Scar revision or correction can be done in many ways.The outcome of the treatment and the choice of the treatment depend on the characteristics of the scar. These factors include skin type of the patient, extent of scarring, duration of the scar, cause of the scar – acne,post surgery, chicken pox etc, depth of the scar, and type of the scar itself. Also, it is important to know whether there are keloids/ exuberant scars elsewhere on the body. Similarly, it is important to assess the general health of the person undergoing scar correction, since all these factors are important in achieving good results.
Scars due to acne are broadly classified as elevated or raised and depressed scars. In medical terms, that would be hypertrophic and atrophic scars, respectively. Atrophic scars are far more common than hypertrophic scars, but the latter are much more difficult to treat. Atrophic acne scars can be further divided into rolling, boxcar and icepick scars.Treatment options for acne scars include the following.
Subcision – where a needle is used to lift the floor of the scar, and release the scar from its attachment to the surrounding skin. This is the best option for rolling scars, and works even better when combined with suction. Dr Renita Rajan pioneered the use of Vicryl threads for advanced Subcision of acne scars – this innovation gives thorough and better volumetric correction of acne scars.
Dermaroller – where multiple needles mounted on a hand held device, are used to create tiny wounds in the skin, which when they heal, lift up the acne scars with them.
TCA CROSS – this is a popular and easy technique, where a high concentration of TCA is applied to the base of the scar to lift it. This is a great option for very deep scars like ice pick scars, and also is very useful in smoothening the scar edge, which can be a problem with boxcar scars.
CROSS stands for Chemical Reconstruction of Skin Scars, and TCA stands for Trichloroacetic acid, which is the chemical used in the treatment. The concentration of TCA used for this treatment is usually high, from 50% even up to 100%. The procedure itself is painless, quick and among the most economical options available to treat acne scars. However, there is a significant downtime of 3 -4 days, when the scabs are present after the treatment. After 3-4 days, the scabs fall away leaving behind pink skin which slowly returns to normal colour over a period of 4 -6 weeks. Results continue to improve over 3- 6 months, even after a single session, as collagen remodeling continues.
The crucial requirement is complete and strict sun protection, after a treatment session. If for any reason, that patient cannot/ does not want to use sun protection, the TCA CROSS is not a suitable option. It should be used with caution in patients with keloidal and abnormal scarring tendency. However, the high accuracy of treatment delivery possible with this treatment is unmatched.
Dermabrasion – where a manual/ motor dermabrader is used to remove the superficial layers of the skin in a controlled fashion, to improve the textural aberrations caused by acne. This procedure involves some downtime, and so needs to be planned with that in mind.
Microdermabrasion – is often used in combination, or as a finishing procedure in a series of acne scar revision treatments. Used alone, this technique requires several sittings to see significant results. Also, for scar resurfacing, a higher setting needs to be used than for indications like rejuvenation.
Chemical Peels – are very useful in managing superficial scars, and often require to be combined with another procedure for deeper scar correction. They can also be used in combination with procedures like subcision and after dermaroller, to improve the final outcome.
Chemabrasion – this involves the use of chemical peels in combination with a dermabrasion/ microdermabrasion procedure.
Fractional resurfacing – this involves the use of LASER/ radio-frequency energy to create tiny wounds in the skin, which lift the scars as they heal.
Scar excision – sometimes, a scar can be easily removed, while still maintaining the cosmetic outcome.
Punch floatation – in deep scars, the floor of the scar is raised using this technique.
Filler therapy – this technique involves the use of hyaluronic acid fillers/ fat/ silikon to lift the scar base.
Platelet Rich Plasma (PRP) therapy is one of the latest advances in scar revision techniques. While this modality can be used as stand alone treatment for antiageing, wrinkle reduction and hair growth on the scalp, its true potential lies in its ability to step up the results of other resurfacing procedures like subscision, radiofrequency needling, LASERs and so on.
About 20 ml of blood is adequate for one session of PRP rejuvenation for the cheeks and the forehead. This blood collected from the patient, then undergoes a process of differential centrifugation to yield the platelet rich component. This is then injected into the scars, or into the deeper dermis in the case of rejuvenation using special cannulae, that are specifically designed to minimize trauma to deeper vessels and nerves. Since scar tissue has disordered blood supply, infusing growth factors and remodeling agents found in blood into the scarred area, helps tissue remodeling and promotes scar revision significantly.
Adequate local anesthesia helps to minimize pain greatly, and so the treated area may feel numb for up to an hour after leaving the Clinic. There may be some swelling of the treated area for up to 24 hours, but this hardly interferes with routine activities. Patients resume work the same day of the treatment on most cases.
An ideal course of treatment for scar reduction involves a session every month for about 4- 6 months. Results will typically start to be apparent within a week to ten days after the procedure, but maximum results will continue to accrue over a period of 6 – 8 months. Since the tissue for rejuvenation comes from the patient, this treatment is much less expensive than fillers.
Given that the field of scar revision is rapidly increasing, this technique has gathered popularity rapidly, and seems to be promising on the clinical front as well.