Whether a scar is from an accident, surgery, disease, or skin condition such as acne, scarring can negatively affect a person’s self image and quality of life. Unfortunately, the scarred skin often serves as a reminder of a traumatic or painful experience in one’s life, such as a burn or accident.
Fortunately, there are many effective treatment options available. By reducing or eliminating the appearance of scars, dermatologists can help patients overcome negative emotions associated with them. Cosmetic treatment options that can improve the appearance of scars include laser treatments, surgical procedures, chemical peels, and, in some cases, dermal fillers. Continue reading to learn how scar tissue is formed, different types of scars and the treatment options available to improve their appearance.
What are the different types of scars?
Contracture scars
This type of scar is typically caused by a burn, leading to extremely tight skin that can restrict your ability to move.
Keloid scars
True keloid scars are caused by abnormal, overgrowing scar tissue at the site of a skin trauma which may even be as small as an acne pimple, that continues to grow beyond the site of the original injury. This type of scar can appear as a firm, rubbery, misshapen lesion or shiny, fibrous nodules.
Hypertrophic scars
This type of scar tissue is characterized by excessive collagen deposits that cause the scar to be raised, but unlike true keloid scars, which are abnormal neoplastic growths, hypertrophic scars stay within the site of the original injury or surgical scar.
Acne scars
There are many different types and shapes of acne scars, from rolling, to boxcar, to icepick, but very commonly these scars are caused by a lack of normal wound healing, with collagen that produces a pitted (or atrophic) scar. Acne scarring can be among the most socially consequential scarring, but unfortunately is also stubborn to treat in many cases.
How scar tissue forms
The development of scar tissue is part of the body’s natural healing process after the skin is wounded due to an injury, surgery, or other trauma. The wound healing process is complex and involves coagulation, formation of granulation tissue, re-epithelialization, and extracellular matrix remodeling.
In regards to scar tissue formation, the process begins when cells called fibroblasts in the skin’s lower layer of fibrous connective tissue (also known as subcutaneous tissue) are stimulated after an injury to grow into granulation tissue to seal the wound. Scar tissue is formed by dense masses of granulation tissue.
The reason scar tissue has a different texture and appearance than the surrounding skin is due to the final stage of wound healing, extracellular matrix (ECM) remodeling. The ECM is created and modified by fibroblasts, and is comprised of a network of type-III collagen. Over time, the type-III collagen is replaced by type-I collagen, which is stronger and consists of longer strands. Even though this stage can take many months, the new ECM forms scar tissue that never achieves the flexibility or strength of the original tissue. (Adv Wound Care. 2015)
How in-office treatments can improve the appearance of scars
Although scar tissue is the result of the body’s normal healing process, scars can be cosmetic concerns for both men and women. The good news is that several nonsurgical treatment options offered by dermatologists can significantly improve or even eliminate the appearance of scars. In order to know which cosmetic treatment option is best for you, the type and size of your scars will need to be evaluated. Treatments vary based on several factors.
Dermal Fillers
For example, indented scars that are the result of acne can be treated with injectable dermal fillers, such as Juvéderm® or Restylane®. Both Juvéderm® and Restylane® involve injecting hyaluronic acid into the treatment areas. Hyaluronic acid is a glycosaminoglycan (a sugar-based compound) that is naturally produced in the body to keep skin healthy and moisturized.
The injection of dermal fillers is a minimally invasive procedure that takes approximately 20 minutes with no downtime, although the filler will need to be readministered 6 to 12 months after the initial treatment.
Laser Treatments
If a scar is pigmented, dermatologists can utilize specialized in-office laser treatments to reduce their visibility. At the Art of Dermatology, Dr. Jessica Krant treats pigmented scars, such as from acne, with either Intensed Pulse Light (IPL) or the PicoSure® laser technology. PicoSure® is an FDA-approved aesthetic picosecond laser that is the first of its kind. It improves the appearance of scars by using a gentle pressure instead of the damaging heat that is used with traditional lasers. Treating scars with the PicoSure® laser is safe and effective, with no need for downtime. Multiple laser treatment sessions are typically required to see optimal results, but the results can be permanent or very long-lasting.
Finally, surgery, including local subcision, serves as an option to physically remove or improve the scar tissue in the case of severe scarring. However, most moderate scars can be visibly reduced or even eliminated without surgery.
Scar Treatments in NYC
For more information about how you can improve the appearance of scarring, schedule a consultation with Dr. Jessica Krant of Art of Dermatology at the Laser & Skin Surgery Center of New York, located in Manhattan. Dr. Krant does treat many types of scarring, but not all. If she is unable to help you with yours, she can direct you to a colleague who would be a more appropriate expert.