Scars

Scars are the result of skin repair following wounds which may be related to accidents, disease or surgery. The more the skin is damaged, the longer it will take to heal and the greater will be the risk of a noticeable scar. Scars appear red and thick initially, then gradually fade. Scars that seem unsightly at three months may heal nicely by six months or one year. The scar on the knee above has been present for many months, looks darker that the surrounding skin and is raised. This scar is unlikely to improve spontaneously and may benefit from the treatments outlined below.

     
ACNE Scars
ACNE scarring is the result of abnormal healing of the skin as a result of ACNE. This is the most common scar problem that presents to our practice. The scars often cause the patient to be self-conscious and may impact on their self-esteme. The scars may be of different types from very deep to shallow. They may involve small or large areas of the face. The patient above has had ACNE scars for many years, they involve most of the areas of her face. The treatment  depends on many factors and is highly individualised. Treatment of ACNE scars will result in  reduction in the number of visible scars, a reduction in the depth of the scars and a greater uniformity of colour of the affected area. A 50% improvement in appearance of the scars is considered to be a good result.

Raised scars
This is the second most common reason for presentation to this practice. Raised scars are the result of poor wound healing that may be due to external factors or internal factors. Some people produce raised scars in all their wounds, these patients are referred to as keiloid formers and clearly they have internal factors at play. Other people develop raised scars because the skin may have been excessively traumatised, an infection may have formed during healing or the wound edges may have been under excessive tension. In the example above, the skin over the shoulder is quite tight and this patient developed a raised scar from a routine mole removal, this patient had a raised scar which was not a keiloid. The car responded well to treament.

Keiloid scars
Not all raised scars are keiloid scars. In the pictures above, the scar on the left is a keiloid. The features that make it a keiloid are:

• It has been present for a long time -- more than one year
• It is hard
• The lump is much bigger than the original scar -- it began as an insect bite
• It is itchy and irritating

Keiloid scars will often require more treatment sessions. They usually respond to treatment as shown above on the right.

What problems can scars cause?
There are many types of scars, many locations for scars and many causes for scars. Each scar has to be individually evaluated when treatment is being planned. Scars can cause the following problems:

• Raised scars 
• Depressed scars
• Dark scars
• White scars
• Irregular scars
• Itchy scars
• Painful scars

The treatment plan for individual scars is determined by the length of time it has been present, the location of the scar, the appearance and whether it is causing irritation.

What treatment options are available for scars?
There is a wide range of treatments available for scars

• Cryotherapy -- Uses liquid nitrogen to burn the skin by freezing it. The blistering that results, heals within one week. This technique is used on raised scars including acne scars. 
• Silicone-containing products  -- Available as gels, creams and bandages through pharmacies. They are helpful in reducing scar thickness and pain. 
• Cortisone (steroid) injections -- Using a very fine needle, cortisone is injected directly into the scar. Used with raised scars causing them to shrink and flatten.
• Surgery -- Surgical scar revision can improve the appearance of scars, however, no scar can ever be completely removed. Surgical scar revision results in a less obvious mark. Each scar is different and each will require a different approach.
• Dermabrasion -- Dermabrasion is a method that uses an electrical machine to remove the top layers of the skin to give a more even and smooth contour to the surface of the skin. It can result in improvement of certain scars, however, it cannot get rid of the scar entirely. 
• Resurfacing lasers  --  Also referred to as peeling lasers, are an excellent method of improving acne scars and chicken pox scars. High energy lasers are used to remove tissue which is making the scars more visible. Patients can return to work usually within two weeks. The skin may remain pink for several weeks or months. This treatment is used in the treatment of wrinkles and sun-damaged skin, it is discussed in detail in the page titled Laser resurfacing .
• Non-resurfacing lasers -- These lasers are very useful for reducing scar redness. They may flatten raised scars and can also improve itching and burning sensations. Acne scars can be improved with this type of therapy without any need for time off work. For a full discussion regarding non-resurfacing lasers please look up the page titled Laser rejuvenation .
• Fillers --  There are a number of these injectable materials that are particularly helpful with depressed scars. They are injected under scars to lift them up and decrease their appearance. Fillers are used in the treatment of wrinkles. For a full discussion regarding fillers, please access the page titled Wrinkle Treatments . Alternatively visit the pages devoted to each individual product  Aquamid , Bioinblue , Collagen ,  Fat transfers , Restylane 
• Blood injections -- In this technique a small amount of blood is collected from the patient and it is immediately injected ito the scar. This technique is used in scars which are excessively pale. It causes a bruising reaction that lasts one week.

Some specific techniques for ACNE scarring

Costs
Costs for scar procedures are determined individually for each patient.