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Scar treatments
Jul 18, 2002
UPDATED 7-24-02 WITH NEW INFORMATION

Just remember all of these treaments have worked well for some people and have not worked at all for others. I share this research to help YOU make your own comparisons and to educate people in the process.

From reading various other boards and internet sites I compiled this list of common scar treatments. PLEASE correct my mistakes as I am not a doctor but I did want there to a post that summarizes things for us. After additions or corrections maybe we can make a new post where people can look for an overview of scar treatments. I tried to be conservative and not promote one treatment over any other.

LEVEL 1 up to 20% improvement depending on scar severity

*Microdermabrasion
exfoliates dead skin by blasting crystals in small rows across the face. Improves texture, but is not a scar treatment per se.
*Derma-sanding uses a sterile type of sand paper and is sometimes used in conjunction with certain surgeries listed below.

*Light peels (AHA) (lactic – from sour milk, Tartaric – from grapes, Glycolic – from sugarcane, Malic – from fruit)– removes dead skin, the new skin that comes in is tighter and skin is noticeably smoother for a few days or weeks. Glycolic is the most popular because it has the smallest molecular structure so can penetrate the skin easier. If you are on certain prescriptions this can cause additional damage to your skin.

*Topical creams (elcina, collagin builders, dermatique, Neosporin, Cellex-C,etc) – Some people claim they see results, others do not. Cellex-C and Elcina require at least 3 months to see results. Dermanew makes skin feel smoother but doesn’t help scars.

LEVEL 2 20-60% improvement depending on scar severity
*Cool Touch / Smoothbeam – removes 5 –20 micrometers of skin. (Skin is approx. 100 micrometers thick) Has very variable results per patient. Requires several treatments. Most people don’t notice any improvement the first treatment but occasionally some see good results from day 1.

*TCA peels (A “Blue” peel is 30% TCA)– removes top layer skin,the tightness from the new layer of skin lasts longer but some patients see scars return weeks or months later. Some derms refuse to do over 20% because of the risk of increased scarring.

*Injections
– collagen or fat transfers (can leave skin bumpy and only last a few weeks or months).
– Artecoll – Not yet approved in the U.S. but thought to be more permanent. Sometimes leaves bumps, usually requires several treatments. Some patients say that if you have severe scarring or have never had resurfacing done you will need countless shots over a long period of time. Slight possibility of pinprick scarring since it is injected subdermally.
– Saline – raises the epidermis, allowing collagen to fill in the gap, also breaks down the collagen fibers under scars that “pull” the skin in (indentations).
– Isologen – Your own collagen is cultivated in a lab using fibroblasts (the cells that make collagen) taken from your own skin behind your earlobe. Then it is injected into your scars. Still under review, only a few doctors are authorized to perform this currently.
– Silicone. Some people are swearing by this new type of silicone which must be injected in tiny droplets or else it can harden. Takes up to 3 sessions, is thought to be permanent, but does “retreat” slightly thus taking up to 3 sessions. This type of silicone is FDA approved only for use in certain retinal procedures but can be used “off label” for acne scars. Therefore no dermatologist will advertise this in a brochure since the FDA had strict laws against off label promotion. No chance of it entering the bloodstream if injected correctly.


LEVEL 3 up to 70 % improvement – depending on scar severity

*Punch Excision – the scar is surgically punched out, stitched back up for a week, healing time can be 6 months to a year, a new scar may actually form.

*Subcisions – suture type threads are inserted “under” the scar tissue and tied in a knot above the skin, then covered with tape. This raises the epidermis and allows collagen to form in the space under the raised skin. Sometimes a back and forth scraping motion is used with a needle to cut up the root tissue holding the scar down. This causes a blood clot which takes 2 months to heal. During the healing process collagen forms. The process is often repeated for maximum results. Some people have dramatic improvement but others have seen the scars recur in a few weeks or months.

LASERS (can be effective at stimulating collagen, doesn’t abrade the skin but vaporizes it instead. Upon re-epithilialization the new skin will have more collagen and fibroblasts than the skin which was removed.
*Erbium/N-light- not for deep scars, often used as a precursor to CO2 to smooth scar edges but not scars themselves - much less thermal damage/downtime than C02

*CO2 The “big gun” of lasers. removes 20 –60 micrometers of skin, causes 150 micrometers of thermal damage. This level of thermal damage promotes more collagen growth. Results depend on depth and number of passes. Can cause pinkness that lasts for years and an inability to tan and dramatic susceptibility to sunburn that lasts for years. Can take 6 or 7 months after treatment for the collagen to build up final level. Years later the deeper scars may reappear.


LEVEL 4 (for deeper scars – preformed by cosmetic surgion)

Dermabrasion - freezes then sands off the skin with a sanding abrasive machine. Not always permanent. Weeks of downtime.

Dermabrasion w/ Laser - An aggressive approach for most dramatic results. Sometimes they are preformed the same day sometimes a few weeks apart.

Face Lift – the skin is undermined (lifted from the face) so the scar tissure that anchors itself to the flesh is lifted reducing the depth of the scarring.

Notes:
-Skin renews on a 30 day cycle (cell turnover). Therefore you need to use an SPF of 15 or higher for 30 days after any peel.
-Lower cheek and jaw area scars can defy treatment, are prone to scabbing and have longer healing times.
-Some patients and doctors insists that it is necessary to “prep” the skin with retin-a treatments or glycolic acid several weeks before a TCA peel or laser surguery.
Many before and after pics use lighting or makeup to accentuate the scars in the before and hide them in the after. Also some after pictures are taken when the skin is still swollen and thus the scars are unnaturally puffed out. Yes this is deceptive advertising but it does happen.
Skin is a living organ (not a piece of furniture) and must be treated very carefully and most of all with respect. If it’s in the middle of a lifecycle change (puberty or pregnancy for example) the results may be worse than when you started.



[This message has been edited by Hombre (edited 07-24-2002).]





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