About Scars

Healing is a dynamic process, which involves 3 interconnected phases as follows:

  1. Inflammatory Phase
  2. Fibroblastic or Proliferation Phase
  3. Maturation Phase

FACTORS THAT INTERFERE IN HEALING

  • Local factors

Low vascularization of the wound edges, degree of wound contamination and treatment of the wound with medications that hinder or delay healing.

  • General Factors

Unsightly scars are caused by several factors, such as infection, hypoalbuminemia, poor tissue perfusion, pre-existing diseases, radiation, smoking, use of corticosteroids, site of injury, trauma mechanism, race, age and genetic factors.

UNATTENTIVE SCARS

Unsightly scars are due to several factors, such as infection, hypoalbuminemia, poor tissue perfusion, pre-existing diseases, radiation, smoking, use of corticosteroids, site of injury, trauma mechanism, race, age and genetic factors.

There are 4 most common unsightly scars and their causes:

  • Fibroproliferative Disorder – Hypertrophic Scars and Keloids.
  • Scar Contraction Disorder – Burn Scars
  • Pigmentation Disorder – Hyperchromia and Achromia.
  • Resistance Disorder – Dehiscence and Enlargement

POST-OPERATIVE SCAR CARE

SCAR WITH STITCHES
In the post-operative period, a simple dressing, surgical glue or micropore may be used and this must remain in the surgical incision at the doctor's discretion.

SCAR - AFTER REMOVAL OF STITCHES
Keep micropore in areas of tension or, if there is no tension, opt for silicone gel, which moisturizes the scar, is inert, and forms a film protecting the incision from bacterial invasion.

AFTER THE MATURATION PROCESS OF AROUND 4 WEEKS, START USING NULLSCAR SILICONE TAPE WHICH HAS THE FOLLOWING BENEFITS:

  • Keeps the scar hydrated;
  • Prevents friction of the incision with external agents;
  • Reduces skin tension over the scar, preventing widening;
  • Perform gradual pressure therapy that promotes vasoconstriction and consequently reduces the stimulation of fibroblasts, preventing hypertrophy;
  • The active ingredients help the skin to regulate epithelialization and hydration;
  • The silicone tape increases the temperature of the scar tissue by 1 degree, stimulating the production of collagenase. This enzyme is responsible for degrading unstable collagen, replacing it with stable collagen that aligns itself according to the skin's tension lines.

WIDE SCAR
It can start after 3 to 4 weeks post-operatively. It is important to use the tape at this stage for prevention.

For treatment:

  • Erbium fractional laser
  • BIOSTIMULATORS (Poly-L-lactic acid, Hydroxyapatite)
  • RETRACTED SCAR
  • SUBCISION – fibrous cutaneous strands are sectioned to release tissue retraction.

New surgical intervention.

HYPERTROPHIC SCAR

  • It starts on average after 60 days. The NULLSCAR tape should be used for at least 3 to 4 months.
  • If hypertrophy has already occurred after 60 days, Occlusive Drenison can be used.
  • The occlusive Drenison should only be used right on top of the hypertrophy, without reaching the normal skin, then I place the NULLSCAR tape on top.
  • VASCULAR LASER – Dye laser, after 17 days post-operatively and repeat every 30 days.
  • Co2 ABLATIVE FRACTIONAL LASER – Low density and high fluence plus application of Triamcinolone 40 mg/ml (Drug delivery)
  • NON-ABLATIVE FRACTIONAL LASER – Apply Triamcinolone 40 mg/ml as Drug delivery after the procedure.

Final considerations.

Do not undergo Fractional laser treatment before 3 months after surgery to avoid destabilizing the healing process.

  • MICRONEEDLING with Triamcinolone 40 mg/ml (drug delivery).
  • OCCLUSIVE CORTIDOID + Nullscar Silicone Tape (pressure therapy with vasoconstriction of dermal vessels).

HYPERCHROMIC SCAR

  • HEMOSIDELIN CHELATING – Nanovectorized 10% Thioglycolic Acid in stick, leave for 10 minutes, then wash.
  • Picosecond Laser
  • Laser Q switched
  • NON-ABLATVOUS FRACTIONAL LASER ERBIUM with depigmentation (New Melan TD) drug delivery.
  • HYPOCHROMIC SCAR
  • TRACOLIMUS – Apply twice a day
  • EXCIMER LASER
  • ERBIUM FRACTIONAL LASER with BIMATOPROST associated 2 x day
  • MMP® 5 to 6 sessions with 5-FLUORACIL induces melanocyte migration
  • CO2 FRACTIONAL LASER with hole technique
  • MELANOCYTE TRANSPLANT
  • COSMETIC TATTOO – Micro Pigmentation

KELOID SCAR

  • INTRALESIONAL SURGERY – Associated with cryotherapy and/or injectable corticosteroid
  • ZETAPLASTY – To reduce scar tension associated with laser
  • BETATHERAPY – Reserved for the elderly and large keloids
  • INJECTABLE – Triamcinolone 5 to 10 mg/ml, 5-Fluorocil 500 mg/ml, Bleomycin 3IU/ml
  • Co2 ABLATIVE FRACTIONAL LASER – High fluence and low density plus infiltration of 1/3 Triamcinolone 40 mg + 1/3 Lidocaine + 1/3 5-FU)