Light and Laser Scar Vanishing System
Vanishing Scars with art, science and technology.
In Cderma we know that there are multiple types of scars and depending on its type it will be the type of treatment to be done, alone or combined.
In Cderma our main focus for the treatment of the scars is the combination of Lasers to vanish them; however, in many cases we use the combination of alternative techniques to obtain better results.
Types of scars
According to the causes and the healing of the wound we define the different types of scars:
- Atrophic scars (depressed, lack of collagen)
- Hypertrophic scars (swollen)
- Scars that extend further to the wounded zone (keloid)
- Acne scars (atrophic ice pick scar)
Atrophic scars (superficial, scarce)
When a few fibers are produced in the process of the healing of the wound which can substitute the damaged tissue, a type of dimples around the scars are produced located at a deeper level of the surrounding skin, the so called atrophic scars. They can be a consequence of acne, for example.
The anomaly scars are formed when there are considerable hypertrophic scars (swollen scars) or keloid (scars which extend an exaggerated growth of the scarring tissue). They are specially produced when the process of healing of the wounds is interrupted due to strong traction forces, for example, due to regular exercise or secondary healing, when this wound could not be cicatrized in the first intention then it is left to heal by its own and it takes a prolonged time.
The cause of the formation of hypertrophic scars, as well as keloids, supposedly is the localized interruption of the formation of the conjunctive tissue in which it is substituted by a lower quality conjunctive tissue or a defective collagen type which does not have the same information of the limitation of space and distance as a good collagen.
This responds in great part to hereditary genetic information.
Sometimes, after suffering from serious burns, scars with anomalous formation appear. In them, the scars hump more than the surrounding cutaneous tissue. When the anomalous formation of the scar that reduces is limited to the zone of the wound, it is a hypertrophic scar (as a difference with the keloid ones).
The hypertrophic scars tend to be thick and swollen and for the patients they are annoying at an esthetic level. When they are located near the joints, the hypertrophic scars might diminish freedom of movement.
The pustular or encysted acne produces scarring lesions which in most cases leave depressions and wide areas lax of collagen therefore a bad quality skin.
Other patients present real scars produced by acne. The most frequent are those in which there is a loss of substance (skin depressions), but we can also see hypertrophic and keloid scars in patients who have suffered from acne.
Treatment for scars:
In Cderma we are a specialized clinic in Dermatology and in Plastic Surgery, therefore we are the specialists needed to treat scars in the best way.
In Cderma we count with non-invasive treatments such as creams, silicone gel patches, micro invasive treatments such as the Laser of CO2, Nd:YAG 1064, IPL, application of Intralesional Triamcinolone, placing of NanoFat Graft. And finally the surgical revision of the scar itself in selected cases.
Let us explain briefly each form of treatment:
Ointments and gels for scars
The ointments and special gels which are applied carefully for the scars, reduce the reddening, relieve pain, itching and avoid the growth of anomalous conjunctive tissue, the principal cause of the origin of swollen scars with anomalous growth (hypertrophic and keloid scars).
The treatment with specific gels and ointments can start when the outline of the wound has completely closed and the stitches have been removed. It is necessary to apply the gel or ointment with a soft massage for several weeks, at least twice a day. The gels for scars are indicated for the treatment of scars both new and old. In the case of the old and hardened scars, it is recommended that along with the daily care, to apply ointment and bandage the zone during the night. Thanks to the constant care, the scare diminishes its size, loses the reddish color and turns less visible. The specific ointments and gels for scars are sold in pharmacies and contain active principles such as cepae extract (onion extract), heparin or dexpanthenol.
Hydro active treatment
It can be useful in the formation of the scars to apply a good treatment on time. For this end, the so called hydro active treatments are applied, which help in the natural process of scarring.
Bandages or strips which have a special layer to cover themselves are applied in the hydro active treatment of the wounds. This layer does not allow the wound to dry. In this way, substances such as enzymes, hormones and growth factors can be applied for longer time on the wound and it helps in the formation of new cells.
The compression bandage impedes the formation of outgrowth in the scar through pressure and benefits with it the state of the scar. Particularly the scars caused by burns, but also the ones caused by lesions of great extent, are benefited by the adequate application of the compression bandages.
As compression bandages, the elastic bandages and the compression garments made for this end are mainly used, which patients use over long periods of time (normally several months). Thanks to the use of a compression bandage, the excessive stretching of the wound zone is avoided which is produced as a consequence of the frequent movement, this favors the formation of spare tissue. Also, the continuous application of pressure acts as a stimulant in the transformation of the substitution tissue into a functional tissue and makes the scar look more elastic.
