Review of skin scarring

   

<< What is a scar?

<< Recovery in Time

<< Prevention tips

<< scar Treatment modalities

<< Can I really get rid of scarring?

<< Cost of different facial procedures

<< Effectivenss of facial resurfacing methods

<< Non-invasive methods for scarring revision

 
Skin scarring management

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What is a scar?

Most of us have experienced having a few battle scars at some point in our lives. Scar tissues, which are the result of function of skin's repair system, are filled mainly with collagen. They don't follow all skin injuries but the ones seem to be more serious than a simple cut or scratch. This injury at epidermal level could be result of burn, acne , persistent inflammation and accidents. this excess collagen is also associated with hapharzard arrangement of collagen and elastin bundles which gives scarring an appearance different from that of surrounding skin.

Recovery in time

Time is a key element. Many of these marks fade away or very minimized in time. This in particular applies to facial scars and post inflammatory pigmentation.Therefore any consideration for an invasive procedure such as a laser treatment should be delayed for sometime, maybe two to three months. For those that stay longer, there are many available procedures and creams that can help minimize appearance of scar tissue. Although fresh lesions respond better to laser and some of them totally disappear, response of old scar tissue to treatments is not insufficient. We follow treatments later in this page. Let's see how prevention can aid decreasing the appearance and development of these disfiguring marks.

How to prevent a disfiguring scarring?

Many studies indicate that covering a wound can help flatten scar tissue, especially the types, which are more raised such as keloids. Most , not the ones resulted from adult acne, benefit from applying constant pressure on the wound with special bandages or silicone sheets.

External stitches that remain on the skin for long time can cause more skin irregularities. So it is adviseable to remove stitches after the first week.

Wounds should be covered. The more moisture reaches a surface of a wound, the more likely formation of new scar tissue. Applying an ointment of antibiotic under a bondage is a good way of preventing infection. Infection is the worst enemy for wound healing.

How about cleaning a wound? Major reason to delay healing of a wound is infection. So disinfecting a wound is the most crucial measure in its care. Use of hydrogen peroxide to disinefect a wound is quite common. However, some studies suggest that hydrogen peroxide may destroy the new skin cells that immediately begin to grow. To be on the same side use alcohol to clean the cut.

When it comes to vitamins which one really help? One study suggest that vitamin E has been shown to impair wound healing. Instead vitamin C helps with collagen synthesis and wound healing.

Always watch an allergic reaction, for example due to the bandage. This can be detected by noticing redness or itchiness over a lesion.

I have this scarring, how can I treat it?

Mild to moderate forms of a scar could be well treated with topical scar creams or resurfacing scar serums such as Hippocrates Kit for acne, advisable for people who still have active breakouts, or Hippocrates scar serum, suggested for those who stopped having breakouts for at least six months. These scar treatment modalities provide you with a moderate peeling that can be incorporated into your skin care regimen at home. However, extreme care must be exercised in use of these high-potency serums , because they are highly potent with therapeutic effects, however, very safe with no side effects. Serums are also more advisable to patients whose skin is still acne prone and are likely to develop blemishes from time to time. This approach will efficiently help with treatment without any side effects. In addition, you will be enjoying a nourishing retexturizing scar creams, which not only root out scarred skin but also revitalize and protect your skin against free radicals and aging process. It is also to note that many available modalities in the present market are ineffective, an example is onion extract for treatment of skin scars.

Scar treatment solutions, a hype or reality, Can I really get rid of scarring?

The first thing one think of when it comes to a hypertrophic or atrophic scar is that whether his/her skin tissue can be returned to its original state. If you have gone through our pages you might have realized that there are invasive and non-invasive approaches to facial scars resurfacing. Among invasive scar treatment methods subcision and punch graft could be named.Surgical treatment of scarred skin like laser resurfacing typically cost more than other methods such as Hippocrates at-home regimen. Let's first take a look at the costs and recovery time, which basically are two important factors when considering any of these scar treatment solutions.

Laser resurfacing cost varies between $2000 to $4000 depending on the size of the treated area. Recovery time 4-6 weeks

Dermabrasion facial procedures range from $1500 to $2000. Recovery time at least 2 weeks

Chemical peels ranges from $200 to $1500. Time for recovery is at least 2 weeks

How effective treatment methods are?

