Aesthetic Medicine
A less attractive scar may present the following issues: Excessively erythematous: It can be successfully treated with a vascular laser. Excessively pigmented: It can be successfully treated with a depigmentation laser (532 or 1064). Depressed: Sometimes it responds well to a filler (hyaluronic acid, etc.), even better with lipofilling (harvesting, centrifugation, and reinjection of one's own adipose tissue). In other cases, laser resurfacing is used to smooth the leveled edges. Sometimes, for an optimal result, surgical revision may be necessary.
- Hypertrophic-Keloid: Hypertrophic scars are raised, erythematous, and firm to the touch, with the extreme form being called a keloid. Various factors underlie the formation of these pathological scars. Individual and racial factors (darker skin has a greater tendency to heal in a keloidal manner) are predominant, along with location factors (a scar on the chest is more likely to form a keloid than one on the arm). Secondary factors include infections, suture tension, and suture materials.
For hypertrophic and keloid scars, intralesional treatments with cortisone and/or 5-fluorouracil are performed. Sometimes, if the keloid is substantial, preventive excision followed by intralesional treatment or laser therapy is recommended. Regarding the latter, I use a vascular laser called Versapulse, a highly technological American laser that has been successfully used for the past couple of years. The results today are good, especially when treatments are combined. The results of radiotherapy are not encouraging, as demonstrated by a significant multicenter American study published in a prestigious journal in 2006.
- Dystrophic: Recent studies have highlighted that lipofilling, i.e., injecting very small amounts of adipose tissue into the subdermal layer, leads to improvement in scarred areas.
Retracting: This is a short and cord-like scar. In this case, a procedure called “z-plasty” is used, which aims to elongate it through specific incisions.
Misoriented scar: Sometimes, a scar outcome has an orientation different from the lines of Langer (the lines and wrinkles created on the skin due to mimetic muscle movements: for example, the folds of nasolabial grooves, periorbital wrinkles, etc). In this case, surgery is performed to bring the scar as much as possible along the axis of natural lines.
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