case basis.

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