Scar Over

From pesky reminders of your youth (we don’t miss you, acne) to more major surgical wounds, these scar treatments can help diminish them

Our skin has an ability to heal itself after sustaining damage that is almost miraculous. If only that healing process were perfect—it’s quite unfortunate that it generally results in scars. Burns, acne, and stretch marks can all push the skin’s regenerative capacity to the extreme, leaving moderate to substantial scarring in their wake.

Modern medicine is becoming more and more skilled at making up for the shortcomings of the skin’s self-healing properties. It’s now possible to treat scars with special techniques that come very close to restoring the original look of the skin.

There are lots of approaches to scar treatment used today, involving a whole range of devices and techniques from chemical “peelers” to lasers. Most of those methods involve applying a controlled injury to the skin, which will then heal more smoothly than the original scar. The injuries can be inflicted very precisely—as when tiny chemical burns are administered by needle point— while others are “field treatments” that effectively sear off a layer of skin, allowing for a more perfect regrowth.

TCA (trichloroacetic acid) is a common chemical peeler that can be spread on an affected area to destroy the superficial skin layers, prompting new, unblemished skin to grow in its place. Mechanical dermabrasion is another technique, where a rough surface on rotating heads is used to brush off the scarring, inducing skin regrowth. The trick is usually not to go too deep— otherwise the downtime for recovery for these procedures can be very long.

Focused light and heat from fractional lasers can also be used to selectively destroy small areas of scarred skin to stimulate regrowth. A more intense version of this treatment uses CO2 to induce a burning effect at the same time. This is a better treatment, but it involves a period of recovery from one to two weeks, and has some risk of complications and infections.

A Cut Beneath The Surface
Scarring involves the disappearance of collagen and elastin fibers that make up part of the skin’s hypodermis layer. Sometimes there can also be bridges, or adhesions, between the surface of the skin and its deeper layers. In these cases, subcision can be an effective treatment.

Subcision means “to cut under the surface.” It’s a technique that is now being tried not only for scars but also for localized cellulitis. It usually involves inserting a tiny blade under the skin to cut through the scar tissue, like cutting grass with a sickle. As this is an aggressive and potentially painful form of treatment, it is usually performed under local anesthetic.

There are less aggressive solutions—one of them being to insufflate gas under the skin, as we do in carboxytherapy. In this technique, a small measure of CO2 is forced between two layers of skin.

CO2 has been used in medicine for many years, although its use in scar treatments is quite recent. It was discovered not so long ago that when you inject CO2 under the skin, it produces an enrichment of oxygen and an increased blood flow. This is because the body interprets the presence of CO2 as a signal that this part of the body needs more oxygen. The body tries to remove the excess CO2 by increasing the blood supply to the area concerned.

Blood flow is like water in a field—it gives life. Many scars are poorly vascularized, so increasing the blood flow can significantly improve those tissues. The gas is preheated, so you can increase the temperature and stimulate the blood flow at the same time.

We can achieve two main effects by insufflating gas under scars. There is a mechanical effect, because you detach the scar tissue from the surface; and there is a chemical effect because of this reaction to the CO2 generating a hyperflow of blood.

A related technique involves performing small punctures in the skin with a dermaroller, which is a cylinder covered in tiny spikes of different lengths, rolled across the skin to create pores. These pores are a mild trauma that prompt a controlled healing process to reinitiate and reverse the scarification, prompting the surrounding cells connected with the reparation of skin to release growth factors.

Another benefit is that the pores created in the skin are not permanent; they last at most one or two hours. They can thus be used to put regenerative substances into the skin—such as PRP, which is a serum of platelets extracted from the patient’s own blood. When massaged into the face, they can reach deeper levels in the skin for more effective healing.

In my practice, I focus on treating stretch marks and acne scars via dermaroller (and a similar precision device called the dermapen) supported by carboxytherapy. The procedure normally takes between 10–30 minutes. First, a numbing cream is applied before either the dermapen or the carboxy treatment (or both) are administered. Commonly, we will use one form of
treatment in the first week, followed by the other a week later, and so on over the course of the therapy. We can expect progressive improvement within a few weeks to a couple of months. The peak of the expected improvement will be between three and six months, at which point the most visible features of the scar tissue should have all but vanished.

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