Scar Removal Techniques

There are a lot of different ways to reduce or remove a scar. Here are some of the most popular options.

Steroid Injections

When a person has keloids or hypertrophic scars, sometimes a small injection of steroids can help to reduce the size and prominence of the scar. The theory behind this is that the steroid will help to inhibit fibroblast growth and activity, and that this in turn will reduce the amount of collagen present (the tissue which makes up the scar).

Many people find great success with this method, although some report experiencing side effects. Sometimes steroids can cause fluctuations of the pigmentation of the patient's skin at the site of the injection. Some other people also report that this method almost works too well, and that they end up with a sunken appearance afterward. Some others report that they develop spider veins in the area where they were treated.

Some people express worries that the steroids will enter their bloodstream and cause strange muscle growth. However, the medical professionals who administer this sort of treatment make sure that the proper dosages are used so as to minimize the possibility of unwanted change. Because of these precautions, very little of the steroid actually makes it into the blood stream at all.

Steroid injection is often used by itself, but it can also be used in conjunction with other methods. When steroid injection is used by itself, it typically has to be repeated several times. A patient will typically have to wait about a month or a month and a half between sessions.

Cryotherapy

The word "Cryotherapy" derives from the Greek root "cryo," meaning "ice cold." This type of therapy freezes the scars in an attempt to make them less noticeable. This is typically done using liquid nitrogen. Cryotherapy is frequently combined with steroid injections to help maximize its chances of success.

On its own, cryotherapy doesn't seem to be the most effective form of scar removal out there. These days, it is most commonly used on scars on large areas like the back. Cryotherapy scar removal frequently leaves the skin temporarily irritated or itchy. However, this typically passes after several days. Blistering and swelling is also possible, but temporary.

One of the benefits of cryotherapy is that it helps to soften the scar tissue, which can make it easier for steroid injections to enter and do their work. However, cryotherapy is not typically recommended for large keloids, as this can sometimes lead to problems.

Pressure Garments

Using pressure garments can sometimes help with scars. However, this is typically most effective when it is done before the scar has fully formed. Pressure garments don't tend to be very effective when used on old scars.

Pressure garments are often used to help treat burn victims. When people have severe burns, they run the risk of developing severe hypertrophic scars. Wearing a pressure garment can help to keep the scar tissue compressed while it is forming so that it does not swell up and create unusual and unsightly deformities. This will prevent the formation of nodular formations and buckling scars, and it will help to keep the scar tissue as thin as possible. This not only helps with a person's appearance, but it also helps to keep the scar tissue from impinging on joint mobility.

Burn victims typically are instructed to wear pressure garments as soon as the wound has healed, often within a month of the original burn. The garments have to be worn 24 hours a day for maximum efficacy, and they should only be removed for bathing. Burn victims will typically need to wear their pressure bandage for somewhere between six and eighteen months.

Saline Injections

Some people also use saline injections to treat scars. This is typically used to help with scars that are sunken. The saline solution is designed to help stretch the tissue and stimulate the production of new collagen which should, in theory, cause the scar to stop being so sunken. Just as with steroid injections, saline injections are administered multiple times, with a gap of a month or two between injections.

There are risks involved with this procedure, just as there are with all sorts of scar removal techniques. Patients should make sure that they are going to adequately trained professionals for this sort of work. Some people try to get scar removal procedures at booths at the mall or even try to perform them at home. With some procedures, this can be very dangerous. Make sure that you find someone who is fully qualified before you allow any sort of injection to be made.

Tissue Expansion

When large areas of skin are damaged through burns, lacerations, or other injury, scars can form which are very difficult to remove. When a scar is too big, just making it so it doesn't stand above or sink below the surrounding skin won't be enough to keep it from being noticeable and unsightly. Also, you can't merely remove the scarred skin, and expect it to heal over, as there wouldn't be enough skin left to stretch across the hole.

In cases like this, tissue expansion can sometimes help. During tissue expansion, a balloon called an expander is inserted under the skin and slowly filled with saline solution over the course of several weeks. This slow pressure causes additional skin to grow. The scar can then be excised, and the new skin can be put over the hole.

This technique is frequently used to help treat burn scars, and it can also help with scars on the scalp. When a person gets a large scar on his or her scalp, hair will typically stop growing there. If a scalp scar is treated with tissue expansion, it is possible to remove the gap in the hair. By making the surrounding tissue expand and then excising the scar, a more normal and natural appearance can be given to the scalp and hair.

Dermabrasion

Dermabrasion is a technique which "sands away" the top layers of skin, which can help to remove imperfections like acne scars. This is typically done under local anesthetic, and it is generally a fairly cheap way of dealing with minor skin blemishes.