Now another factor comes into play, that is efficacy of each approach. This is highly dependent to scar type and depth. For instance, laser does not improve an ice-pick scar (see image) to a great extent. In contrast, its effect on a hypertrophic scar is significant. None of these methods can eliminate deep lesions completely. However, all improve damaged skin's appearance and make skin scar more superficial. There are some other considerations when you are to decide which one works for you such as skin color and type. However, you should first decide whether you want to go for an invasive or non-invasive procedure. If your decision is an invasive office procedure then a plastic surgeon can help you with the rest of your question.

Non-invasive scar treatment methods, Do they work?

Among this group of treatments there are two main categories. Silicon sheets and cell turnover accelerators. Silicon sheets are only indicated for either a hypertrophic scar (see image) or the one remained as a result of surgery. They may not have any effect on an atrophic scar (see image). Among cell turnover accelerators or exfoliants alpha hydroxy acids or AHA's, beta hydroxy acids or BHA's and retinoids can be named. AHA's is a compound found naturally in many common fruits such as pineapple, berries, grape, sugar cane. Among them glycolic acid, found in sugar cane and sugar beets, have been used more prominently in cosmetics. AHA main action is to accelerate shedding of skin cells in the topmost layers of the skin by decreasing their cohesiveness. Continued use of glycolic products may result in a smoother epidermis and to some extent elimination of comedones (blackheads and whiteheads). In doing so AHA generally can enhance the penetration of other agents and nutrients such as Vitamin C, Zinc, amino acids, essential fatty acids and ceramids. Simultaneously it helps to restore the barrier function of the skin, thereby increasing tissue own moisture content. There are evidences that suggest increase in collagen production in dermis layer with use of AHA. Glycolic creams can make the skin more sensitive to the effects of the sun’s UV rays; therefore use of effective sunscreen is essential. Having said all that can AHA alone be used for scar revision or does it have a significant effect in reducing a scar. The answer is pH and concentration of AHA determine success of glycolic products. However, glycolic acid products in their highest concentration available and in lowest pH tolerable by skin can not improve skin scar by themselves.

Beta hydroxy acids are another modlaity among non-invasive scar treatment methods. BHA's, are another group of cell turnover accelerators which are derivative of aspirin and naturally can be found in willow bark. The most well-known BHA is salicylic acid. Some authors claim that BHA's are stronger exfoliants than AHA's and interestingly more gentle to the skin. A salicylic cream is also pore-clearing and can help with blackheads and comedone clearance. Use of BHA's alone is not very promising, even though overall somewhat smoother skin is the net result of using a salicylic preparatioins for at least three months.

Other treatment approaches.

Retinoids are derived from Vitamin A. Retinoids could be found in alcohol form (retinol or acid form of retinoic acid- Retin-A cream). Unlike their close structures, retinol and retinoic acid seem to act very differently on epidermal tissue. Retinol by helping to restore the barrier function of the skin is very hydrating to the skin. On the contrary, retinoids are very drying and irritating to the skin. Interestingly, keratolytic effect of retinoic acid is different from that of retinol. Retinoic acid causes desquamation of skin tissue, so dead cells get separated more readily (smoother skin ). It also appear to help collagen synthesis (firmer skin and fewer wrinkles), as well as redistribution of melanin (skin pigment) by which even-tone the skin. Effect of retinol treatment creams sounds very limited.

Use of anti oxidants such as alpha lipoic to treat a hypertrophic or atrophic scar is very questionable. It is very skeptical to assume alpha lipoic creams or bioflavanoids, known anti oxidants, can change the collagen rearrangement in dermal layer of the skin. This more sounds like a cancer patient taking vitamin pills to cure its cancer. Vitamins will help immune system but hey will never be able to cure any form of cancer. Effect of lipoic acid on oxidative damage could be perceived as a protection against any new damage. However, skin damages already taken place in the epidermal and dermal layers could not be altered by oral or topical application of this substance. Lipoic acid is a substance with strong anti oxidant activities, however, its effect in improving scar tissue remains undetermined.

References:

1. D A McGrouther, MWG Ferguson, skin scars developement, BMJ. 2003 January 11

2. HAKVOORT T. E. (1) ; ALTUN V. (1) ; RAMRATTAN R. S. 1999, vol. 434, Epidermal participation in post-burn hypertrophic scar development

3. B R Klass, Postgraduate Medical Journal 2009, Transforming growth factor β1 signalling, wound healing and repair

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High potency serums for treatment of scarring:

Scar revision using an at-home treatment is a lengthy treatment requires patience. However, Hippocrates has developed an skin care tailored for body and facial scars lesions using high-potency treatment serums. This skin regimen changes your skin dramatically within one month. What will be more noticeable is the glow and smoothness in your skin rather than facial scars. Areas of damage might never disappear completely, yet, your skin will divert into a skin strikingly different in terms of overall smoothness and radiance. Read also frequently asked questions.

