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Laser Scar Removal vs. Surgical

about-weight-loss-surgery-ga-1 What’s the difference between Laser Scar Removal vs. Surgical ? Laser scar treatment is a modern technique for improving all types of scars.  This also can be accomplished by time tested techniques such as dermabrasion as well. Whether your blemishes were caused by acne, a wound or a medical condition, laser treatments or dermabrasion can help reduce the appearance of the scar. Even if your scar has extended beyond where the initial injury occurred, the built up collagen that has caused this to happen can be removed with laser procedures. For more severe scars or those that are “against the grain” of facial lines see the last section below on z-plasty and w-plasty.

Of course, not everyone should get laser treatments for scar removal. If you have skin already struggling with the pressure of a condition such as psoriasis, it isn’t a good idea to use lasers to reduce scarring. In fact, scar removal on sensitive skin can just make things look and feel worse. There are also some medications that shouldn’t be mixed with laser scar removal.

The basics of how lasers remove scars is by removing layers of skin. Exposing fresh, healthy and ultimately unmarked skin below, you leave each treatment with your scar less and less visible. The laser also activates collagen cells in your skin, the very things that help your skin heal and stay firm. This means that getting laser treatments for scar removal can actually help your skin look, feel and actually be healthier and firmer.

The biggest risk you will be taking in getting laser scar removal is a change in color around the area treated. The sun often makes the color difference more obvious, too. In the case of infections post laser scar removal, antibiotics can keep you healthy and healing.

The most common type of scar removal these days is done with lasers or dermabrasion. This is a simple, low risk procedure that takes less than two hours to complete. Depending on the strength of the scar, more treatments may be needed.

For very severe scars, your doctor may recommend getting it surgically removed or re-arranged instead. Techniques such as z-plasty or W-plasty can improve the appearance of facial scars by re-orienting the scars into what are called resting skin tension lines. Your own wrinkles and facial muscles then help the re-aligned scars to heal better. This type of scar removal takes a lot longer to heal and is usually only done in severe cases. However, it is the more traditional method as laser scar removal is still a relatively new technology. What type of procedure is best for obliterating your blemish is a decision to be made with your cosmetic surgeon.

Scar revsion for the face

Some of the simplest things that we surgeons take for granted can be of utmost importance to patents. Just this week I saw a model/actress in follow-up. She cut her lips last year in Paris in a motorbike accident, and had her lip stitched up in an emergency room. Unfortunately, a thick scar formed and she had been unable to work since. Six weeks ago, I performed upper and lower lip scar revision. She is back to work and just booked a national TV commercial for the upcoming holiday season (HIPPA privacy prevents me from revealing more details).

The principles of scar revision have to do with what makes a scar visible and how to better hide the mark. The least visible are usually the ones that come from our own planned incisions for facial surgery, either cosmetic, for facial reconstruction or to fix facial fractures. Many of these approaches were pioneered by Dr. Tessier in his quest for the least visible scars when reconstructing children with inborn facial defects.

In order of preference:

  1. The best place to make an incision is inside an orifice such as the mouth, nose, etc.
  1. Next is at the junction of two structures such as the hairline or ear and cheek
  2. Third is to use what are called minimal skin tension lines, MSTL, where I have patients smile and grimace. The lines that form in the skin are perpendicular to the underlying muscles, and future scars will have the least amount of tension on them. As we get older these lines are visible at rest and called resting skin tension lines, RSTL.
  3. Undermine (lift up under the skin) to eliminate tension on closures.

 

As for traumatic scars, what makes them visible? Scars contract and may widen as they heal. Also long scars that “go against the grain” or RSTL of the face are more visible. Thirdly are pigment changes (red and and brown).

Facial lacerations should be sutured by a facial plastic surgeon or plastic surgeon since our training focuses strongly on skin healing and cosmesis. When an incision or scar is closed, the skin should be undermined to reduce tension. Tension pulls on scars as we move around. This is why scars on the body, arms and legs tend to widen. On the face they should be tension free. The skin is then closed in layers with the edges slightly everted (turned out) so as it heals the scar flattens, since scars contract. Color differences can also be reduced with lasers.

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