Scars left behind from surgery, accidents, or medical conditions can serve as a constant physical reminder of personal trauma. As such, these scars can wreak a heavy emotional toll that impacts every aspect of daily life. Fortunately, there exists a wide array of surgical and non-surgical treatment options that can improve the appearance of these troublesome scars and relieve the associated distress.
Scar revision has been a particular area of focus for the entirety of Dr. Hooman Khorasani’s medical career. Besides having unique fellowship training in wound healing and scar repair, Dr. Khorasani has conducted clinical trials, published medical journals and written book chapters on these topics. From studying scars’ molecular structure to inventing new, innovative techniques, Dr. Khorasani has dedicated himself to helping patients overcome the heavy physical and emotional burden induced by their scars. Consequently, Dr. Khorasani has infused his practice with a broad range of cutting-edge scar revision therapies. The recommended treatment option is hand-picked for each patient based on the scar’s appearance, your unique health profile, lifestyle constraints, and your overall aesthetic goals.
Despite their bothersome appearance, scars are actually part of the body’s natural healing process. When the deep layer of your skin (the dermis) is damaged, your body produces new collagen to repair the wound. During this healing process, the body’s primary objective is to act as fast as possible to protect the surrounding structures and reduce the risk of infection. Additionally, the scaffolding required for normal collagen formation is damaged when the deep layer of the skin is injured. As such, the structure of scar collagen varies significantly from what is found in normal skin. These aberrations in collagen architecture lead to a markedly different appearance between the scar tissue and surrounding healthy skin.
Just as each person is unique, scars are also one-of-a-kind. There are, however, distinct categories of scars. Hypertrophic scars are those in which the body produced excess amounts of collagen in response to the injury. If the over-production of collagen extends beyond the boundaries of the original wound, the scar is then called a keloid. Scars that have caused the surrounding skin to tighten are called contracture scars. These are most often associated with burn injuries and can cause significant mobility problems in the area of trauma. Acne scars are the result of blemishes that have infiltrated the deep layer of skin, inciting the production of collagen. Unfortunately, patients often suffer from more than one category of scar; however, armed with over a decade of experience treating all scar types, Dr. Khorasani will be able to recommend the best treatment option for your individual scars.
All scars will exhibit some degree of redness during the initial healing phase. Most patients, however, will lose this red color over the course of six months to a year. Risk factors for persistent redness include having a fair complexion and/or sun exposure to the affected area in the early stages of your wound’s healing.
Over-production of collagen can lead to elevated scars that are thick and raised. This typically occurs in wounds that occured on the chest, shoulders, and upper back. Family history can also contribute to the formation of elevated scars.
Inadequate collagen formation can lead to scars that are sunken or atrophic in appearance. These depressed scars are typically associated with chickenpox and severe acne.
The rapid production of collagen during the wound healing process can result in ridges, pits, and bumps within the scar. Unfortunately, these texture abnormalities may sometimes be both palpable and visible.
During your initial consultation, Dr. Khorasani will carefully evaluate your particular scar to discern its type and characteristics. Incorporating your personal aesthetic goals, health profile, and lifestyle constraints, Dr. Khorasani will recommend an individualized therapy plan that best addresses your specific needs.
Below is a summary of the scar revision therapies offered at our practice.
Both the Fraxel 1550 and DeepFX emit laser energy deep into the skin to stimulate controlled production of normal, healthy collagen. DeepFX is more ablative than Fraxel 1550, which means it removes more of the damaged skin with each laser blast. Consequently, the results of DeepFX are more significant than Fraxel 1550; however, the more powerful DeepFX treatment requires a longer downtime and may only be used in fair skinned individuals. Overall, resurfacing lasers are most appropriate for patients looking to dramatically improve scar texture and can tolerate some amount of downtime. These lasers need to be used with caution in patients with a darker skin complexion.
Microneedling involves the insertion of tiny needles into the skin to break-up scar tissue in a controlled manner. The body is then stimulated to replace this lost tissue with healthy, normal collagen. The addition of Platelet-Rich Plasma (PRP) to a microneedling treatment speeds up the recovery process and enhances its efficacy. Microneedling with or without PRP is best suited for the treatment of scars in patients with skin of color, as there is minimal risk of post-therapy hyperpigmentation (discoloration) that may be seen with other options such as laser resurfacing.
Bellafill is a long-lasting collagen filler that is FDA-approved for the treatment of acne scars; however, it has successfully been used off-label to treat other depressed (atrophic) scars. The injection of collagen filler results in instantaneous results with minimal downtime. Additionally, the microspheres in this filler stimulate your body’s own collagen production to improve the scar’s appearance long-term. Given the bovine collagen content of this product, all patients need an allergy skin test four weeks prior to the scheduled treatment.
The Vbeam laser uses specific wavelengths of light to target the tiny blood vessels responsible for the red color that is seen in scars. This precise energy allows the laser to selectively reduce redness without damaging the surrounding skin. As such, this laser is highly effective in treating scars in which redness is the primary problem. It does not, however, significantly improve scar texture or irregularity.
The best treatment option for an uneven scar is dermabrasion. We routinely combine dermabrasion with laser resurfacing as they work in a synergistic manner. Whereas laser resurfacing helps remodel a scar’s texture, dermabrasion is simply the mechanical sanding and reshaping of the scar’s irregularities. To demonstrate this synergistic relationship we use a “painting the wall” analogy. When painting a wall, first a primer is applied to the uneven surface and allowed to dry. Then a sand paper is used to sand the primed area and ensure that the surface is even before the paint is applied. In the case of scar treatments, dermabrasion is the “sanding of the primer” and the laser resurfacing treatment is the “paint.” A dermabrasion treatment carefully removes the top layer of the skin, smoothing the irregularities on the scar’s surface. This mechanical procedure then allows the energy from the subsequent laser treatment to reach deeper, remodeling the scar tissue. The use of the laser helps with hemostasis or the cessation of bleeding, caused by dermabrasion, hence completing this complementary relationship.
Triamcinolone is an injectable medication that helps reduce the on-going inflammation in a scar and stimulates enzymes which help in breaking down collagen. Cosmetically, this helps reduce the size and flattens scars that are enlarged and/or raised. Additional benefits include decreased itching or burning that may sometimes be associated with these raised (hypertrophic or keloid) scars. 5-Fluorouracil (5-FU) is another injectable drug, but it prevents cells from replicating. When injected into scar tissue, this medication specifically affects collagen-producing cells to inhibit excess formation of collagen. Consequently, 5-FU can also help improve the appearance of raised (hypertrophic or keloid) scars. Combining triamcinolone with 5-FU yields optimal results for patients struggling with resistant, raised scars. Coupled together, this approach reduces the risk of post-injection atrophy, which can occur with both medications when used independently.
Severe scars that have not or will likely not respond well to other treatments, may benefit from a surgical revision of the area. This in-office procedure is performed with local numbing medication and requires less than an hour to complete. Utilizing the experience from Dr. Khorasani’s decade-plus surgical career, he will develop an operative plan that best addresses your needs and optimizes the best aesthetic outcome.
Dr. Khorasani and his highly-specialized team look forward to working with you to transform your medical or aesthetic goals into reality. To expedite a request for a consultation, message us securely, or contact Dr. Khorasani’s Manhattan office by phone at 347-574-8500. For more information about how to get in touch:CONTACT US