i have lots of skin scars. what's best for getting rid of scars?
How to Remove Scars?
Doctor Answers 23
There is no way to "get rid" of scars. Scars are permanent. Scar revision can be considered for wide, depressed, or irregular scars with the goals of a narrower, smooth scar that is oriented within natural skin tension lines so it is less conspicuous. Topical treatments and laser treatments work best for discolored scars, to improve blending with surrounding skin. Many over the counter scar treatments do not have proven effectiveness. In the situation of new scars or incisions, keeping the skin soft and supple with moisturizer, sunscreen, and simply being patient is usually the best course of action. Scars mature and fade to normal skin color at around 1 year, and sometimes longer in certain individuals. Everyone heals differently. Abnormal scars such as hypertrophic scars (raised, nodular, red and inflammed scars) and keloid scars (scars that outgrow the zone of injury) respond best to steroids (topical or injections) and silicone sheeting with pressure over the scar.
Scar Treatments and Stretch Mark Removal
There are many kinds of scars. They can result from acne, infection, injury or surgery. While technically not scars, stretch marks, which may follow a rapid growth spurt during adolescence, pregnancy or prolonged overweight, possess some of the microscopic characteristics of scars and for that reason have been included here. Whatever their cause, all scars are by definition permanent. Happily, however, there are now a variety of successful approaches for improving the appearance of scars and making them less visible. The precise technique or combination of methods chosen must be tailored to the specific kind of scar and its location on the body. Acne pock scars, like those from chicken pox, are tightly bound down.
Although they may be cut out and the resulting wound stitched together with delicate stitches, I have found that combining subcision and microneedling to be quite effective. Subcision involves the insertion of a needle below the skin surface to break up the tight fibrous bands that pull the scar downward.
Medical microneedling employs a roller containing numerous spoke-like needles to create microchannels in the skin, which besides physically breaking up the underlying abnormal collagen stimulates new collagen synthesis further improves the appearance of the scar. Many treatments, including a variety of lasers, have been proposed for dealing with stretch marks. None have proven universally satisfactory and to date the results have been far from gratitying in many cases.
I have found a combined using of a series of medical microneedling sessions followed by the injection of Radiesse at a later date to be quite helpful. The microneedling improves both the crinkly surface of the stretch mark and softens up the dermis below, making it more responsive to plumping right up when injected with the Radiesse. I have also used this approach successfully for improving traumatic and surgical scars.
Acne pit scars may be removed by simply punching them out, next closing the site with superfine sutures (so that stitch marks will be minimal) and finally, gently dermasanding the resulting wound with sterilized sandpaper about ten weeks later to leave the area barely perceptible when healed, a process known as scarabrasion. Pit scars may also be successfully improved by instilling a potent solution of trichloracetic acid 100% deep within the long, narrow walls of the pit.
During healing, the irritated tissue seals together making the pit more shallow and less noticeable. Hypertrophic scars and keloid scars are entirely different forms of scarring and require their own therapies. Hypertrophic scars, or "proud flesh" stick up above the surface of a healed wound site like a reddish or reddish purple mountain. They can sometimes be itchy or tender. I find they respond well to injections of an antiiflammatory agent, such a triamcinlone acetonide (TAC)uspension.
When healed, they are flat and slightly off-white in color. Keloids are a bit more problematic. They, too, extend up like mountains over the wound. But they characteristically spill out to cover normal surrounding tissue. Keloid scars typically need higher TAC concentrations and a series of treatments in order to induce significant shrinkage. In addition, other treatments, such as topical imiquimod and silicone gel bandages may be needed to achieve more significant and lasting improvement.
Scar removal treatment depends
The "removal of a scar" is a loaded concept. When you remove a scar you replace it with another scar. The idea is determining to what extent the removal technique will allow the result to be better than the current scar. The answer depends upon the scar and the conditions under which wounding occurred as well as the patient's capacity to heal.
See a plastic surgeon who brings expertise in scar revision and improvement and go from there. Some scars can be revised in the office under local anesthesia with good results.
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Best method of scar revision depends on the scar itself!
Since there are many options for scar removal, the choice of the best suited treatment method is dictated by the type of scar, location, duration, cause and so on.
Scar revision is a broad topic, and unfortunately your question does not classify what type of scar you have in terms of location, depth, width, age, etc. A thorough evaluation is necessary. Among some of the options I can discuss with you are scar excision, rearrangement, shifting to a new location, sanding, lasering, and filling. Realize however that scars cannot be completely removed, only minimized. Many times the scar can be made quite negligible in appearance.
Scar removal treatment depends on what scar looks like
If the scar is large, you may have to excise it first and then close it. If it is long you may need to close it in an irregular way to break up the line so that the brain doesn't notice it.
Your brain is more likely to notice a line that is over 7mm in length. Anything longer than that will need to be made irregular for the brain to not notice it as easily. Once the scar is thinner you can then use lasers to resurface the area to make it look better.
CO2 lasers are the best for this and there are a lot of names for these lasers depending on the company. Lumenis, with its Active FX is the best CO2 laser out there in my opinion, and it also has Deep FX, which is fractional and can tighten the skin.
Some very large scars need more complicated treatment approaches to make them look better. Dermabrasion can also help the appearance of the scar.
All of these techniques depend on the person doing it, so you want to go to someone with a lot of experience with these techniques and someone with a diverse approach to treating scars.
Scars can be improved but not removed
You have got to be realistic. When the skin is cut, there is going to be a permanent scar, which hopefully becomes inconspicuous with time.
In our plastic surgery practice in New York City, we have a whole protocol to PREVENT bad scarring. And there is exciting research for the future.
We have patients use a gel (Scarfade) after surgery.
But when there are existing noticeable scars, we work with a dermatologist, because laser treatments can be very helpful (different lasers for red or for brown scars).
I suggest you see a board certified dermatologist.
For the first ten days after surgery, keep the scar...
For the first ten days after surgery, keep the scar moist with bactroban antibiotic ointment. Then for the next six months, avoid sunlight and wear sunscreen.
Laser scar revision
Unfortunately scars are permanent but they can often be made less noticeable. Ways to improve scars range from injectable treatments (steroids, 5FU, etc), laser treatments, dermabrasion, surgical excision, and topical scar maturation treatments.. However, it is impossible that all traces of any scar will be totally gone. Consult with a board certified plastic surgeon or dermatologist to determine the best course and what you can likely expect