The first and foremost step in the journey of scar to scarless is to consult the right doctor and they are cosmetic or aesthetic plastic surgeons:

Cosmetic or Aesthetic plastic surgeons are those who have MBBS, MS, M.Ch./DNB in ​​Plastic & Reconstructive surgery degree and they mostly do cosmetic surgery. Plastic surgeons know where the final scars should be. Plastic surgeons use a microscope to accurately and precisely examine the wound and apply the perfect stitches. Looking at scar behavior, he knows when the stitches should be removed. For example, the stitches on the face are removed between 3 to 5 days. If stitches are removed at the right time, then suture tracts, also called hatch marks, can be prevented.

Plastic surgeons prescribe the right antibiotics as well as after-care advice while keeping in mind the possibility of infection.

Good aftercare advice:

If you have had your stitches done by another doctor, then you need to know when they should be removed. 3 to 5 days on the face, 10 days on the legs, 10 to 14 days on the stomach. Quite often the scars are reddish in the initial days and they turn black later on. So a medical-grade sunscreen with SPF-50 and above should be used. Along with this, you should use Moisturizer which contains Vitamin E, Aloe vera content.

Silicone Gel and Silicone sheets are also very helpful in scar treatment:

You should start using silicone gel or silicone sheet 3 weeks after getting injured or getting stitches. You have to massage with silicone gel twice a day for 2 minutes. Take a small amount of silicone gel on the fingers and massage it with clockwise, anticlockwise, zigzag and irregular patterns on the scar.

You have to put the silicone sheet in the scar in the right way as shown in this diagram. You have to keep it for at least 22 hours a day and you should use it for at least 6 months. Silicone sheets like Cica Care and Epi-Derm are easily available.

Why should we use Silicone gel or sheet?

Whenever your scar starts to form, the fibroblast muscles in the body form collagen. If this collagen is produced in excess and irregularly, then we get an elevated scar called hypertrophic scar and keloid is formed. Silicone gel or sheet modifies the process of collagen preparation. This is an important step of scar treatment that you should not ignore. It will benefit you a lot in the long term.

Pressure Therapy:

Pressure garments help in scar maturation. Due to continuous pressure, the supply of blood vessels and oxygen to the scar tissue decreases. Pressure garments should be used in burn scars, it gives great benefit to the patient with hypertrophic scars and keloids. In the rest of the examples, for ear clip ear keloid and face burn, transparent plastic masks should be used.

Scar Massage:

It works in two ways.

Reflex effect- due to stimulation of peripheral nerve-muscle relaxes, reduces pain and increases the overall sense of well-being.

Mechanical Effect – venous return increases, lymphatic drainage increases, and movements between muscle fibers increase.

Now we will try to know when this scar should be treated. For this, you have to understand the four S's formula.

First S - Site of the scar - Are they located in “high-visibility” areas? Is your scar on a very visible part of the body? Or it is at joints or pressure areas such as the palms or plantar feet.

Second S - Symptoms - Pain pruritus means itching or itching, contracture “stretching” which means a feeling of tightness in the muscles, or hyperesthesia which means the area around the scar feels more sensitive.

Third S - Severity of functional impairment - To what degree is there functional impairment of a joint, skin segment, neck, orifice, or digit? That is, to what extent do you feel weakness in function due to scars, such as joints, skin segments, neck, opening parts of the body like mouth, nose, ears, etc., fingers of hands and feet.

Fourth S - Social stigma - What will people think after seeing your scar? Especially it is more in facial scars. They shy away from mingling with people. Some patients are worried about their scared area.

Now we will see how surgical corrections are done:

If your scars are old and are in an unfavorable location, then we can transfer them to the right place by surgery. Scar revision surgery should ideally be done after 6 to 9 months after your scar is formed. Sometimes we can reduce this time to 2 months. In scar revision surgery, if your scar is more in width then it is cut and sutures are made and a plain scar is prepared. This technique is called a scar excision. For the scar which is long, straight, and not parallel to the relaxed skin tension line, scar repositioning surgery is done. Generally, z plasty, w-plasty, geometric broken line scar closure technique is used in this. The common method is that any long scar you have is broken into small scars and irregularized until they are less noticeable. It is hidden by changing the position of the scar.

Now let's learn about laser treatment:

Laser and light devices in scar management

Lasers have a special role in scar management.

The first is to accelerate the improvement of the color tone and texture of the skin by driving spontaneous improvement of the skin.

Secondly, correcting the scars formed by the natural process of healing.

Third, preventing the possibility of large scar formation in high-risk patients.

CO2 laser, Erbium, yag laser, PDL, KTP&IPL. These lasers are commonly used. Now we will see which laser should be used and when.

Red Scars:

Everyone's scar is red in the beginning, this is due to the underlying blood vessels. Lasers that target laser blood vessels such as KTP, IPL, PDL should be used in this type of scar.

Cutter scar /deliberate self-harm scar:

These are quite difficult to treat. A vascular laser can be used for initial red scars. If the redness is cured, then Erbium or CO2 laser is used for repigmentation. It can give the best results only if the treatment is started immediately after the injury.

Erbium tag or RecoSMA or Co2 laser is used for acne scars.

Q switch laser or Pico laser help in removing the black discoloration in tattooing with traumatic scars.

Scars with PIH, that is, the scars which are black, use Q switch Nd yag, or q switch Alexandria, or Erbium laser.

308 excimer laser repigmentation helps in hypopigmented scars ie white scars. 1550 Erbium laser is also very helpful.

In surgical scars, we can use PDL or KTP for redness, RecoSMA or Erbium, or co2 laser for resurfacing for scar treatment 1 month after surgery.

The important question is when laser treatment should be started. It depends on your scar analysis like how much redness is there, what is the type of scar, how much itching is there for the patients? Usually, it should start after 2 to 3 weeks. The exception to this is burn scar, it should be started a little late, after 6 to 8 weeks, the skin should heal well and there should be no complications of the laser.

Collagen Induction Therapy:

In this technique, microscopic injury is done from a microneedling machine or a dermaroller. Due to this injury, the skin starts to heal.

Dermabrasion:

Dermabrasion is a treatment in which the edges of the scar are flattened.

Fat Grafting:

Fat grafting techniques are also used in scar removal in some cases. In this technique, fat is removed from the abdomen, thighs, or buttocks area and grafted under the scar. It gives volume to the depressed scar so that the scar comes to the normal level of the skin. Fat consists of stem cells that dramatically improve the color, texture of the scar. It is used for burn scars, radiation scars, and very large scars where scar revision surgery is not possible.

Tissue Expansion technique:

In this technique, by putting balloons on the side of the scar, which is called a tissue expander, they increase the size of the good skin. Good skin is placed at the place of the scar.

Scar camouflage-Hide the Scar (Camouflage of scars with makeup or tattoos):

Cosmetic makeup or micropigmentation temporarily reduces the visual discoloration of the scar. Tattooing and micropigmentation, this technique is also called permanent makeup. In this, the scar is covered with a tattoo of the natural color of the skin or any other tattoo color.

To understand these Scar Removal Techniques and Treatment in more detail, you can contact us on the given contact us on +91-8378860999 or write us an email at arraaesthetics@gmail.com or meet us directly by visiting the clinic. I hope you will help us make sure that the information given in this blog reaches those who need it.