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A scar is a mark left on the skin after the healing of a wound or a burn. The word scar originates from the Greek word eskhara, which means scab.
A scar is devoid of skin markings and appendages such as hair follicles and sweat glands and may be skin coloured, hypo pigmented or hyper pigmented.
The treatment of choice for scars resulting from past acne damage (i.e. acne scars) will depend on the type and severity of the acne scars. Treatment options range from surface treatments for superficial scars such as peels and microdermabrasion to treatments for deeper scars using advanced medical lasers such as the latest fractional laser technology.
There are various types of acne scars and many different methods of classifying them. Many patients have a combination of several different types of acne scars at the same time. Essentially acne scars can be considered to be either raised, flat or depressed.
When acne causes raised scars these may be either hypertrophic when they are enlarged but confined to original area of acne or keloid when the scarring extends beyond the original area of acne. The choice of treatment depends on how raised the scars are and can include local treatment such as corticosteroid injections or more generalised treatment such as FRAXEL laser treatment.
Flat scarring also called macular scarring is largely a problem of pigmentation rather than changes in skin texture.
Initial treatment options include 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.
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).
If the depressions are very superficial then peels and microdermabrasion can be effective in smoothing the skin surface.
For deeper depressions where it is necessary to promote collagen production, the use of lasers particularly the FRAXEL laser can provide very effective treatment with minimal downtime.
Certain types of severely depressed acne scarring may require surgery such as subcision which aims to release depressed scars from underlying structures and fat grafts to fill very deep scars that have lost supporting tissue.
Any injury that extends into the deep dermis will result in a scar. 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.
The appearance of scars can often be reduced or modified by medical lasers. Lasers such as the Pulse Dye Laser have been used successfully for several years especially for red raised scars. Recently the result from laser treatment of scars, particularly depressed scars such as found with acne scarring, have improved significantly with the advent of fractional lasers such as the FRAXEL.
The FRAXEL laser treats the skin in a pixel like fashion and penetrates into the skin down into its deeper layers to produce more collagen and blend scars better into surrounding normal skin. A series of treatments is required with results increasing for several months afterwards.
The two commonest scar conditions that we treat at the Cosmetic and Laser Medical Centre are either acne scarring or surgical scars.
A scar reflects how wounded skin heals. Wound healing is a dynamic process that involves the three overlapping phases of inflammation, granulation tissue formation and remodelling. The relative importance of these steps depends on the depth of tissue loss.
Partial thickness wounds which involve only the epidermis and superficial dermis without damage to skin appendages such as hair follicles, sweat glands and sebaceous glands tend to heal with minimal or no scarring although pigment changes sometimes occur.
Full thickness wounds which involve the deep dermis heal with scarring. Initially there is clot formation to halt bleeding from damaged blood vessels followed by inflammation and granulation. Contraction allows the edges of the wound to come together with scar tissue forming to replace the tissue loss.