The patches are a product line of silicone gel for the treatment or prevention of scars, keloid and hypertrophic scars, both recent and old. The product helps in the renovation and regeneration process of the dermis, with anti-inflammatory and anti-oxidant action. It improves the texture, color and hydration of the treated zone and it softens the skin.
It is a product based on silicone of medical grade, without animal origin components nor active principles. It can be used with other complementary treatments. It is contraindicated in open wounds, infected zones and tissues which are not healthy.
These patches are applied in the shape of sheets which can be cut to adjust them to the size of the scar. They are transparent, thin and flexible, they softly adhere to the tissue and fragile skin, adapting themselves to the body shape. They are waterproof and steam permeable, they can be used daily with all comfort. They can be reusable and its removal is easy and fast.
They are used for 8 to 12 weeks and notably improve the scar and in immediate post-surgery cases because they prevent a very visible scar to happen in 80% of the cases.
The keloids and the hypertrophic scars are benign hypertrophic growths of the dermic fibroblasts. The patients with these cutaneous problems experiment pronounced physical (deformity, pain and itching) and psychological problems. Even when the etiology has not been totally explained, it is suggested that the fibroblasts derived from the keloids and hypertrophic scars produce collagen in an increased form compared with the normal fibroblasts. The suppression of the activity of the fibroblasts in hypertrophic scars and keloids could be essential in the therapeutic of these answers of abnormal scarring. An increment has been found in the vascularization in hypertrophic scars and keloids.
Depending of the size, shape, location and age of the keloids, dilutions of Triamcinolone acetonide in a range of 10 to 40 mg/kg can be used. The injections are repeated every 2 to 4 weeks, depending of the strength of the corticoid used and the size of the keloid. The most common cause in the fault in this therapy is the use of very low doses. Concentrations inferior to the 10 mg/ml are rarely efficient in a mature keloid. The majority of the big mature keloids require 40 mg/ml. the strength is reduced little by little. The corticoids are more useful in the sessile keloids and in the ones in which the surgery has no possibilities of success. They are rarely helpful in the pedunculated keloids. Even if the keloid remits partially, there can be a sack of redundant skin which will finally need of surgery in order to be removed. The pedunculated lesions are better managed with surgical excision followed by the corticoid injection in the base to avoid the recurrence.
Triamcinolone with Collagenase and/or 5-Fluoracile can be combined.
In Cderma our base for the erasure of scars is performed with laser. Depending on the origin of the laser light is its specific function in a scar. The CO2 Laser works in texture mainly reorganizing the architecture of the collagen fibers. The Nd:YAG 1064 works in those scars with a lot of pigment clarifying them. And in the scars with a high vascular content, this is, those scars in which blood vessels can be seen through, then we can use a laser to coapt either with IPL or Nd:YAG o Diode depending on the case.
The best is to use the combination of the three technologies in one same treatment to improve results.
The treatment with laser is special because it is capable of restoring the internal layers of the skin reconstructing them with new collagen, improving this way the appearance of the post-surgical scars in a very short time and at the same time preventing the abnormal scarring of these wounds, avoiding the formation of keloids. To obtain better results it is important that the treatment is performed a few days after the removal of the stitches of the wound, because its recovery and the result is much faster than when the treatment is performed months or years after. This technology is apt for treating all types of scares such as: keloids, hypertrophic scars or depressed scars and acne scars with amazing results.
The treatment consists in the application of two or three sessions approximately, depending of the case. It is tolerable, therefore no type of anesthesia is required, only topic cream and it does not require any disability.
It is performed in a package of sessions, sometimes only Laser therapy or combined.
Injection of tissue growth factors coming from the grease
From the studies carried by Dr. Tonnard from Belgium and the Tissue restoration with Nano graft or in Spanish grease serum graft which contains growth factors and stem cells, which are around 5 years old, these have scientifically proven a significant recovery in the flexibility, and in the diminishing of the fibrosis improving the atrophic scars as an only therapy by itself.
This technique apart from restoring the atrophic fibers of the scars, is a very important weapon for facial rejuvenation.
Its only defect is its delayed effect of 10 to 12 weeks.
Surgical Revision of the Scar
In many cases the best is to start with a partial or total resection of the scar itself and then start with Laser or Pulsed Light therapy or other laser used.
Adding Silicone patches and erasing creams to the scar.
Each case is individualized.
There are many substances, medications and techniques to improve a scar but here we mention the techniques which are mainly used in Cderma and in the Centers of high specialization in the world with scientific prove.