Today’s Scar Wars

    Treatment and Prevention Strategies Are Plentiful

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    As a parent of two young children, I know I look closely at every scrape and cut, worrying if it is going to leave a mark on my kids’ delicate skin. For some people, scars are a badge of honor, for others, scars represent an amazing story, like a child who had heart surgery as an infant. Scars are part of the body’s ability to heal.

    Scars result when the largest organ in our body, the skin, gets injured. The reason that we don’t heal perfectly is because of collagen, the basic building block of skin. In normal, healthy tissue collagen is organized in neat bundles that stretch and conform to our body’s shape, almost like small protein bungee cords. When we heal from an injury, the collagen does not get replaced in the same orderly fashion. Scar collagen is more like a frayed bungee cord that does not stretch or perform as well. This is one of the reasons why scars often feel tight or harder than the surrounding tissue.

    There are many factors to consider when it comes to attempting to reduce the appearance of scars at the sight of a wound.

    Moisture Your grandfather may have encouraged you to let a wound air out, but this can actually make a scar worse. One of the best things you can do for any wound is to keep it moist by liberally applying Vaseline, Aquaphor, or an over-the-counter bacitracin ointment to the area three to four times a day after a good cleansing with warm soap and water. The moisture helps to keep the body’s natural protective layer intact and helps prevent newly formed skin cells from being damaged or drying out. A wound kept clean and moist for the first ten to fourteen days will heal much faster with less chance of a scar.

    Inactivity If a wound gets pulled or stretched, the chances of a bad scar are much greater. The forces of pulling damage early collagen and interfere with the natural healing contraction process. Products such as Steri-strips or butterfly bandages can be very helpful to keep healing tissue secure and decrease the chance of a scar.

    Topical or oral medications There are literally thousands of different products which make claims to reduce scarring, and the choices can be overwhelming. In my experience, I have seen good results with silicone-based products such as scar sheets or ScarGel. Silicone acts as a wonderful barrier and is very effective in helping minimize scars. I use a special scar gel that is compounded in a pharmacy that has silicone as well as several other medicines in it which have been shown clinically to reduce scarring.

    Gentle massage Gently rubbing a wound once it has a healthy skin covering can be beneficial by encouraging the wound to soften and flatten. I recommend gentle massage for one to two minutes three to four times a day until the area feels soft. You can also add a moisturizer to make
    the massage more comfortable.

    Sun avoidance It is critical to avoid exposure to the sun during the healing process. The pigment cells in a wound are very sensitive and sun exposure can cause permanent darkening of a scar. Sunscreen products of at least SPF 50 are recommended.

    Although we cannot erase a scar completely, the last five years have seen some amazing medical advancements that not only make scars almost invisible, but also can help restore form and function to scarred parts of the body.

    When I trained as a surgeon, I was taught that the only thing that could be done for scars was to wait at least a year after an injury before surgically excising the scar in hopes of reducing its visibility. Today, there are better and much more effective options.

    Lasers use energy from light to stimulate collagen to reorganize itself in a more orderly fashion, a process known as remodeling. Remodeling improves the function, texture, and the appearance of scars. Some lasers can even help severely burned patients whose scars have caused difficulty using their hands or bending their knees. These kinds of laser treatments can be performed in a doctor’s office with little to no downtime, so inquire about the types of lasers being used.

    Platelet-rich plasma (PRP) Have you ever noticed that after you scrape your knee a clear, amber colored fluid often appears on the surface of the wound several days later? This fluid is your body’s platelet rich plasma and is concentrated with healing and growth factors that help your body heal. Orthopedic surgeons use PRP to treat joint injuries. Dwyane Wade and Tiger Woods have both had treatments to help heal sports injuries. Plastic surgeons have used PRP for treating severe scarring in burn patients.

    In the realm of scar treatment, PRP can be injected into scars or placed topically with very fine needles. Growth factors released by the platelets signal the body to begin the healing process and can result in more orderly collagen remodeling, better skin tone, and more natural looking tissue. This is done in the office with a blood draw.

    Dermabrasion can be a very effective technique for helping scars which are raised or have an irregular texture. The scar is anesthetized and a high-speed diamond burr is used to slowly remove scar tissue. The area then remodels with new collagen formation.

    Steroid injections of potent medications such as Kenalog or triamcinolone directly into scars can also reduce the inflammatory phase of scars and can help with the itching, redness, and firmness of scars.

    Fat grafting It sounds odd, but fat grafting for scars can be extremely effective for several reasons. Fat cells, called adipocytes, have a high concentration of readily accessible stem cells. When adipocytes are placed into a scar, the stem cells become activated to regenerate normal tissue and help replace the scar. The added volume of fat cells can also be very beneficial for scars which are sunken or depressed, like acne or chicken pox scars. By making the area level with surrounding tissue the scar is much less noticeable.