Hippocrates scar treatment kit takes six to twelve months to smooth away skin damages, depends on their depth. Acne scar resurfacing serum works on the surface of the skin, epidermis, as well as deep within the dermis layer by stimulating collagen remodeling.

Hippocrates scar treatment kit also benefits from retexturizing properties of retinol, AHAs and BHA's for removal of scar. This scar serum, formulated to treat scar lesions, also provides the skin with the nutrients it needs the most to make up for lost nutrients while the epidermis involves with skin renewal.

The result is a new skin, where damaged skin is hardly recognizable because overall smoothness of the skin overwhelms the gradually-disappearing scars. Acne treatment works on scar lesions in a slower rate, targets acne lesions and aims to clear the skin. If you still have active acne and you are concerned about your scarring as well, your best choice would be acne kit.

 

How to start dealing with my scarring, where to seek treatment? First thoughts when dealing with scarring.

I have these scars for a while , what are my choices? Is there a real cure out there? Can they be removed permanently? How effective present modalities work on different type of scar? Do they work only on the surface or do they work deep within my skin? These are the type of questions you may have on your mind. Here we try to address them on this page and throughout this site.

First identify your scarring? What type of scar you have? Is it a hypertrophic or a ice-pick scar or only some pigmentations (skin discolorations)? Acne is involved? (You can find out more about scar types on our homepage). Is it the consequence of acne lesions or consequence of an injury or some accidents? Scarring resulted from adult acne is mostly limited to scars with decreased skin tissue (atrophic scar lesions), which means there is nothing raised or lobulated (tissue formation increased) there; it's more of a pitted appearance like an orange surface.

The second question you should have an answer for is where it 's located? Is it on your face or your body? Body scars tends to respond more slowly to most scar resurfacing procedures. One obvious reason is that microcirculation of skin in face region is more likely to be robust compare to that of rest of the body. Third question, how deep they are? The deeper they are, the less chance of improvement? That is not true. No matter how deep they are, you shouldn't be discouraged to seek improvement. With the aid of present modalities your overall skin appearance can be improved significantly. They will get better and your skin can change. However, you should keep your expectation in a realistic jurisdiction. Complete eradication of body or facial scars may not be feasible using available modalities.

plan for treatment

Now if you made your mind to improve appearnce of your acne scar and its treatment, which one suits you most? There are many factors you should consider. Among the most important ones are recovery period, cost, complexion type, an at home prgram as oppose to an office procedure. Can you stay home for three four weeks after a procedure at a plastic surgeon office? For how long you have been dealing with scarring and damaged skin? Ongoing regimens versus one-time procedures? Which one works better? Does the result of office resurfacing procedures last longer? Is the result permanent? These are the type of questions you may have for at a dermatologist or a plastic surgeon. See also our frequently asked questions page to find answer for some of your questions.

Course of an acne scar

Some scarring can get healed on their own. Spontaneous restoration of hypertrophic lesions is sometimes seen. Wait at least six to twelve months to see how your skin can heal itself. The truth is most available facial treatments work through skin resurfacing, renewing your skin by removing top layer of the skin. The result could be different though. One factor that especially affect the result is individual's skin type. Interestingly, individual's skin type can make you a better candidate for certain procedure. Most of these treatments even retinoid creams act on epidermis, removing the top layer of the skin, their influence on dermis, the second top layer, if there is any, is minimal. Arrangement of extracellular fibers has been impaired as a result of work of skin's healing mechanisms in response to an injury. Disorderly reorganization of extracellular fibers is clearly noted. Rearranging these haphazardly-arranged collagen fibers in dermis is not something most procedures/treatments can achieve. There are some hopes in that regard using Vitamin C serums enriched with antioxidants, however, the net result is not very promising, especially when they are used alone. Having said all that, should I treat acne scarring? Our answer is yes, we understand the amount of distress scars can bring to your life and we are here to help. We believe, deep facial acne scarring may not be relieved entirely, however, their appearance could be improved. Your face can experience smoothness, vitality and a healthy glow. Simultaneously, appearance of deep facial scarring could be overwhelmed by epidermis uniformity and integrity.