scar revision
a personalized sequence protocol
Scars
Scarring is part of the natural healing process after injury to the skin. The appearance of a scar is dependent on many factors including the location of the wound, your healing process and type of injury. Scarring, no matter how severe can be improved by various methods. Matching the right treatment and technique to the scar type will give the best outcomes.
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.
Self-Harm / Cutting Scars
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
Yes! We need to be able to have a visual and tactile evaluation for the most accurate assessment. Atrophic areas (soft) vs fibrosis (hard) can not be felt via photos or videos. Virtual consultations are not available for this service.
In some cases, yes, in others I would need to create a treatment plan and have you consent to the potential "down time."
Simple treatments such as steroid injections, & dermal fillers can be performed at the same time of consultation.
Yes! More evidence is showing early intervention produces superior results! So no wait time.
Depending on the sequence you are in. The majority of the work may be om the outside layers or underlying tissue. You can expect swelling and redness for 3-7 days at minnimum, depending on the sequence of scar revision you are in. Lasers & deep focal peels take 5 -10 days to recover.
We decide this for you and it all really depends on your scar type, skin type & allocated downtime.
Some people may find themselves in "phase II or III" for multiple sessions.
To obtain the best possible result, the best time is after the summer season, to avoid direct, intense sun radiation during the treatment. In some areas where radiation is unavoidable, it is recommended to avoid direct exposure, the use of a hat and adequate specific photoprotection.
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 significant change takes place weeks after treatment. Collagen takes time to build, and in some cases, repeated treatments need to be done to clear away old damage tissue and stimulate the body to start anew. Results can take months to years, but we strive to get you results safely and after your first session.
If you do not follow the home routine, you are interrupting the treatment and will therefore not obtain the expected results. Not applying healing products and depigmenting agents with regulating action involves not regulating the melanocyte and, therefore, a persistent uncontrolled, excessive production of melanin in darker skin tones. The potential post inflammatory hyperpigmentation will appear as the skin layers are renewed, as melanin migrates to the surface making the dark spots increasingly evident.
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.
Depending on the invasive of treatment, in most cases it does not make you unable to fulfil your activities of daily living normally.
Caution must be exerted when fulfilling some type of activities during the first days, a skin adaptation period after the in office treatment. For instance, it is advisable to avoid bathing in swimming pools, prolonged sun exposure and activities that involve excessive sweating.
The majority of treatments do include anesthetic. This may be very mild or moderate sedation. This ensures patient comfort levels during the procedure.
Ideally your acne should be under absolute control before your visit. Why? If you have background inflammation, you will not heal well, meaning your tissues will not regenerate collagen to the maximum extent.
If you have active acne, we can first work on its management. Most often we can work in conjuction, meaning just as long as you take effective steps to control your acne, revision can be undertaken at the same time. The number one cause of poor outcomes to respond to treatment is active acne.
At least 2-8 sessions, over 6 months to a year is what you can expect at minimum . This is the variability of scarring. Shallow boxcar scars, & or isolated atrophic scars may only take one session.
Deeper rolling acne scars with significant "fibrosis" & atrophy, especially in patients of darker skin type will take much longer. If you have active acne, add another 4-6 months.
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 end goal of any revision process is to give you the confidence and comfort in your own skin. All measured accrding to your own perception.
Scars are natural! However, you can expect to see a 30-75% improvement. No scar can be completely eliminated. I encourage you to have a healthy outlook on the revision process, with support by your family & friends. If you have body dysmorphic views, I am not the right provider for you nor will I provide treatment.
If I feel I can not carry out your treatment at an expert level, I refer out. Setting you up for success with the right resources and integrity of my capabilities is a core value. If I feel you can benefit from adjunctive treatments, I will refer you to work with specialist alongside 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.