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Scar Removal

Scar Revision: Improving the Appearance of Scars
Skin is a seamless covering, like a fine cloth. Imagine a piece of silk. Just one small tear can make a big difference in how it looks. And it's the same with skin. Any burn, injury, or other trauma, such as surgery, can cause a scar.
A scar isn't bad if it's small or it can be easily concealed or it is not associated with any functional impairment. There are ways to treat scar rather than hiding it under your clothes, which will make it go away or at least change how it looks. Scars appear red and thick initially, and then gradually fade. Scars that seem unsightly at three months may heal nicely by six months or one year. But one thing should be clearly noted that once the scar developed from full thickness damage to the skin, it could never be removed completely. The only possibility after a good management is to make it almost invisible or very thin & less visible, so that it can fade with surrounding skin crease or geometry of face.

How Does a Scar Form?
Scar is the result of a complex process the skin goes through as it recovers from damage. There are many factors that affect how a wound heals, and the way the wound heals affects how the scar will end up looking in the long run. How skin heals and scars varies from person to person. Its appearance and its treatment depend on multiple factors.
The depth and size of the wound or cut and the location of the injury matter. So do your age, genes, sex, and ethnicity. It also depends on how you care for the wound before the scar is done forming.
Timely management of a wound by a specialist and experienced plastic surgeon results in almost invisible scar.

What Are The Types of Scars?
ACNE Scars
This is the most common scar problem in young population. The scar makes the patient self conscious and may impact their self esteem. . There are many types of acne scars, ranging from deep pits to scars that are angular or wavelike in appearance.
The treatment of acne scar is highly individualized. Treatment of such scar by microdermabrasion results in reduction in the number of visible scars, a reduction in the depth of the scars and it gives a better uniformity to the skin. A 50- 60% improvement is considered as a good result.

Keloid scars
These scars are the result of an overly aggressive healing process. Keloid scars are most common in dark skinned people. Keloids can appear anywhere on the body, but they're most common over the breastbone, on the earlobes, and on the shoulders. All raised scars are not keloid. Keloid is usually present for a long time. It is hard and usually tender on touch and itchy. They grow beyond the original injury. Over time, a keloid scar may hamper movement. Treatments include surgery to remove the scar, steroid injections, or silicone sheets to flatten the scar. Smaller keloids can be treated using cryotherapy (freezing therapy using liquid nitrogen). You can also prevent keloid formation by using pressure treatment or gel pads with silicone when you are injured. Keloid scars are very difficult to treat, if not impossible.

Hypertrophic scars
These are raised, red scars that are similar to keloids but do not go beyond the boundary of the wound. These types of scars can be avoided by proper management of wound or burn from the beginning by an experienced plastic surgeon. Once developed, this type of scar can be managed to a great extent making them less visible. Treatments include injections of steroids to reduce inflammation or silicone sheets, which flatten the scar.

Contractures
Burns or other injuries resulting in the loss of skin may form a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may affect the adjacent muscles and tendons, causing functional impairment.
Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases where a linear contracting band is present a procedure known as Z-plasty may be used. New techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need good physiotherapy after surgery to restore full function.

What are the treatment options for scar?
Many scars that appear large and unattractive at first may become less noticeable with time. Some can be treated with steroid injections to relieve symptoms such as tenderness and itching. For these reasons, it is recommended to wait as long as a year after an injury or surgery before you decide to have scar revision.
If you're bothered by a scar, your first step is to contact our office. Dr. Goyal will examine you and discuss the possible methods of treating your scar, the risks and benefits involved and the possible outcomes. Be frank in discussing your expectations with him, and make sure you're realistic. Don't hesitate to ask any questions or express any concerns you may have.

Silicone Containing Products
Available as gels, creams and bandages through pharmacies. They are helpful in reducing scar thickness and pain. Your doctor can also recommend you to use pressure treatment or silicone gel sheets to help treat scars or as preventive care.

Steroid injections
Using a very fine needle, steroid is injected directly into the keloid or hypertrophic scar. Used with raised scars causing them to shrink and flatten.

Surgery
Surgical scar revision can improve the appearance of scars to a great extent; however, no scar can ever be completely removed. Surgical scar revision results in a less obvious mark or hidden in natural skin crease. Since the nature of each scar is so varied, Dr. Goyal will develop an individualized treatment plan for you during your consultation in his office. Usually the scar is removed and the skin is stitched in several layers using very fine material.

Fillers
There are a number of injectable materials that are particularly useful for some pitted or depressed scars, although these are not usually permanent solutions. They are injected under scars to lift them up and improve their appearance. Fillers are also used in the treatment of wrinkles.

Dermabrasion
In dermabrasion the top layers of the skin is removed to give a more even and smooth contour to the skin. It can result in improvement of certain scars like ACNE Scar or scars due to childhood smallpox or chicken pox. However, it cannot get remove the scar entirely.

Resurfacing LASER
Also referred as peeling lasers, are an excellent method of improving acne scars and chicken pox scars. Patients can return to work usually within two weeks. The skin may remain pink for several weeks or months. This treatment is used in the treatment of wrinkles and sun-damaged skin. Indian population is not very suitable for resurfacing laser, as they can lead to hyper pigmentation or dark discoloration of skin even after trivial exposure to sun rays.

Subcision
This technique is used in depressed ACNE scars. A needle is inserted under the scar to lift the scar up.

Micro needling or Dermaroller
This technique can be used in all ACNE scars. Needles are used to break the superficial skin layers, to stimulate a healing reaction resulting in a smoother appearance. The Dermaroller is a cylindrical shaped drum studded with very fine needles. It is a medical device used in micro needling to break down old scar tissue & to stimulate skin cells to proliferate. This cell multiplication results in the formation of new tissue layers of elastin and collagen fibres (neo-collagenesis) as well as in new capillaries for an improved blood supply (neo-angiogenesis). The procedures are called Scar Reduction Therapy (SRT) & Collagen Induction Therapy (CIT). The Dermaroller significantly improves atrophic scars & improves skin texture. The Dermaroller improves the thickness of the dermis as well as the epidermis. This in return improves skin texture and reduces wrinkles. It also has a positive effect on hyper-pigmentation as well as on hypo-pigmentation. Reduces disfiguring scars & acne scars, stimulates new collagen fibres, and improves blood supply and harmonies pigmentation. For Collagen Induction Therapy we recommend to start with 3 treatments, but with a minimum separation time of 6 to 8 weeks between treatments. For Scar Reduction Therapy an average of 3 to 5 treatments are recommended, with an improvement of 70-80%. Unlike ablative procedures for facial skin only, the Dermaroller can be used on all skin parts of the body (neck, arms, legs, etc).

Fusiform excision
Deep small ACNE scars can be removed surgically.
While no scar can be removed completely, Dr. Goyal is a skilled Facial Plastic Surgeon who can often improve the appearance of a scar, making it less obvious. He is an expert in both scar revision surgery, and less invasive non-surgical treatments to diminish the appearance of scars.