Part II: Post-injury, post-accident and post- burn scars before and after treatment
Normotrophic scars as a rule are formed after injuries, surgeries and cuts, and they need to be treated during the maturation period. Otherwise there is risk transforming they to hypertrophic or atrophic scars without proper control and treatment (Fig.1)
Fig.1. Transformation of normotrophic scars after surgery into hypertrophic
For the treatment of normotrophic scars, the following methods are used: microdermabrasion, early repetitive rotational dermabrasion, enzymotherapy, microneedling (collagen induction therapy), scar removal creams, cosmetic procedures (moisturizing, massage, lymphatic drainage), peeling: glycolic acid, ТСА peeling, phenol, surgical excision to improve appearance.
Treatment of normotrophic scar with microdermabrasion
Treatment of normotrophic scar with microdermabrasion is a skin polishing of the scar localization place with aluminum oxide micro-crystals (Al2O3). Aluminum sand is applied onto the skin surface by means of negative pressure (vacuum) and knocking the particles out of the problem zone. Vacuum enables to elevate the scar bottom (Fig.2). This method does not require anesthesia, the recovery period being 4-10 days. To notice tangible results, it is necessary from 3 to 5 procedures with an interval of 3-4 weeks.
Fig.2. Treatment of normotrophic scar with microdermabrasion before and after 2 procedures
Treatment of normotrophic scar with deep rotational dermabrasion
Treatment of normotrophic scar with deep rotational dermabrasion gives a good result in relation to fresh normotrophic scars. In the 60 years of the last century, the practice began to implement grinding mill with a speed of 18 000 – 35 000 rpm (Fig.3).
Fig.3. Deep rotational dermabrasion
These devices are used to treat fresh and correction of old normotrophic scars. The application point is the papillary layer of the dermis. With respect to normotrophic scars, the cutter removes unevenness of the scar tissue and stimulates the healing process (Fig. 4).
Fig.4. Treatment of normotrophic scar with deep rotational dermabrasion before and after
Treatment of normotrophic scar with enzyme therapy
Various enzymes application is not only reasonable, but necessary for adequate scar treatment and wound healing. Thus, participating in phagocytes (48-72 hours after injury) some enzymes (e.g. chymotrypsin) assume the macro-phage part, reducing the inflow of leukocytes to the wound which are responsible for the size of edema and inflammation. Others (e.g. hyaluronidase) dilute extracellular matrix by means of hyaluronic acid depolymerization, facilitating free cell migration. Some (e.g. collagenase) induce the destruction of excessive collagen.
Fig.5. Treatment of normotrophic scar with enzyme therapy. Photos before and after treatment
Treatment of normotrophic scars with microneedling (dermaroller, dermapen, dermastamp)
The application of dermaroller (Fig.6) forms hundreds of microscopic channels in the skin. Following a number of complicated consecutive reactions (hemostasis – inflammation – proliferation – remodeling), fibroblasts, special skin cells, “patch” the microscopic channels formed by dermaroller needles. Collagen islands are synthesized within the channels, which are attracted to one another, thus gradually aligning the edges of scars or striae. In this manner an elastic backing of fresh collagen tissue is created on the one hand, decreasing the width of scars/striae by retracting and elevating their bottom to the skin surface on the other hand.
Fig.6. Treatment of normotrophic scar with microneedling (dermaroller)
Fig.7. Collagen induction therapy of normotrophic scar
Treatment of normotrophic scar with scar removal creams
For treatment of normotrophic scar 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. To this end used Kelo-cote, Dermatix, Stratoderm, MedGel, Kelofibrase, Scarguard, Contractubex, Aldara, among others are applied. 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. Topical therapy is usually applied either in parallel to, or after mechanical treatment methods.
Fig.8. Normotrophic scar before and after combined treatment with moisturizing
Treatment of normotrophic scar with chemical peel
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:
- superficial – several layers of keratinized cells;
- middle – throughout keratinized layer;
- deep – throughout epidermis down to the basal layer and papilla dermis, penetrating into reticular dermis.
Treatment of normotrophic scar with TCA chemical peel
For fresh normotrophic scars, the concentration of 15% TCA peeling is sufficient. After appling the acid, the skin gets a powerful boost to regeneration. This is due to the inflow of stem cells needed for recovery. However, there is an opinion that the resource of stem cells is not infinite, and the more often peels are made, the faster their resource is exhausted. The old scars are affected only by phenol peeling.