During this procedure, the surface of the skin is frozen so that it can be more easily and accurately sanded. Then, the surgeon uses a special surgical implement to abrade or rub away the skin. As the patient heals, a new layer of skin will develop to replace the skin which has been rubbed away. This new layer will typically appear smoother and more natural.

A patient's skin is typically fairly raw and red after dermabrasion, and patients should take care to protect their skin and keep it from injury as it heals. New skin will typically begin to form within a week of surgery. The new skin will start out with a pinkish color, but this pink hue will fade over time. It usually begins to look more normal within a couple months of the procedure.

Patients frequently can return to normal activities within a week or two after the procedure, although they should still try to protect the surgical area from sunlight. Too much sunlight could do damage because the skin does not have its usual protective layer over the top. Also, too much sunlight can cause overtanning and result in a peculiarly dark appearance.

Some possible side effects of dermabrasion can include infection, changes in skin pigmentation, and in some cases scarring. Dermabrasion can help to treat scars from acne or chicken pox, tattoo scars, scars from accidents and diseases. It can't typically help with burn scars.

Microdermabrasion

Microdermabrasion is similar to dermabrasion in that it also uses an abrasive tool to help smooth out the skin. It differs in that it is much less invasive and sands away much less skin than dermabrasion. This is both a positive and a negative. Microdermabrasion does less damage to the body, which means that the patient can recover more quickly. This also means that the patient is less likely to experience scarring or other blemishes from the procedure.

On the other hand, microdermabrasion cannot treat scars quite as extensively as dermabrasion can. It works well on superficial scars, but it may not be able to get rid of deep-seated scars. It tends to work better on hypertrophic than on atrophic scars.

However, because it is gentler, microdermabrasion can be used on some places that dermabrasion cannot. For example, the neck is a place which is difficult to treat using dermabrasion, because the skin there is so thin and fragile. Microdermabrasion can help to treat scars on the neck and other sensitive areas of skin.

Z-plasty

Z-plasty is a form of scar revision which makes a z-shaped incision over the scar in order to help change the position and alignment of the scar. This can be used when the scar lies relatively close to a natural line or crease in the skin, because a portion of the scar can be hidden in that crease. Z-plasty is typically performed on an outpatient basis, and it usually doesn't require anything more than local anesthesia.

Z-plasty can also be used to help relieve tension caused by a heavily contracted scar. This can be especially beneficial for burn scars. After a Z-plasty, the incision is stitched closed, and the wound is allowed to heal.

Z-plasty can give significant help with some types of scars. However, it is no magic bullet, and there are many scars which Z-plasty will not help with at all.

Skin Grafts

A skin graft is a piece of skin which is removed from one part of the body and transferred to another to replace missing skin. This is a fairly common form of scar revision. However, it is also pretty extensive and invasive. A skin graft is performed in two procedures. One removes skin from the donor site, and another surgery implants the skin into the area which needs the graft. Both of these procedures typically need an overnight stay in the hospital.

There is a certain risk of infection at both the donor site and the transplant site, and there are also occasionally times when the grafted skin doesn't take. However, the skin will typically take hold in its new position and begin to grow.

Skin grafting can sometimes be helpful in dealing with large-scale scarring. However, it does pose some risks as well. Because additional incisions are being made, there is the possibility to develop new scars, both at the donor site and at the site of the graft.

Skin grafts are typically only considered when other methods would not work. They should only be attempted by very skilled surgeons. Think carefully and look for some lower-risk options before you decide to get skin grafts for your scars.

Radiotherapy

During radiotherapy, low doses of radiation are directed at a keloid or scar to help prevent further growth. This technique is not used very commonly, because it has the potential for serious side effects, and because radiation tends to make lots of people nervous. Radiotherapy is only typically used in extreme cases where someone has severe and recurring problems with keloids and hypertrophic scars. It is not typically used in everyday scar revision.

Punch Excision and Dermal Grafting

The word "excision" means "surgical removal by cutting." "Dermal" is simply a word which means "having to do with the skin." Punch excision is a technique which is used to cut out deep, "ice pick" acne scars. It is particularly useful when a person has areas where there is significant damage from acne scarring.

During this procedure, a doctor will excise, or cut out, each individual acne scar. This area will then be filled in using a dermal graft of skin from behind the patient's ears. The skin behind the ears is typically covered by the hair, which makes it much more easily hidden. Although some scarring behind the ears may happen, chances are nobody will see it. At the very least, it will be less noticeable than large-scale acne scarring on the face.

Punch excision and dermal grafting are typically performed under local anesthesia. Some amount of swelling, bruising, and reddening is common after the procedure. However, these are typically temporary, and the good results that punch excision and dermal grafting are usually very long-lasting.

