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Scars usually fade over time. Makeup can help cover the scar while it is healing. Some scars can be minimized by certain dermatological techniques. However, treatment can only improve the appearance of a scar; it cannot completely erase it.
Dermabrasion. Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that abrades the skin. As the skin heals from the procedure, the surface appears smoother and fresher.
Chemical peels. Chemical peels are often used to minimize sun-damaged skin, irregular color (pigment), and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving the skin's appearance.
Collagen injections. One type of collagen (made from purified cow collagen) is injected beneath the skin. It replaces the body's natural collagen that has been lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines. There are several other types of injectable materials that can be used also.
Punch grafts. Punch grafts are small skin grafts to replace scarred skin. A hole is punched in the skin to remove the scar. Then the scar is replaced with unscarred skin (often from the back of the earlobe). Punch grafts can help treat deep acne scars.
Surgical scar revision. Surgical scar revision involves removing the entire scar surgically and rejoining the skin. A new scar will form. But the goal of this surgery is to create a less obvious scar. Surgical scar revision is usually done on wide or long scars, scars that healed in an unusual way, or scars in very visible places.
These are thick, rounded, irregular clusters of scar tissue that grow at the site of a wound on the skin, but beyond the edges of the borders of the wound. They often appear red or darker in color, as compared to the surrounding normal skin. Keloids are formed from collagen that the body produces after a wound has healed. These scars may appear anywhere on the body. But they are more common on the chest, back, shoulders, and earlobes. They occur more often in darker-skinned people. Keloid scars may occur up to 1 year after the original trauma to the skin.
Steroid injections. Steroids are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations that these scars may produce. Sometimes, the injections help to decrease the size of the scar and soften the scar tissue. Atrophy and skin discoloration are the main side effects.
Surgery. If the keloid scar is not responsive to nonsurgical management options, surgery may be performed. One type of surgery directly removes the scar formation with an incision, and stitches are placed to help close the wound. Sometimes, skin grafts are used to help close the wound. This involves replacing or attaching skin to an area that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Surgery is not performed often on hypertrophic scars and keloids due to the high rate of recurrence or creation of even larger keloids.
Laser surgery. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done in conjunction with other treatments, including injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be required, regardless of the initial type of therapy. Pulse dye laser is a good choice to use for keloids.
Hypertrophic scars are similar to keloid scars. But their growth is confined within the boundaries of the original skin defect and may be more responsive to treatment. These scars may also look red, and are usually thick and raised. Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally. But this process may take up to a year or more.
In treating hypertrophic scars, steroids may be the first line of therapy. But there is not 1 simple cure. Steroids may be given as an injection. Or they may be directly applied to the scar, although topical application may not be useful. These scars may also be removed surgically. Often, steroid injections are used along with the surgery. The injections may continue up to 2 years after the surgery to help maximize healing and decrease the chance of the scar returning. Like keloids, hypertrophic scars may respond to topical silicone dioxide application.
Follow all instructions to help maximize your recovery and healing. Your healthcare provider will advise you on all activity restrictions, depending on the type of surgery that was done. Scars can't be removed completely. Many factors will be involved in the degree of healing of your particular scar. Some scars take more than a year after surgery to show improvement in how they look.
Scar tissue is composed of the same protein (collagen) as the tissue that it replaces, but the fiber composition of the protein is different; instead of a random basketweave formation of the collagen fibers found in normal tissue, in fibrosis the collagen cross-links and forms a pronounced alignment in a single direction.[1] This collagen scar tissue alignment is usually of inferior functional quality to the normal collagen randomised alignment. For example, scars in the skin are less resistant to ultraviolet radiation, and sweat glands and hair follicles do not grow back within scar tissues.[2] A myocardial infarction, commonly known as a heart attack, causes scar formation in the heart muscle, which leads to loss of muscular power and possibly heart failure. However, there are some tissues (e.g. bone) that can heal without any structural or functional deterioration.
All scarring is composed of the same collagen as the tissue it has replaced, but the composition of the scar tissue, compared to the normal tissue, is different.[1] Scar tissue also lacks elasticity[3] unlike normal tissue which distributes fiber elasticity. Scars differ in the amounts of collagen overexpressed. Labels have been applied to the differences in overexpression. Two of the most common types are hypertrophic and keloid scarring,[4] both of which experience excessive stiff collagen bundled growth overextending the tissue, blocking off regeneration of tissues. Another form is atrophic scarring (sunken scarring), which also has an overexpression of collagen blocking regeneration. This scar type is sunken, because the collagen bundles do not overextend the tissue. Stretch marks (striae) are regarded as scars by some.
Hypertrophic scars occur when the body overproduces collagen, which causes the scar to be raised above the surrounding skin. Hypertrophic scars take the form of a red raised lump on the skin for lighter pigmented skin and the form of dark brown for darker pigmented skin. They usually occur within 4 to 8 weeks following wound infection or wound closure with excess tension and/or other traumatic skin injuries.[4]
Keloid scars can occur on anyone, but they are most common in dark-skinned people.[7] They can be caused by surgery, cuts, accident, acne or, sometimes, body piercings. In some people, keloid scars form spontaneously. Although they can be a cosmetic problem, keloid scars are only inert masses of collagen and therefore completely harmless and not cancerous. However, they can be itchy or painful in some individuals. They tend to be most common on the shoulders and chest. Hypertrophic scars and keloids tend to be more common in wounds closed by secondary intention.[8] Surgical removal of keloid is risky and may exacerbate the condition and worsening of the keloid.
A scar is the product of the body's repair mechanism after tissue injury. If a wound heals quickly within two weeks with new formation of skin, minimal collagen will be deposited and no scar will form.[17] When the extracellular matrix senses elevated mechanical stress loading, tissue will scar,[18] and scars can be limited by stress shielding wounds.[18] Small full thickness wounds under 2mm reepithelize fast and heal scar free.[19][20] Deep second-degree burns heal with scarring and hair loss.[2] Sweat glands do not form in scar tissue, which impairs the regulation of body temperature.[21] Elastic fibers are generally not detected in scar tissue younger than 3 months old.[22] In scars, rete pegs are lost;[23] through a lack of rete pegs, scars tend to shear easier than normal tissue.[23]
The scarring is created by fibroblast proliferation,[25] a process that begins with a reaction to the clot.[27] To mend the damage, fibroblasts slowly form the collagen scar. The fibroblast proliferation is circular[27] and cyclically, the fibroblast proliferation lays down thick, whitish collagen[25] inside the provisional and collagen matrix, resulting in the abundant production of packed collagen on the fibers[25][27] giving scars their uneven texture. Over time, the fibroblasts continue to crawl around the matrix, adjusting more fibers and, in the process, the scarring settles and becomes stiff.[27] This fibroblast proliferation also contracts the tissue.[27] In unwounded tissue, these fibers are not overexpressed with thick collagen and do not contract.
Early and effective treatment of acne scarring can prevent severe acne and the scarring that often follows.[38] In 2004, no prescription drugs for the treatment or prevention of scars were available.[39]
Chemical peels are chemicals which destroy the epidermis in a controlled manner, leading to exfoliation and the alleviation of certain skin conditions, including superficial acne scars.[40] Various chemicals can be used depending upon the depth of the peel, and caution should be used, particularly for dark-skinned individuals and those individuals susceptible to keloid formation or with active infections.[41]
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