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The appearance of a scar is dependent on many factors - the size and depth of the wound as well as the individual's age, genes, and skin pigmentation. "Many scars fade to near invisibility on their own over a period of months," says Dr. Jocelyn Lieb of Advanced Dermatology, P.C.
"But some disfiguring scars do not fade and cause emotional and physical discomfort long after the initial wound has healed. Fortunately, we can take steps to reduce the severity of a scar and, although we can't always remove it entirely, we have a range of treatments that can minimize the scar and make it more consistent with surrounding skin."
A scar forms when there has been damage to the deep, thick layer of skin called the dermis. As the skin heals, the new collagen fibers that replace the damaged tissue have a different protein composition than the original tissue, which causes the new skin to have a different texture and appearance than surrounding skin. There are different types of scars: Most are flat and pale. When too much collagen is produced, the scar may be red and raised (hypertrophic) and if the raised scar extends beyond the boundaries of the original wound, it is known as a keloid scar. Contracture scars result from burns; as they tighten, they can restrict movement and may affect underlying muscles and nerves. Cystic acne and chickenpox scars are often pitted or indented (atrophic).
Tips to Minimize Scarring"How you treat a wound can make a big difference in the appearance of the scar after the wound heals," says Dr. Lieb. Here are the most important preventive steps:
- Don't let the wound get soaking wet but keep it moist with a light application of petroleum jelly. Don't use home remedies or over-the-counter lotions, creams or ointments that purport to prevent scarring. Most, including the popular vitamin E, don't work and many have ingredients that can be irritating or cause an allergic reaction.
- Keep the area clean with a gentle cleanser. Don't use soap and don't scrub. Pat dry.
- Let the wound breathe. Cover it with a thin, light bandage that allows air to circulate; change the bandage daily.
- Avoid sun exposure, which can make scarring worse.
- When a scab forms, don't touch it! Picking at a scab will impede healing and might cause scarring that would otherwise not have occurred.
Treatments to Improve the Appearance of Scars"If, despite your best efforts and the passage of time, you are still bothered by the appearance of a scar, your dermatologist can suggest a course of treatment appropriate for the severity and characteristics of the scar," says Dr. Lieb. "Options range from topical applications to surgery."
- A silicon-based gel or a silicon gel sheet that is pressed on the skin can help flatten a swollen, raised scar. Silicon gel sheeting can also be helpful as the wound is healing, leading to a thinner, softer, less red and less painful scar.
- Injections of corticosteroids are used to soften and flatten keloid and hypertrophic scars. Filler injections can raise sunken scars to the level of surrounding skin.
- Dermabrasion and laser therapy are different methods that achieve similar results: to remove the surface layers of the skin. They are used on raised scars.
- Surgery can alter a scar's shape or make it less visible. The scar may be removed completely and the new wound closed carefully (excision) or a series of small incisions can re-orient the scar so it better follows the natural folds of the skin and is less noticeable (Z-plasty). A skin graft may be used when a large area of skin has been lost.
- For keloid all scars that are resistant to corticosteroid injections, there is a new procedure called the Cryoshape. It freezes the keloid from the center and causes all or most of it to fall off, causing improvement. It is not yet covered by insurance.
"Any injury or trauma to the skin can cause a scar," Dr. Lieb concludes. "If it is small or can be easily concealed, a scar may not be troubling. But for those that make people self-conscious and cause emotional distress, we can take steps to minimize the effects." Jocelyn Ann Lieb, M.D. F.A.A.D., is board certified in dermatology and is a member of the New York Academy of Medicine, the American Medical Association and the American Academy of Dermatology. Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation with 13 locations in New York and New Jersey, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies.www.advanceddermatologypc.com.
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