Sometimes the skin of the face is a different shade than the skin behind the ears. If this is the case, it can lead to a slightly unusual appearance. However, skin resurfacing procedures like microdermabrasion can help to normalize the skin color and make it more homogenous.

Sometimes punch excision can simply be performed on its own, without dermal grafting. In these cases, the scar is simply excised, and the remaining tissue is brought together and sutured shut in one small line. This will result in a small, less-noticeable linear scar. This scar often fades with time, although some doctors choose to perform skin resurfacing to help it disappear.

Fillers

There are a number of bio-neutral fillers which can be injected into the body. These fillers are sometimes used for cosmetic procedures such as cheek, chin, and jaw augmentation, but they can also sometimes help with scar revision. Fillers work best when they are used to help fill in atrophic, sunken scars. Relatively shallow and broad acne scars are excellent candidates for fillers.

Collagen injections are sometimes used here, although this seems to be sinking in popularity due to some people having allergic reactions to it. In addition to collagen, there are a number of other types of fillers, including Restylance, Cymetra, Artecoll, Cosmoderm, Hylaform, Juvederm, and Radiesse. Fat transplantation is also sometimes an option for filling in scarring. You should ask your surgeon which sort of filler he or she would suggest.

Note that most fillers do not provide permanent results. Typically, the filler will begin to be absorbed by the body over the course of a few to several months. If you want to keep your scars filled, you will likely have to return twice a year or more for additional injections.

Chemical Peel

Chemical peels apply a chemical solution such as Phenol, alphahydroxy acid, or tricholoarcetic acid to the face. This solution help to remove some of the outer, damaged layers of the skin, and they can help to give the face a younger, more vibrant look.

Chemical peels can help to remove or reduce mild scars. However, acne scarring that is deep and obvious may take more than just a chemical peel to remove.

A large variety of solution strengths are available, which gives chemical peels a lot of potential variety. Typically, the stronger the solution used, the more dramatic the results. However, increased solution strengths also increase the chances of negative complications like scarring or blemishing, and they also increase the amount of recovery time necessary. Your surgeon or technician can help you to decide which strength would be best for you.

After a chemical peel, you may experience some amount of stinging and irritation. Having a reddish hue to the face is also fairly common, but this should pass. Some amount of crusting is also common. When the crust falls off, the new skin will be exposed. You will need to keep your newly-peeled skin away from direct sunlight, at least for the first several months.

The strongest chemical peels available (phenol peels) can sometimes cause the facial skin to permanently lose its ability to tan. This inability to create pigmentation will require patients to protect their skin from the sun at all times. Please be sure to speak with your surgeon about any possible chemical peel side effects.

Chemical peels are sometimes offered by people without adequate training, and one can even sometimes find at home kits. This is a bad idea. You should find someone who knows what chemicals should be used in your condition and who knows how to properly apply the peel. Don't cut corners here just to try to save some money, or you'll likely regret it later.

Laser Scar Removal

During a laser scar removal, a surgical laser is pointed at the scar and moved along it. As it goes, the laser will destroy and remove the upper layer of skin. Like dermabrasion, this reveals the healthier, more normal skin below. Over time, this skin will heal and normalize, and in the end, the patient's skin ends up smoother and more attractive.

There are a wide variety of laser-based scar treatments which are currently being performed, and they're all good at different things. Red scars can be treated using a pulsed-dye laser (or PDL). This type of laser targets vascular structures such as blood vessels. The destruction of the scar's blood supply can help lessen the reddish appearance. Some studies have also suggested that this type of laser can also help to minimize keloids and other hypertrophic scars. Examples of pulsed-dye lasers include the Candela and Cynosure lasers. It is also claimed that these lasers can help stimulate new, healthy collagen growth.

CO2 and Er:YAG lasers are common, and they are manufactured by a wide variety of companies. CO2 lasers tend to be more powerful, for better or worse, than Er:YAG lasers. Increased power means a greater ability to affect the scar, but it also means a longer recovery time and more damage to the skin. These sorts of lasers are frequently used in acne scar removal.

Fractionated CO2 and Er:YAG lasers are also available. These lasers are called fractionated because they only affect a fraction of the skin. This means that less damage is done and the wounds are able to heal more quickly, which ought to translate to a shorter recovery time for the patient. Fractionated lasers of this sort include the Pixel and Fraxel lasers.

Not all types of laser scar removal have been shown to work well for African-Americans. The genetic makeup of this race makes it such that many lasers cause more harm than good. However, recent reports show that the Thermage laser may be able to help treat scars in African-Americans.

After laser scar removal, it is common to experience some amount of discomfort. As with many other forms of scar revision, you should protect the affected skin, and you should keep it out of the sun. Too much sun exposure early on could increase your chances of developing unusual pigmentation patterns at the surgical site.