Health

Treating your scar.

The skin is the largest organ with many important functions, including protecting the body against infections. Throughout our lives, everyone will suffer a few or more minor or larger injuries to the skin that heal with a scar. How these scars appear will depend on many factors: the depth and size of the wound, your age, genetic factors, and even your gender and ethnicity (skin color and type). There are four main types of scars and various treatments can help reduce their size or improve appearance. But it is important to know that a scar will never completely disappear.

Scars are divided into four main types:

Hypertrophic scars.
These are raised, red scars, which may resemble keloids (see below) but unlike keloids do not come beyond the limits of the original lesion. Treatment options are injections with corticosteroids and laser treatments.

Keloids.
These scars of the skin ‘grow’ beyond the original injury limits and are the result of overproduction of scarring cells. Over time, keloids can become so large that they can lead to mechanical or mobility problems. In addition, they are often not aesthetically pleasing. Possible treatments include surgical removal, laser treatment or corticosteroid injections. Smaller keloids can be removed with cryotherapy (freezing therapy using liquid nitrogen). Keloids are more common in dark skin types, especially people of African or Asian origin. Keloids are known to return often after treatment.

Contracture scars.
This type of scarring causes a tightening of the skin which, depending on where the scar is located, can influence or limit certain movement. This phenomenon can occur, for example, after a burn.

Withdrawn scars.
In some cases there may be a withdrawn scar. This can be seen in acne scars, scars after an accident, scars caused by surgery, but also certain wrinkles and ‘cellulite pits’. The skin is then pulled downwards through fibrous connective tissue strands and anchored to the deeper tissue layers.

Treat it yourself.

Some things you can do to make the healing process more smooth.

  • Fresh scars are still very sensitive to external influences. It is wise not to expose the scar to extreme temperatures (such as sunbathing, tanning beds, saunas and extreme cold).
  • Avoid tight clothes if they irritate or damage the scar
  • Be careful with strength sports and gymnastics exercises because the scar skin is still sensitive and can easily be damaged. Also remember that after 1 year the scar skin only has 70-80% of the original pulling power.
  • Take care of the scar regularly with a moisturizing cream. A scar lacks proper moisture management and should therefore receive extra attention. Also for a moisturizing cream you have to protect yourself from spending too much money on a cream whose scientific background is unclear.
  • Watch the ingredient list on the cream you are using. Some ingredients can irritate the skin. A scar is very sensitive.
  • Only treat a closed scar.

Personally i use a tube of Bergman Beauty Care sensitivity sos balm. It is very vaseline textured but lubricates nicely. Chose this because the Bergman Clinic is behind the products. This clinic does also plastic chirurgy operations.

The treatments by the doctor:
The treatment options for scars depend on the size and type of scar. Effective treatment options are: peelings, laser treatments, filler injections or lipofilling, subcision (whether or not in combination with filler injections or lipofilling), surgical removal, corticosteroid injections, cryotherapy. Which of these treatments are suitable depends on the type of scar and will be discussed during an intake interview with your doctor.

Peelings.
In a chemical peel, a liquid is applied to the skin that removes the upper layers of skin cells. At the same time the underlying connective tissue is activated. There are different types of chemical peels. For example a fruit acid, TCA or Phenol peeling. Medium or deep peels can be effective with withdrawn scars, especially acne scars. In my country The Netherlands there are peeling options like fruit acid available at beauty salon. Qualified estheticians are able to treat you.

Laser treatments.
Laser treatments come in different types and sizes, each with their own treatment goal. Some types of lasers are suitable for removing hair, others for removing small blood vessels. With a fractionated CO2 laser several signs of aging and skin damage can be tackled: skin relaxation, fine wrinkles, coarse skin (pores), pigment spots, acne scars and scars after for example an accident, burns or surgery can be improved with the fractionated CO2 laser. Not only the skin of the face, but also for example those of the backs, neck and décolleté can be treated.

Filler injections and lipofilling.
Fillers and own adipose tissue (lipofilling) can be used to correct volume loss, also with a sunken scar. However, it is possible that the scar is not only sunk, but is also anchored to the deeper tissue layers with connective tissue strands. In such cases, filling with fillers or own fat alone will not work, but a combined treatment with subcision is required.

Subcision.
Subcision is made to cut the fibrous scar strands that pull the skin down and anchor it to the deeper tissue layers. For this we use a special NoKor needle, which has a sharp and flattened end. Once applied under the skin, the cutting surface of the needle is held horizontally, and in a reciprocating movement the scar strands are cut below the level of the skin. Subcision is suitable for scars or wrinkles that lie deeper than the rest of the skin. In certain types of scars, fillers or injections with own fat (lipofilling) after subcision can be used to fill up the cavity created and thus prevent the scar from retracting during the healing process.

Surgical removal. 
Scars can be surgically removed or corrected. However, a new scar is created. That is why this approach is only suitable for scars that cause complaints, such as keloids or contracture scars. Keloids can be completely removed by surgery. However, the chance of a new keloid scar is quite large. Therefore, excision of a keloid is often combined with another treatment method such as cryotherapy, corticosteroid injections or pressure therapy. Contracture scars can cause mechanical complaints and movement limitations. In this type of scars it is usually not sensible to remove the entire scar, but it is better to correct the scar so that the restriction is removed, with a so-called skin plastic (moving skin).

Corticosteroid injections.
In the case of elevated scars, such as keloids or hypertrophic scars, your doctor may choose to use corticosteroid injections to flatten the scar. The scar will therefore look calmer and less red. Such injections can be used as a stand-alone treatment or in combination with other treatments. It is important for these injections to act with care and not to dose too high. At high doses, the effect of corticosteroid injections can break through and cause skin to dilute.

Cryo Therapy. 
Cryotherapy is particularly suitable for keloids and hypertrophic scars. The scar is frozen from the outside with liquid nitrogen. This causes the superficial skin layer and the scar tissue to die off and is replaced by a new scar, which hopefully creates a calmer and flatter scar. The Cryoshape treatment has been in place for several years now. Here the tissue can be frozen from the inside by applying a special needle in the scar. This results in better results than with freezing from outside.

Camouflage Therapy.
Because in current treatments it can sometimes take a long time (weeks to months) before a clear effect can be seen, many patients want to use camouflage make-up in the meantime to make the scars less noticeable. The esthetician can help you with this. She can advise you which means you can or can not use. She will also give you the camouflage therapy, so that you can apply it yourself in the right way. By applying a special opaque cream, disturbing scars can be made almost invisible. This appears to have a good effect on the self-confidence of the patient.

If a recently operated operation or injury has caused the scar, it is better to wait at least one year before deciding whether or not to correct or treat the scar. Many scars fade and become less visible with time.

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