Raised Scars

Remove raised scars

scarring after injury

Remove annoying scars

Images from ongoing user study. Single case report of a patient with a keloid scar on the left thigh.

Picture 1 from July 13.09.2020th, XNUMX, Picture 2 from July 05.10.2020, XNUMX.

No conclusions can be drawn about the success of other treatments from this individual treatment case.

What are raised scars?

 

The hypertrophic or excessive scar forms after injuries or surgical procedures. It may become thick and bulging or contracted and firm. As a rule, there is a disruption in scar maturation. In addition, the scars are the result of a completed wound healing process and therefore represent a newly formed, fiber-rich replacement tissue. They are formed from skin cells in the dermis (dermis), the so-called fibroblasts, and, in addition to unsightly pigmentation, can be accompanied by pain and itching.

Complaint-free Scar

They heal quickly and without complications, are level with the skin and are soft and movable. Slight reddening and itching can only occur in the early stages.

Active Scar

Chronic irritation of the scar tissue causes the scar to remain red for longer and can be painful.

hypertrophic Scar

They are caused by an overproduction of connective tissue, especially in regions of increased stress, eg over joints. They are bulging, hard and not very elastic or movable. Wound healing is often delayed and redness, itching or pain occur. They are limited to the wound area and can regress over time.

keloids Scar

Here, too, there is an increase in connective tissue with a bulging, fixed scar as well as redness, itching, sensory disturbances or pain. However, they exceed the edge of the wound and typically do not regress. Keloids are more common with a family history and dark skin color.

atrophy Scar

Due to a reduced formation of connective tissue, these scars lie below the level of the skin and heal with a delay. They are tight and contracted, cannot move and are prone to itching and pain. They have poor blood circulation and therefore tend to be pale. These scars often form as dimple-like acne scars on the face, for example as a result of pimples or after chickenpox.

sclerotic Scar

They are hard, inelastic and glued to the surrounding tissue. They can continue to shrink over time and very often cause symptoms. In the area of ​​the joints in particular, these scars can significantly limit mobility.

1. The coagulation phase (exudative phase)

 

Foreign bodies, viruses and bacteria that have penetrated are flushed out by blood and tissue fluid that escape from the wound.
Blood platelets (thrombocytes) and special coagulation proteins (fibrin) mediate blood clotting and form a protective blood clot within a very short time, which temporarily closes the wound.

It creates a barrier that prevents pathogens and other harmful substances from entering the body while the healing processes inside the wound are initiated.

2. The inflammatory phase (resorptive phase)

Macrophages, as scavenger cells of the immune system, migrate to the wound, where they clean the tissue and free it from pathogens and destroyed cells.

This impressive ability of macrophages ensures that the healing process is optimally supported by creating a clean and healthy environment for regeneration.

3. The repair phase (proliferative phase)

 

After about four days, new tissue formation begins. The wound with the temporary blood clot is gradually being replaced by new cells, so that the wound is gradually getting smaller.

This coordinated work causes the wound to gradually shrink and the healing process to continue.

4. The reparations phase

Depending on the size of the wound, it takes about seven days to four weeks for the wound to detach from the edges and be replaced by new skin cells.

The wound begins to close.

This marks the beginning of the wound closure as the body persistently works to regenerate the damaged tissue.

If you have a larger wound, you should take it easy during the healing phase. If a surgical incision can heal without pulling forces, the risk of growths decreases. A surgical technique that is based on the skin tension lines also plays a role. At the same time, however, targeted, gentle movement can promote blood flow to the scar tissue, making it more supple and looser. It also helps if you apply silicone creams or silicone gels to a scar regularly from two weeks after the operation. To do this, gently massage the cream or gel into the scar tissue at least twice a day. For scars that have hardened, an ointment dressing overnight can also be useful. Preparations with onion extract can also help preventatively. Compression from the outside of a wound, such as compression stockings or a pressure bandage, supports healing.

In the case of injuries, you should make sure that no dirt gets into the wound. Basically, you should protect scars well from the sun's rays so that they don't turn dark.

Despite removal, a proliferation of scars will probably never be completely invisible. But with a variety of treatment methods, we can prevent the annoying side effects such as itching and pain and make the appearance more bearable.

Scars take time to heal completely. Experts estimate it takes six to XNUMX months, sometimes up to two years, for the redness and tenderness of the scar to go away. After this time, the initial itching also disappears in many cases. People with wound healing disorders or burns are particularly at risk from proliferating scars, as are allergy sufferers. The older a person gets, the worse their wounds heal. Because the elasticity and blood supply of the skin decreases and the fat layers become thinner. On the other hand, children and young people are particularly at risk of developing bulging scars because their bodies are set to grow and often produce too much new connective tissue. Hormones also seem to play a role.

Keloids are very rare. The darker the skin color, the more common keloids are. People with long-standing acne are also at an increased risk of developing keloids.

In atrophic scars, the scar tissue contracts. Especially with longer wounds, it is noticeable that the entire area looks like it has sunk in.
However, those affected find the excessive scars (hypertrophic scars and keloids) significantly more disturbing. Sometimes only a slight, reddened bump can be seen on the skin. Instead of being thin and inconspicuous, the scar arches wide over the body. Or - especially with keloids - thick and unsightly tumors form. In the case of hypertrophic scars, only the scar itself is affected. Keloids can occur individually or be distributed over a large area. They are particularly common on the earlobe, chest, and upper back.

