Treatment of scars


  • Why do some scars remain on the skin?

    Skin is a beautiful layer that covers the organs and creates a beautiful view for different parts of the body. Skin has several layers and could repair itself if damage would happen. If the surface layers of skin are damaged, the repaired skin will be just like the one before injury. So do not worry about the scars in the case of slight wound on skin, because everything goes back to normal state. But if deep layers of skin are damaged, the repaired skin will not be like the one before injury and scars would remain.

    How can we prevent scarring?

    Many people do not know that when the injury happens, they can do something to prevent scarring, in order to have less mark on skin. Sometimes these points are really easy and if you do them, the result would be amazing, even better than any kinds of surgery such as Laser etc. So, to prevent scarring, you should keep these points in your mind.

    1. To avoid infection and further damage of surrounding cells

      For example, in the case of burning or surface scratches, due to improper care, the wounded area would be infected, and skin layers would be damaged, and these cause forming scars. Therefore, in some cases of wounds, to prevent infection, you must take antibiotics.

    2. Do not use Betadine

      Contrary to people’s thoughts, using Betadine on open wounds is completely wrong. Because Betadine eliminates microbes, but also damages healthy cells. And this makes the situation worse. In general, wound is as sensitive as mucus of eyes, then whatever we can’t pour in the eyes, we can’t use for wounds.

    3. Keep the wound clean

      Keeping the wound clean, helps the skin for being repaired. Washing the wound with soap and water (and especially baby shampoo) is really helpful, of course to the extent that just clots and secretions are removed. It is better to do this 3-4 times a day. Not following this important point, is one of the most common causes of remaining stitch mark on skin, for people who have had Rhinoplasty.

    4. Avoid unnecessary touch of the wound

      Unnecessary touch of the wound (such as removing its upper layer) should be avoided. Most of us know that one of the major factors which causes scars, is to keep touching pimples. Unfortunately, up to now, no method (laser, medicine, etc.) can remove scars of pimples.

    5. Removing the gap between edges of the wound

      If there is a gap between edges of the wound, it should be removed in different ways (such as suitable stitches, Band-Aids, etc.). Otherwise, the gap will be filled with scar. During the years that I worked as a doctor, I dealt with people who sometimes due to fear of stitches scars, were not willing to use this method. If we look at this matter scientifically and honestly, I would say that stitch in some cases works great and it’s like a miracle, but sometimes incorrect stitching makes the situation worse.

    6. Removing the difference in levels of edges of the wound

      Sometimes edges of the wound are not at the same level, which means that one side is upper or lower that the other one. This is one of the major causes of forming ulcers like steps, which should be removed by appropriate stitch.

    7. Removing dents of edges of the wound

      If edges of the wound go toward inside the wound, a bad mark will remain on the skin. This is an important cause of dented ulcers. So, this should be fixed by appropriate stitch. (This needs skill of an expert doctor)

    8. Holding edges of the wound stable

      If the wound is in an area which always moves and stretches (such as around the lips, eyelids and eyebrows), stitch is recommended, even though the wound edges are exactly next to each other. Because while skin is being repaired , movement of surrounding tissues may cause distance between edges of the wound.

    9. Stitch in the early hours

      If you have injuries requiring stitches, it should be done as soon as possible. Because by passing time, swelling of the wound edges decrease positive effects of stitch.

    10. Do not use cream or ointment for removing scars in the first 2 weeks

      Until the complete wound closure and covering by epithelium of its skin (takes approximately 2 weeks since the time of injury), do not use cream or ointment (such as Elise, Rejuderm, alpha, etc.) for removing scars. Using these medications can be effective in wound healing, but early use of them could have negative effects.

    Methods of hiding scars

    1. Hiding scars by hair

      Women who have scars on their foreheads, eyebrows, ears and neck, can hide the scars by their hair. Men, who have scars around their mouth, on their face and upper part of neck, can hide the scars by their beard and mustache. (See below Fig)

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    1. The use of cosmetics

      People who have small scars or scars with different color from their skin, can easily hide scars by the use of cosmetics.

