scar revision
a personalized sequence protocol
Scars
Scars are a natural outcome of the skin's healing process following an injury. How a scar looks depends on various factors, such as where the wound is, how your body heals, and the nature of the injury. Regardless of the severity of the scarring, it can be enhanced through different approaches. Choosing the appropriate treatment and technique for the specific type of scar can yield the most effective results.
Keloid Scars
An exuberant scar that appears at the site of an injury and spreads beyond the borders of the original lesion. The Keloid scar is a mass of collagen fibers and fibroblasts. It has a shiny surface with a rubbery consistency and usually found on the shoulders, chest, and back.
Contracture or Cicatricial Scars
Scar causing many contractions. This type of scar tightens the muscles making it impossible or in some cases very difficult to move. Contracture scars may sometimes be deep-seated sometimes even affecting muscles and nerves. This type is usually seen in burn cases.
Hypertrophic Scars
This type of scarred and are raised just like keloid scar but they tend to spread beyond their borders.
Nerve Pain Scars
In this type, nerves are also involved causing pain during healing. The nerve endings sometimes become bulbous. This condition is treated either by dissecting the scar or excising the nerve.
Acne Scars
This type of scar is usually present in people who had a severe outburst of acne. These scars can either be a deep pit, angular or wavelike.
Atrophic Scars
Occurs in cases where the structures that lie beneath the skin such as fats or muscles are lost.
Surgical or Self-Harm Scars
All these scars vary. These are very difficult to fully treat- however in the vast majority of the time, treatments can improve these types of scars. These require more treatments compared to facial scars due to several factors, including the site, color (these are often white, so pigment can not be placed back into the scar line), and the areas are often wide spread (hence laser resurfacing has to be conservative or skin will not heal).
Stretch Marks
They are also a form of scar caused due to stretching of the skin rapidly. Usually seen in pregnancy or during teenage when there is a growth spurt or during weight gain. However, these scars begin to fade after a few years.
The Healing Process of Scars
- Inflammation. The inflammation starts right after the injury and lasts until the wound is closed; the inflammation is preventing infection. The wound isn’t sterilized until it is protected by a new external layer of skin.
- Transitional repair. This is when scar tissue is formed by the body in order to hold the wound together. This phase’s duration will depend a great deal on the nature of the injury or wound.
- Maturation. Maturation is the phase which typically starts about 7 – 12 weeks after the damage occurs. It is also the stage in which problematic scars may show up. Under ordinary circumstances, a repair process takes place. The new skin is developing and the scar tissue that was formed in the second phase of healing disintegrates.
A problem scar, which may require scar revision, will likely develop when the repair progression does not happen normally, for any number of reasons including cell renewal.
Skin cell renewal occurs when new skin cells travel from the basal layer of the skin up to the epidermis. Scar tissue’s renewal rate is different than normal skin’s renewal rate. Check out this blog post on homecare to minimize scarring.
phases of the treatment
PHASE 1
phase 1: priming skin cells
treat existing surface scars and discoloration, and to aid in the healing
PHASE 2
phase 2: clearing damaged collagen
creating an optimal environment for collagen formation and altering the appearance, size and texture of scar tissue.
PHASE 3
phase 3: regulating and triggering new collagen
controlled means of remodeling the nature of tissue
PHASE 4
phase 4: controlling & polishing
never chasing perfection, just supporting long term sustainability
Nutrition & Scars
Those who aren’t eating a well-balanced diet probably aren’t consuming enough protein to heal their wounds.
To promote adequate protein intake, try flexibility in your diet and we encourage you to consume foods you enjoy that are easy to prepare and economically feasible. A diet that’s too restrictive may seem unappealing and could lead to decreased intake and unintended weight loss. Keep in mind that adequate calories are also important for wound healing; otherwise, the body uses protein calories to provide glucose for energy production instead of tissue repair.
scar revision home care
FAQs Scar Revision
Absolutely! For the most precise evaluation, it's essential to have both a visual and tactile examination. It's not possible to discern the difference between atrophic areas (which are soft) and fibrosis (which are hard) through photos or videos. Therefore, virtual consultations are not offered for this service.
Certainly! For some situations, immediate treatment is possible, while for others, I would need to develop a treatment plan and obtain your agreement regarding any potential recovery period. Straightforward procedures like steroid injections and dermal fillers can be carried out during the consultation itself.
Yes! Increasing evidence suggests that early intervention leads to better outcomes. Therefore, there's no need to wait.
The recovery time varies based on the stage of treatment you're undergoing. Most of the procedure might focus on either the outer layers or the deeper tissues. Typically, you should anticipate swelling and redness for at least 3-7 days, which can differ according to your specific stage in the scar revision process. Recovery from treatments like lasers and deep focal peels generally takes about 5-10 days.
This is determined by us, based on factors such as the nature of your scar, your skin type, and the downtime you can afford. It's possible for some individuals to be in "phase II or III" for several sessions.
For optimal results, it's advisable to undergo the treatment after the summer to minimize exposure to strong, direct sunlight during the process. In regions where sun radiation is inescapable, it's recommended to steer clear of direct sunlight, wear a hat, and use appropriate, specific sunscreen.