Treatment options

The therapy of a hypertrophic scar is not determined solely on the basis of its intensity, but also takes into account the origin of the scarring, the assessment of the patient's complaints and possible functional impairments. Appropriate treatment can usually only be given after the plastic surgeon has personally examined the patient.

Scar care (creams and ointments)

Scar creams and ointments have the ability to relieve itching and flaking and can be used to accompany treatment. Nevertheless, they are less suitable to offer a targeted therapeutic solution for problematic scars.

silicone pads and silicone foils

Silicone pads and foils can have a beneficial effect on scar treatment. They reduce the thickness of the scar, any pain and itching. They also accelerate and optimize scar maturation.

injection therapy

In cases of excessive scarring, corticosteroid injections may be used provided the scars have not fully matured. With the goal of a lasting effect in the affected scar, we rely on the injection of crystalline cortisone. As a rule, several sessions are necessary, which are carried out over a period of several weeks.

 

surgical therapy

In the case of extensive scars, surgical intervention is often unavoidable. There are several treatment options, including dermabrasion, which uses a special bandage to remove the scar. It is also possible to cut out the scar, optionally with or without a skin transplant. Larger defects require flaps, which can be performed either with or without prior tissue expansion. Numerous methods from the field of reconstructive surgery are also used in the treatment of scars.

Fat injections, Microfat, Nanofat

Fat injection techniques are widely used in aesthetic and reconstructive surgery. New research results indicate that these procedures can also be promising in the treatment of scars.

The use of autologous fat grafting to inject scars improves scar mobility on the surrounding skin. In addition, the mesenchymal stem cells present in the fatty tissue have a positive influence on the maturation of the scar. Depending on the method chosen, the cell suspension is either injected into the scar and the underlying subcutaneous tissue (Microfat), or very fine, specialized cannulas are used to inject the suspension directly into the skin (Nanofat). The diverse techniques of fat injections (lipotransfer) have been applied and used regularly by the experienced plastic surgeons at KSW for some time. New findings suggest that these approaches can also be extremely successful for scar treatment.

 

Medical needling

The technique of medical needling is a comparatively young method of treating scars. Precise needle pricks are used to create tiny micro-wounds in the affected skin region, which in turn stimulate increased production of collagen in the treated skin area. To ensure the control and targeted placement of these micro-stitches in the dermis, we use special rollers fitted with fine needles. Depending on the specific area of ​​application, the lengths of the needles vary between 1 and 3 mm.

Before the actual needle treatment, a previous application of a cream with a high content of vitamins is necessary. This preparatory measure helps to optimally prepare the skin for the procedure. In most cases, we carry out the needling treatment under local anesthesia or after pre-treatment with an anesthetic cream in order to ensure that the procedure is as comfortable and painless as possible for our patients.

 

irradiation

Long-term effectiveness of the treatment often requires close interdisciplinary cooperation. In addition to being used to fight cancer, radiation is also proving to be extremely valuable in scar therapy. Especially after surgical removal of scar tissue, we usually use targeted radiation to prevent excessive scar growth again. Radiation oncology specialists at the cantonal hospital in Winterthur are responsible for carrying out these radiation treatments. In most cases, this comprehensive therapy is coordinated by the specialist in plastic surgery.

Lasers and immunosuppressants

There are numerous therapeutic approaches for the treatment of scars, the success of which can vary. These include laser therapy, administration of immunosuppressive drugs, and cryotherapy (cold therapy), all of which can help treat scars effectively. The applicability of these procedures is determined individually on a case-by-case basis. Although they are not part of the standard therapies at KSW, they have impressively demonstrated their effectiveness in certain situations.

Treatment with
of phlebolysis:

Raised scars, such as keloids or also hypertrophic cells, are boiled off on the surface through the targeted application of radio frequency and electrolysis and thus smoothed out. The healthy skin cells are not damaged because the very fine needle remains cold.

Although this does not eliminate the scars, it can result in a significant improvement in terms of appearance and, in some cases, motor skills.

This can be done without anesthesia as it is usually somewhat uncomfortable but not or slightly painful. Despite many documentations of the removal, the formation of new scars or other side effects are not known.

Disturbing scar removal

Advantages of phlebolysis treatment:

  • no anesthesia
  • Scar formation not known
  • gentle and painless method
  • immediately visible reaction
  • applicable to any skin
  • Burns impossible because the tool is cold
  • no bleeding
  • no risk of infection
  • no threads, no pressure bandage
  • Patient is in no way restricted after treatment

Interview with Andreas Oehme, co-developer of phlebolysis.

Age spots
angiomas
aphthous ulcers
Spider veins
Birt-Hogg-Dubé Syndrome
Couperose
Raised Scars
Fibroma
Fresh tick bitee
herpes simplex
condylomas
liver spots
Seborrheic keratoses
telangiectasias
Warts
xanthelasma

Images from ongoing user study

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