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Methods for treatment and correction of atrophic scars (depressed scars)

Part III: Atrophic- and acne scars and Stretch marks before after treatment

For removal, treatment and correction of atrophic scars following methods are used:

microdermabrasionrotational dermabrasionmicroneedling, creams and gels against depressed scars, subcision, mesotherapy, laser therapy, peeling, hydration, surgical excision.

Microdermabrasion for atrophic scars (depressed scars)

Is a process of skin polishing in the scar localization using aluminium microcrystal. Throughout vacuum aluminium fillings are delivered to the outer surface of skin and after knocking the particles out of the problem zone they are sucked in other container. Such method does not need anesthesia. Restoration period is within 4-10 days. The patient is able to live their usual social life. This method is also called “the day-off procedure”. 3-7 procedures through 3-4 weeks each are to be taken to achieve some visible results.

Fig.1. Fresh depressed scar of forehead before and after 2 procedures of microdermabrasion

Deep rotational dermabrasion for atrophic scars (depressed scars)

Zone of application is papilla layer of derma. Surgical dermabrasion with use of rotational discs was first described in 1905 by Kromayer. In 1960s of 20th century high speed (20-60 r.p.m.) polishing milling cutters were first introduced. They were named after their inventors Schumann and Shrews. Nowadays this device is being effectively used for correction of hypertrophic, atrophic and normatrophic scar.

Fig.2. Atrophic scar (depressed scar) before and after deep dermabrasion

Microneedling or Collagen Induction Therapy (CIT)

Microneedling, or Collagen Induction Therapy with dermaroller, dermapen, dermastamp gives a good result in the treatment of all types of fresh atrophic scars. With the help of dermaroller an abundance of perforations 0.08 – 0.22 mm in diameter are formed. The depth of microneedles penetration ranges from 0.2 – 2.5 mm depending on the problem intensity and its localization. 150 perforations may be performer per one square centimeter.

Fig.3. Fresh atrophic acne scars before and after microneedling

Creams and gels against atrophic scars (depressed scars)

Different ointments, creams and gels are applied depending on the stage of scar formation, such being antibacterial, normalizing blood circulation, reducing or stimulating collagen synthesis, diluting wound environment, boosting immunity of the wound area, etc.
Each individual case surely requires a consultation with the attending physician to select the necessary cream, ointment or gel, because some products are capable of not only improving, but as well as of worsening the scar condition. Some products which containing onion extract or allium cepa (e.g. Contractubex®, Mederma) shall not be applied in the treatment of atrophic scars (depressed scars) and stretch marks. The onion’s extract has antiproliferative effect on the fibroblasts. Such effect is unacceptable for atrophic scars with impaired collagen synthesis. Application of these products on the atrophic scars and stretch marks will further their retraction. Topical therapy is usually applied either in parallel to, or after mechanical treatment methods.

Subcision for atrophic scars (depressed scars)

This method was developed by David Orentreich, american dermatologist. The principal of this method is as follows. The process of scar maturation is accompanied by the development of connective tissues that fixate the scar bottom embedding it into derma. Connective bridles are subcised by the special needle and the released scar bottom elevates. The deficiency aligns (Fig.4).

Fig.4. Subcision. The scheme

Fig.5. Atrophic scars before and after subcision

Mesotherapy for atrophic scars

Mesotherapy in its broad context is the injection of cosmeceutical and pharmacological drugs into the middle layers of skin (mesoderm) to improve the scar appearance, whereby primarily using the so-called fillers (filling agents). Fillers can be natural, synthetic and semisynthetic. Apart from fillers, fibroblasts are injected (those being cells, synthesizing collagen), a variety of microelements stimulating the healing of wound and scar formation, different enzymes, etc.

Treatment of atrophic scars with lasers

Ablative and non-ablative lasers are used in atrophic scar correction. Carbon dioxide laser (CO2 Laser)  The treatment with carbon dioxide laser may cause complications (lasting redness, pigmentation, transformation of atrophic scar into keloid).is ablative laser – vaporizes upper skin layers or burn through microchannels into the skin (Fig.6), where new collagen fibers are formed after this. The skin relief is being aligned due to the formation of multiple collagen islands.

Fig.6. Treatment of fresh atrophic acne scars with an ablative fractional laser (Fraxel)

Vascular  laser (non-ablative laser) simply “stick together” the vessels within the scar (Fig.7). As a rule, vascular laser treatment is not followed by any complications.

Fig.7. Treatment of atrophic scars with a vascular laser

Treatment of atrophic scars with peeling

Peeling incorporates the notions “to purify”, “remove the skin” and “exfoliate”. Therefore, any exfoliation-related process of epidermis in the upper layers of derma is basically referred to as a peeling. Depending on depth of effect, all peelings are divided as follows:

  1. superficial – several layers of keratinized cells;
  2. middle – throughout keratinized layer;
  3. deep – throughout epidermis down to the basal layer and papilla dermis, penetrating into reticular dermis.

Fig.8. Scratches and small scars before and after series of middle peeling

Treatment of atrophic scars with hydration

Recently fresh wound was cleansed with potassium permanganate. Such treatment often caused formation of crust with scar under it. Besides, the scar got rough. It’s essential that wound is to heal in humid medium so that cells could migrate, divide and receive necessary information. A series of synthetic and semisynthetic coatings are being applied to moisturize wound.

Enzyme therapy of depressed scars

Enzymes are applied to cleanse the wound from necrotic masses, their presence is required for normal healing and formation of a normotrophic scar. Some of the enzymes can align the rough connective tissues creating a more delicate tissue from their block-fractures. To this end, iontophoresis, phonopheresis, injections with enzymes are used.

Fig.9. Post-injury depressed scar before and after enzyme therapy and hydration