    2. Hair transplantation

      Hair transplantation is very helpful, especially for whom with scars around eyebrow and on head. Because of hair loss in these areas, scars are more visible. That is why hair transplantation works great.

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In some cases, despite following the above mentioned points, there are some scars with very bad view and worse than that, sometimes the scars are uglier when the person talks, laughs or by any movement of facial muscles. (Below Fig)

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Methods of removing scars

There are various surgical and non-surgical methods (such as laser and different types of medications) for removing scars. Each of these methods has its own characteristics. In general, no single approach is effective enough for any types of wounds. Therefore, for using any methods of treatment, we should pay attention to features and characteristics of each wound. Notice that none of the treatments can completely eliminate scars. Therefore, the purpose of using different methods is changing the appearance of the wound so that it becomes less obvious or completely hidden. Non-surgical methods are such as laser, topical medications, dermabrasion etc. In many cases their impacts are similar to each other, to the extent that we can substitute one for another. For example, laser and dermabrasion have quite similar effects.

Surgery for small scars (such as scars of pimples) is not an appropriate method and can make them worse. But for large ulcers, surgery is a very effective method and has great results, more than any other non-surgical methods. Look at the below Fig, as an instance. Despite using laser and different types of medications, the patient is still unsatisfied. And as you can see, the scar is completely visible.

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Ways for betterment of scars in surgical approach

  1. to narrow scar as much as possible

    Many scars are wide and that is why they draw attention. So, we can make them narrow, so that they will be less visible. Narrowing the scar is possible just by surgery. If you have wide scars, you should know that by using methods such as topical medications and laser, you are wasting your money and you will never get the desired result. Because non-surgical methods cannot narrow scars.

  2. To level the scar and its surrounding area

    In mild cases, scars which are not level could be treated by non-surgical methods. But in severe forms, surgical methods will be more helpful. By leveling the scar and its surrounding area, we can make it less visible.

  3. To make the pattern of scar irregular

    Many scars due to their regular and linear pattern are easily able to be seen. If these straight and uncluttered lines turns to broken or zigzag lines, they are less visible because our eyes cannot easily follow irregular lines. In fact, this method causes optical illusion and that is why the scar is thought to be hidden. This method is also possible just by surgery. As we see in the following pictures, three methods mentioned above have been used for betterment of the patient’s scar.

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  1. To hide scars in natural wrinkles

    This method of hiding scars, is very interesting and has a great impact on beauty. It has its own scientific principles, but it needs doctor’s skill and patience. This method is also possible just by surgery.

Note:

If the scar is new and its primary repair is not good enough, we must not immediately do the surgery. Because the wound is not prepared for a new change and any early repair may cause bad results. When injury happens, we should wait at least 3 months for doing surgery. It is recommended that you postpone the surgery until next 6 months. During this period, you can use non-surgical methods for betterment of the scar. If a doctor advises you to have a surgery earlier than this 3 months, he may not have enough information about this case, or he wants to do the surgery because of the money!

Non-surgical methods

Non-surgical methods are such as laser, dermabrasion, topical medications etc. Generally we can consider following characteristics for them:

  1. In the case of small scars (such as pimples scar) non-surgical procedures are preferred, but for big scars, surgical methods are more helpful.
  2. Shortly after the initial wound healing, non-surgical procedures are able to be used. Therefore people who must wait another 3 to 6 months for skin repair process, should use non-surgical methods.
  3. Non-surgical procedures are good supplements to surgical methods for improving the result. That is why most of the times, after wound healing by surgery, these methods are also able to be used.
  4. Most of the times, mechanism of non-surgical procedures is as following way. They stimulate new skin cells and rebuild collagens by means of removing or destroying some parts of the skin. So the impact is limited to the skin and in the case of scars of deep wounds, they are not helpful.