Modalities are selected based upon each case.
The most common devices used to revise scars include–
- Vascular lasers (red scars)
- Nd:YAG 1064-nm laser
- RF Microneedling
- Skin Pen, Dermapen, Skin Roller
- Mesotherapy
- Filler
- Subscision
- Biostimulators
- Chemical Peels
The most noticeable transformation occurs weeks following the treatment. Building collagen is a gradual process, and sometimes, multiple sessions are required to remove old damaged tissue and encourage the body to regenerate. While results can vary from months to years, our aim is to achieve safe and noticeable outcomes starting from your first session.
Failing to adhere to the prescribed home routine disrupts the treatment process, leading to less than optimal results. Neglecting to use healing products and depigmenting agents with a regulatory effect means not managing the melanocyte activity. Consequently, this can result in continuous, unregulated overproduction of melanin, especially in darker skin tones. The likelihood of post-inflammatory hyperpigmentation increases as the skin renews itself, with melanin moving to the surface and making dark spots more pronounced.
Not using photoprotection, melan 130 pigment control, involves a very high risk of damage to new tissue, as skin is more sensitive and receptive to external aggressions during the treatment.
During the initial duration of your customized sequence, it is not recommended to use any other type of invasive treatment that can cause a skin lesion, as well as peels, microneedling, etc., as it can even cause disruption to your program.
It is advisable to use soothing and regenerating treatments both in office and at home in case it is needed.
The level of invasiveness of the treatment generally determines its impact on your daily activities. In most instances, it won't hinder your ability to perform everyday tasks.
However, during the initial days following the in-clinic treatment, when your skin is adapting, certain precautions are necessary. For example, it's recommended to avoid swimming in pools, lengthy exposure to the sun, and activities that cause heavy sweating.
Most treatments do involve the use of an anesthetic, which can range from very mild to moderate sedation. This is to ensure that patients remain comfortable throughout the procedure.
It's best if your acne is completely under control before your visit. The reason is that if there's ongoing inflammation, your healing process will be compromised, hindering optimal collagen regeneration in your tissues. In case of active acne, we can initially focus on managing it.
Often, we can handle both concerns concurrently, meaning as long as you are actively working to control your acne, we can proceed with the revision simultaneously. Active acne is the primary reason for suboptimal responses to treatment.
You can anticipate needing a minimum of 2-8 sessions spread over 6 months to a year, given the variability in scarring. Shallow boxcar scars or isolated atrophic scars might only require one session.
However, deeper rolling acne scars with considerable "fibrosis" and atrophy, particularly in individuals with darker skin types, will likely take a longer time to treat. If you are also dealing with active acne, expect to add an additional 4-6 months to this timeline.
It all depends on the complexity of your case. In the majority of cases I we use a multi modality approach.
As a guide, out of pocket costs range from $650 - $5000 per procedure.
Payment plans and additional financing can be found here.
The ultimate objective of the revision process is to boost your confidence and make you feel comfortable in your own skin, with success judged by your own standards.
Remember, scars are a natural part of healing. You can anticipate a 30-75% improvement in their appearance, though it's important to note that no scar can be entirely removed. It's crucial to approach the revision process with a positive mindset, supported by your family and friends.
However, if you struggle with body dysmorphic disorder, I must clarify that I am not the suitable provider for you, and will not be able to offer treatment.
If we determine that we cannot perform your treatment to an expert standard, we will make a referral. Ensuring your success with the right resources and being honest about my capabilities are fundamental principles for us. Additionally, if we believe you would benefit from supplementary treatments, we will refer you to a specialist who can work in conjunction with our treatments.
Advanced Surgical Dermatologist:
Dr. Jason Emer: Beverly Hills board-certified dermatologist who specializes in a variety of procedures from acne scarring treatment to body sculpting.
Arisa Ortiz, MD: A a board-certified dermatologist and director of laser and cosmetic dermatology at UC San Diego Health.
Dr. Salar Hazany: Los Angeles board-certified dermatologist, micrographic dermatologic surgeon, and Mohs micrographic surgeon, in Beverly Hills.
This treatment is a part of the signature scar revision sequence, which mimics the results of ablative lasers like Fraxel without the trauma and associated risks. In which, people with brown or olive skin tones are at risk for increased hyperpigmentation, and there are better skin rejuvenation options for deep skin tones. This is a customized multi-modality treatment, meant to address all layers of the skin and associated challenges. Essentially this is done for scar revision and refining the texture of the skin. Only offered for safety and best outcomes in the sequential customized plan.
Benefits:
7-10 day of downtime.
It can treat acne scars that both over-the-counter and prescription creams aren’t powerful enough to improve alone.
Patients see fresh, smooth-textured skin just a couple of days post-peeling, so better skin is attainable relatively quickly —and it continues to improve for six months afterward.
Utilize the skin’s natural healing process and factors to produce new skin cells without invasive action.
It helps to tighten and smooth your skin and improve its overall texture and tone, not just treat specific conditions.
It is also beneficial to resurface the skin on your hands, neck, and décolletage.