Options for treatment, removal of unsightly, unwanted scars

By Mathew Epps CONTRIBUTOR

An unpleasant scar often can be revised. As plastic surgeons, we are frequently asked to consult about unacceptable scars. Such scars might be the result of acne, trauma, or surgical interventions such as MOHs surgery, as well as direct excision of skin cancers on the face, neck or limbs.

In the modern plastic surgery era, patients should not have to feel that they must live with an unsightly scar, as modern advancements in surgical and non-surgical techniques can dramatically improve or disguise the scar.

Scar treatments require a strategy that, if tailored appropriately, can be quite effective to minimize its appearance. Surgical intervention relies on techniques that manipulate the shape, size, and/or orientation of a scar.

While no scar can ever be completely gone, simply converting a scar from a straight line into geometric angles is effective to disguise the scar as a natural skin fold. Another technique called a z-plasty has been perfected to relieve scar webbing or bandings.

In addition to years of training centered around perfecting a layered, tension-free wound closure, plastic surgeons also gain knowledge on how to optimize a wound care strategy for improved healing.

One method for optimizing the wound healing of a scar is through dermal microneedling. This technique has evolved dramatically and can begin as soon as six to seven weeks following a traumatic event or surgical procedure.

Modern microneedling devices, such as the SkinPen, penetrate skin with small needles into the dermis, creating micro-injuries that stimulate remodeling and the production of wound-healing proteins. This stimulation of reinjury helps reform scar tissue to flatten and tighten the scars appearance.

Platelet rich plasma (PRP), rich in natural platelet-derived growth factors, can be applied during microneedling to – in a way – “super-charge” the scar healing process.

Silicone-based treatments, including silicone scar creams and bandages, further help to improve scar cosmesis. The silicone is thought to align maturing collagen fibers. For six to nine months, it is important to protect the scar from UV/sunlight exposure with mineral-based sunscreen of 30 SPF or more. The light interrupts the wound-healing process and leaves a disorganized scar that may be red and raised.

Mathew T. Epps, MD, MS, DABS is a plastic surgeon, triple-fellowship trained in facial, eyelid and breast surgery. mathewepps.com or info@dreppsmd.com