Scars come in an infinite variety depending on location, shape, age, origin and skin type. In general, traumatic and surgical scars tend to be more amenable to treatment than others. Keloids are traditionally the most treatment resistant. They develop more likely in darker skin types, over joints and breastbone in lighter skin types and in situations where the scar goes against the grain of the skin.
Treatment modalities include:

  • Linear flat red scars:
  • – Pulsed Dye Laser (PDL) to clear the red color
    – Fraxel Re:store (FXL-R) to resurface skin texture

  • Linear raised red scars:
  • – from facelifts, breast surgery, abdominoplasty, cancer sx
    – UPCO2 for flattening
    – PDL for the red color
    – FXL Re:store for retexturing, best done during red phase
    – Silicone gel sheets to enhance or maintain flattening

  • Linear white scars: FXL-R
  • Ice pick acne scars: Punch excision followed by FXL-Re:store
  • Boxcar scars:
  • – as seen in acne and chickenpox
    – punch elevation (cutting out the base and elevating the scar)
    – subcision (severing all the attachments under the scar) + filler to keep the
    scar elevated followed by FXL resurfacing

  • Atrophic and undulating acne scars:
  • – become more apparent in the 40s and 50s
    – FXL-Re:store or FXL Re:pair resurfacing
    – Cooltouch CT3
    – Sculptra to restore fullness of skin

  • Hypertrophic scars:
  • – due to excessive collagen deposition, they remain confined to the area of
    injury and flatten out within 18 months.
    – FXL-Re:store treatments are excellent

  • Keloids:
  • – also due to excessive deposition of collagen, but these scars extend beyond
    the area of injury and never disappear. Keloids hurt, itch, contract, pull and
    disfigure. (Accidents, cardio-thoracic surgery)
    – re-excision immediately followed by application of imiquimod
    – re-excision followed by FXL-Re:store resurfacing, started on the day of
    suture removal.
    – FXL-Re:store especially while still red.
    – PDL to decrease the red color.
    – Liquid nitrogen and pressure dressings have poor success rates

  • Burn scars, fresh or mature: FXL Re:store laser, preferably while still red.
  • Scars due to self mutilation and hesitation marks from attempts at wrist slicing are best treated with the FXL Re:store laser while still fresh.
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