Scar treatment remains a difficult problem that plastic surgeons endeavor to tackle. However, variables such as scar type, wound cause, patient skin conditions, or prior treatment always make the repair of little use or short of expectations. In particular, as they are vulnerable to the effects of facial expressions or skin wrinkles, facial scars should be handled with greater caution. The common scar types in clinics are as follows:
This is the most common type of linear scar and is mostly caused by skin trauma (such as cutting) or facial surgical incisions. It primarily presents as thickening of the epidermis at the initial stage, making the scar appear red, prominent, or pigmented within 3–6 months after wound healing. During this stage, cosmetic gel, silicone gel sheet, scar removal gel, or other scar relieving products are used to protect the wound and promote scar recovery, while severe patients are given a scar removal injection containing traces of steroids. Under good care, the scar will gradually fade and become soft after approximately 6 months and automatically turn smooth and light, on average, within a year, and does not need additional treatment. However, if the scar still appears prominent or depressed after a recovery period of over a year, the patient may consider surgery to repair it.
Atrophic scars are mainly the result of epidermal and dermal atrophy from skin lesions that cause shallow saucer-shaped or depressed defects at the surface of the skin. They are mostly caused by chickenpox or acne (spot scar). Atrophic scars mostly develop over time and frequently form different sizes of disc- or pyramid-shaped cavities on the face of the patient; therefore, dermabrasion or scar abrasion of the whole area is considered, and multiple surgeries or treatments are necessary for a distinct improvement. At present, there are 2 techniques to deal with such depressed scars. One is a non-surgical dermabrasion laser such as Fraxel, erbuim doped-yttrium aluminum garnet (Er:YAG) laser, or carbon dioxide vaporized laser. The advantages of this technique include no skin wounds and a short recovery period. The disadvantages are the necessity of multiple treatments (approximately 8–10 times) and the occurrence of sequelae such as darkening, frequently observed among Orientals. The other is mechanical dermabrasion, where the physician utilizes a high-speed hand driver and diamond grinding head to directly smooth the skin. Its advantage is the rapid response that dermabrasion needs to be performed only 2-3 times on average to achieve an obvious improvement. The disadvantage is skin wounding after the operation, so recovery takes at least 1-2 months and postoperative care is relatively complex and inconvenient.
Keloids are caused by a special constitution and generally occur at sites with relatively high skin tension or body parts with frequent motion such as bone joints. They are less likely to develop on the face, and if present, they are mainly caused by surgical wound inflammation or poor healing. Keloids commonly appear as dark red lumbricoid hyperplasia and present botryoidal or claw-like growth over the normal skin in severe cases. Besides, patients frequently suffer from itching or prickling, which becomes more obvious in the summer or on body heat. Keloids sometimes grow along with physical development and re-grow after several years; they are therefore relatively difficult to be radically treated. At present, the treatment of keloids is predominated by the conservative therapy of scar removal injection. Botox injection has demonstrated a remarkable efficacy in recent years in inhibiting scar hyperplasia. Surgical resection or repair is usually not recommended because it is prone to induce the re-growth of keloids, making future treatment trickier.
Currently, our clinic offers the following scar reconstruction surgeries to treat different types of scars: