By Carla Walsh
Scars are the proof of the body’s amazing, but imperfect, ability to heal. Every scar tells a story – the time you fell off the bicycle or the day your cat scratched you. Superficial wounds, like a mild burn or small pimple, are unlikely to leave a scar, possibly only a temporary discolouration, and that technically is not a scar. But in deeper wounds, such as a cut or deep-seated acne, when the body tries to bridge over the split tissues with collagen-producing cells called fibroblasts, a scar forms.
In normal skin turnover, fibroblasts produce an organized network of collagen that is very strong, but in an injury, the skin goes into emergency-response mode, and respond by laying down collagen in a very haphazard way. It seals the hole, but in a messy way and it doesn’t look nice.
A scar is permanent. Even with tremendous advances in medical technology, surgeons will never promise that a scar will disappear after a treatment. To “get rid” of scars is, in fact, making it inconspicuous and less distracting. Apart from appearance, some scars are problematic, causing itch, pain or movement restriction, and can be quite a nuisance. Many seek treatment to curb these discomforts, with no intention to improve it cosmetically. The treatments for scars are constantly evolving with new research findings and technological advances. To find out more on the latest in scar prevention and treatment, I spoke to 2 doctors from SW1 Clinic, who specialises in scar treatments in Singapore.
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When it comes to scar, prevention is definitely better than cure. Especially in the realm of plastic surgery, where surgeries are designed to enhance the appearance, lest add an unsightly scar. Plastic Surgeons are Scar Ninjas. Having mastered the skill to conceal scars, many procedures have ‘invisible’ scars hidden within orifices, such as in the mouth, nostrils and the inside of the eyelids.
Buccal fat removal surgery to address chubby cheeks is approached from inside the mouth. The same applies to jaw surgery to reduce a square jaw (angle reduction) or change your facial profile (orthognathic surgery). A ‘closed’ rhinoplasty has scars nested within the nostrils. Both upper and lower eyelid surgeries, or blepharoplasties, can be scar-less too. The surgery is performed internally, from the underside of the eyelids rather than through the skin, leaving no visible scar externally, like suture blepharoplasty and transconjunctival blepharoplasty.
But scarless surgery is not for everyone, especially when the underlying problem is complex, such as in the case of a deviated nose or severe droopy eyelids, the scar may have to be external. But a scar doesn’t have to be obvious, an experienced plastic surgeon will place it along facial creases and shadows to keep it concealed. Like in double chin reduction, the scar hides behind the ear.
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So if we cannot go scarless, then what are the ways to scar less? Whether it is sustained from an injury or from surgery, it is crucial to get the wound healed as soon as possible, because the longer it takes to heal, the worse the scarring. Follow your doctor’s instructions closely on wound care to ensure that healing is optimum. An exciting area in wound healing is Photomodulation using Light Emitting Diodes, or LED. These special lights interact with cells to activate new collagen formation and enhance wound healing. “Patients that go through a course of LED red light therapy after laser or surgery has a swifter course of recovery,” explains Dr Michelle Lim, Aesthetic Consultant from SW1 Clinic. Dr Lim recommends a collective program with lasers and light, like the Scar Prevention Program, for early scars. It is research-proven that a multi-pronged approach is the best way to curb scar formation.
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After a wound has healed, the scar starts off red/pink and firm, it then darkens, before ultimately softening and lightening to its final appearance. Doctors call this process scar remodelling. This remodelling journey that a scar takes varies between different types of scars, lasting 1-2 years in normal scar, but in complex (hypertrophic) scars, it may take 3-5 years. In keloid scars, a condition where the scar grows out of proportion to the injury, the process may go on for many years.
During the remodelling process, there are ways to curb the scarring process. The simplest way is to apply a scar gel or cream. How do you choose from the wide range of scar removal gels and creams available? Essentially go for those that contain silicone as the active ingredient. Shown in multiple studies to suppress scar production, a silicone-based gel is the one to go for.
If your scar is getting redder and thicker, it may suggest that the scar is overactive and a more effective way to suppress this is to use steroid injections or lasers. The most effective lasers for active scars are the Pulsed Dye Laser (PDL) and Fractionated Lasers. Especially if used together, their powers combined have a synergistic effect on dampening scar activity
PDL, or Vbeam Perfecta, laser targets the blood vessels within the scars. Eradicating these blood vessels not only reduces the redness, it also suppresses the scar activity. To flatten thick scars or smooth out irregular acne scars, a fractionated laser, like SmartX, Pico Smooth or Fraxel Dual lasers, is the answer. SmartX micro-resurfacing laser combines advanced fractional CO2 technology with a high-speed computer scanner to deliver a precise matrix of laser pulse that remodels the collagen and improves the scar. It is research-proven that combining the different modalities of scar treatment gives a more superior result than 1 treatment alone. “Combining the crème of scar treatment lights and lasers in one package,” added Dr Lim, “the Scar Intervention Program is aimed at fading problematic scars.”
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For scars that remains unsightly despite all treatments, surgery is one way to exchange a more deformed scar for a refined one, by a plastic surgeon skilled at scar revisions. It is recommended to consider surgery, only after the scar has stabilised after a few months. “Some scars are more suited for lasers or injections, while some achieve better results with surgery,” explains Dr Chia Hui Ling, Consultant Plastic Surgeon from SW1 Plastic Surgery Clinic, “so do discuss with a doctor experienced in scar therapy for advice on which treatment suits you best.”
Apart from basic scar removal surgery, Dr Chia added that there are specialized scar surgeries, such as:
- Those that restore hair for bald scars (alopecia), like scalp reduction and hair transplant
- Microfat transfer – Dr Chia‘s preferred scar treatment where she re-injects your own fat to soften hard scars or fill up sunken scars
- Releasing surgeries, for scars that restrict face and body movement or distort facial features
- Incorporating radiotherapy with surgery for nasty keloid scars that are resistant to all other treatments