Out, Scar, Out!

The different scar removal methods

As we go on our relentless pursuit of beauty, even the smallest blemish is not spared. As more people make brave decisions to undergo major aesthetic surgeries like breast enhancements and facial feature reconstruction, others content themselves with the relatively modest scar removal methods.

 Types of scars

Although ugly, a scar is part of the body’s natural healing process. When there is an open wound in the skin, the body attempts to protect itself from infection by rapidly generating scar tissue over normal skin tissue. New scars tend to be more obvious and pigmented, while older scars fade gradually. Once formed, however, scars can be permanent.

According to Dr Chua Sze Hon, senior consultant at National Skin Centre (NSC), there are usually two types of scars: depressed or atrophic scars (most common); and elevated (or hypertrophic) and keloidal scars.

Atrophic scars range from ice pick-like depressions (narrow and deep-pitted) to deep holes as if punched by a sharp object. These are colloquially termed as pock marks, and many acne scars belong to this category. Other acne scars or lesions result in hyperpigmentation, which leaves skin darkened to shades of deep red, brown and even black. These pigmented areas will eventually subside, and the process can be sped up with the use of tretinoin, vitamin C, E and AHA.

Hypertrophic and keloidal scars are thick and raised, and occur commonly over the jaw line, chest and shoulder regions. While hypertrophic scars are confined to the original wound, keloids grow beyond the original damaged area. Keloids occur when the skin continues to deposit scar tissue even after the wound heals and are frequently found in dark-skinned people such as Africans.

One of the most common types of scarring for which people seek treatment is acne scarring.

Removing scars

To remove atrophic scars, one method is scar revision or surgery. Deep scars are cut out (excised) and the skin stitched up. Alternatively, the underlying scar tissue is first loosened then released surgically (subcision). Scar revision yields comparatively shallower scars, which can be improved via non-surgical methods.

      Laser resurfacing combines an ablative laser with an automated scanning device to destroy epidermis (surface skin) layers precisely until the upper dermis (layer underneath the epidermis) is reached. As the wounded skin heals, its supportive collagen remodels itself and improves the appearance of the scars.

      During the initial healing phase, however, the skin is very raw and will require meticulous care to prevent bacterial infections. Subsequently, post-laser redness and hyperpigmentation will set in for a few months.

      Another method uses non-ablative collagen remodelling laser technology to selectively heat the upper dermis and stimulate collagen remodelling without destroying the epidermis. This is achieved through the use of a cooling device directed at the epidermis before the laser is fired. This method is suitable for shallower scars, and between four to six rounds of treatment are needed.

      Chemical peeling with acids can improve shallow scars by gradually stimulating upper dermal collagen remodelling. Other benefits include improvement in surface skin texture and reduction in blackheads. But if done by an inexperienced or non-expert hands, the chemical agents may burn the skin.                    Another method of removing atrophic scars involves injecting filler substances directly below the scar into the dermis. This elevates the depression and improves the scar’s appearance rapidly. However, improvement may be merely temporary.

      Dermabrasion makes use of a medical grade sanding device to manually remove surface skin up to the upper dermis. But this method has been largely replaced by laser resurfacing as it can be potentially bloody. Success is highly dependent on the skill and judgement of the dermatologist.

      Treatment for hypertrophic and keloidal scars is difficult. Cryotherapy is a method whereby a freezing agent, usually liquid nitrogen, is applied to the scar. Upon freezing, the scar may be partially destroyed and drops off subsequently. Steroids can also be injected into the skin around the scar.

Beauty at a price

Despite the risks involved and potentially hefty prices tagged to scar removal, many continue to seek treatment.

      Dr Chua says: “Scar removal is getting more popular in Singapore, especially for acne scars.”

      Five years ago, the NSC performed less than 200 scar improvement procedures per year. In 2004, the figure more than quadrupled to above 800. Those likely to seek scar removal are both males and females in their youth or middle ages, especially if scars are accompanied by symptoms like itch
or pain.

      As each removal method mayrequire multiple sessions for greater success, the total cost may add upto thousands of dollars. Obviously though, the high cost is not a deterrent.

As with other medical procedures, it is advisable to consult a certified practitioner. Do visit a qualified dermatologist trained in scar removal methods, who will analyse your case and advise on the best treatment available •