How soon can you begin treatment on a small, thin surgical scar? (photo)

How soon? - Dermaroller on surgical scars? THANKS!

Doctor Answers 1

Scarabrasion Works Well For Young Scars; Subcision & Fractional Medical Microneedling For Mature Scars

For as long as I can remember there has been a controversy as to the best time to treat a scar from any cause, traumatic, infectious, inflammatory, or, as in this case, post-surgical. It was pretty much dogma in the past to allow a scar to "mature" for about a year before considering any intervention to improve its appearance. Then in the late '80s and '90s scarabrasion was introduced, which was a complete 180 degree turnabout in scar treatment. This technique consisted dermabrading scars within a critical eight to twelve week interval after the trauma or surgery--the idea being that the collagen of the scar was not yet matured and still retained the possibility following dermabrasion, at this very early stage, to produce healthy, more normal collagen (non-scar collagen). In some cases, the results of this approach were dramatic with an almost total obliteration of the scar, something that could not be achieved at any stage by any technique, especially when performed on matured scars. So, when a scar, particularly a linear scar, is still within the critical window of the twelve weeks, scarabrasion remains a very viable option.

When scars are fully matured, there are other approaches that can be considered. For over twenty years, subcision has proven an easy and effective method for permanently elevating depressed scars of various types. Subcision is a procedure in which a sterilized needle is inserted, following the administration of local anesthesia, directly beneath a depressed scar (regardless of whether from acne, infection, trauma, or surgery) and used to break up the thick bands of fibrous scar tissue that bind down the surface and create the depression. On a relatively small scar, such as this, treatment would likely take no more than a couple of minutes.

Breaking up the abnormal bands of thickened, scar collagen accomplishes two things. First, it allows the surface of the scar to float to the surface. In addition, the tissue fluid that immediately fills the space following treatment contains growth factors and other wound healing substances that promote neocollagenesis, native collagen production, that allows for improvement and elevation of the scars. Between two to four treatments, spaced at six week intervals, are generally required to promote sufficient new collagen to achieve a satisfactory improvement. Since, the collagen produced is one's own, the results of subcision are typically permanent.

Fractional microneedle therapy aka medical microneedling (or dermarolling) works by creating numerous areas of controlled microwounding that set off in turn a cascade of events that result in new, native collagen synthesis, which translates into healthier, thicker skin that improves the appearance of the underlying scars. It is particularly useful for improving the surface tone and texture of skin to enhance blending with the surrounding normal skin.

Unfortunately, to date I have not been impressed with laser success rates nor the actual degree of overall aesthetic improvement with their use. When it comes to lasers, there is an abundance of media hype and a dearth of rigorous scientific support.

Consultation with a board certified aesthetic core physician with extensive experience in scar treatment is essential.

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