Author Archives: Michael James

Considering Scar Revision Surgery

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Enhancing your appearance with scar revision surgery

There is not a person on the planet who is scarless or a tleast it is highly unlikely. Scars are visible signs that remain after a wound has healed. Scars are unavoidable results of injury or surgery, and the results of this natural healing process can be very unpredictable. Some people naturally heal well; others do not… Poor healing may contribute to scars that are unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be raised or recessed, different in color or texture from surrounding healthy tissue or particularly noticeable due to their size, shape or location.

Facial Scar on Young GirlYour treatment options vary based on the type and degree of scarring and can include:
• Simple topical treatments
• Minimally invasive procedures
• Surgical revision with advanced techniques in wound closure

Scar revision surgery is meant to minimize the scar so that it is more consistent with your surrounding skin tone and texture.
Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased.

Should I Elect Scar Revision?

Scar revision is a highly individualized procedure and you should do it if it adversely effects your self image and esteem.. Scar revision can be performed at any age and is a good option if:

• You are upset by a scar anywhere on your body
• You are physically healthy
• You do not smoke
• You have a positive outlook and realistic goals for your scar revision surgery
• You do not have active acne or other skin diseases in the area to be treated

Ethnicity and Scarring

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Skin Color and Scarring

Increasingly in pluralistic social cultures in the western societies people’s outward appearance may not be the best indicator of the inherited ethnicity. Ethnicity plays a significant part of how skin heals from injury or after surgery.

According to a national report in treating skin of color (SOC), expert physicians necessarily should consider not only patients’ desires and skin color. Additionally, and of prime importance is also the consideration of the patient’s ethnicity and history of scarring, post-inflammatory response, hyperpigmentation (PIH) and tanning.

Dr. Elliot Battle is CEO and President of Cultural Dermatology and Laser Center, Washington, and clinical instructor of dermatology, Howard University College of Medicine. He emphasizes that skin color and ethnicity are separate factors. He comments that out of 1,000 people with the identical skin color, “We would most likely have 1,000 different combinations of African, Caucasian, Latin, Spanish, Indian and Asian ethnicities,” he continues, adding that along with skin color, “Those combinations of ethnicities determine how one’s skin reacts to lasers and skin products.”

Understanding this it is important that your dermatologist to cultivate the habit of asking about a patient’s ancestral history — the ethnicity of their parents and grandparents. “We see many patients who might appear to be Caucasian, but one of their parents or grandparents might be a person of color,” he says. “The future of skin treatments will add ethnicity to the criteria for choosing parameters.

When concerned about scarring for any type be certain that your chosen physician has a good understanding of ethnicity and how it effects scarring.

Healing the Scars of War Victims

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No single group deals with more debilitating scarring then victims of war; both military and civilians. The decade of wars heralding in the 21st Century has left millions of people suffering from life changing injures. Along with the emotional and tragic psychological scars are the physical scars as a reminder. There are organizations globally seeking to help people who unfortunately suffering from the life lone effects of debilitating human conflict. Share this resource with any person who can benefit.

Thanks the MEDSCAR team.

AFIRM
The Armed Forces Institute of Regenerative Medicine (AFIRM) is a multi-institutional, interdisciplinary network working to develop advanced treatment options for our severely wounded servicemen and women. They develop advanced treatment for severely wounded servicemen and women. This organization is designed to speed the delivery of regenerative medicine therapies to assist the most injured service members. The five major research programs include Burn Repair, Compartment Syndrome Repair, craniofacial Reconstruction, Limb and Digit Salvage, and Scarless Wound Healing.

Air Force Wounded Warrior
The Air Force Wounded Warrior ensures great care, services, and assistance before and after wounded warriors separate or retire. They have a strong emphasis on ensuring wounded airmen individualized guidance and support to help them transition out of the Air Force and back to civilian life. The Air Force Wounded Warrior, working closely with the Secretary of Defense programs, will keep these men and women on active duty.

Iraq Star, Inc.
Iraq Star is a recently founded non-profit organization. It offers surgery for disfigured veterans. Iraq Star recruits plastic surgeons across the country to provide free cosmetic surgery for soldiers who want to fix their deformities including scars.

Scars To Freedom
Scars to Freedom Foundation, provides FREE scar revision to all Military Veterans. This is our way of thanking them for their sacrifice and service for our Country.

Reduced Scalp Scarring from Hair Transplant Surgery

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FUE hair restoration can reduce scars

Modern hair transplant is resolving hair loss issues for many people. However the most common form of Follicular Unit Transplant (FUT) surgery ‘Strip Method’ procedure leaves a linear scar that is just not acceptable. This lends to the increasing popularity of Follicular Unit Extraction (FUE) hair restoration surgeries.

Healing of FUE Scars

FUE varies from the other FUT procedure by the method of extracting, or “harvesting,” donor hair. An FUE procedure involves the use of an instrument is to make a small, circular incision in the skin around a follicular unit, separating it from the surrounding tissue. The unit is then extracted (pulled) directly from the scalp, leaving a small wound.

This process is repeated until the hair transplant surgeon has harvested enough follicular units for the planned hair restoration. This nature of this process means it takes o time to complete the procedure. This of course varies under the number of grafts being extracted. The donor wounds are approximately 1-mm in size and in most cases heal within a week to ten days.
Patients can be concerned about the punctuate scars from FUE but in most cases they become undetectable in a short period of time.

Scars from FUE vary do to:
1. The size of the punch (ranges of punch sizes are from 0.8-1.5mm)
2. The density of the donor hair area; the thicker the hair the less visible the scars
3. The inverse is true; the thinner the donor hair the more visible the scare
4. The individual patients healing

Hypopigmentation

Generally, the donor area appears to heal without visible scarring. In some instances a patient can experience loss of color in the donor extraction wounds. These tiny spaces that lack the same degree of scalp colorization than the surrounding donor area. This is more apparent if the patient has darker skin. A hair transplant surgeon can test with a few test extractions prior to committing to a full surgery.

Adult Acne Scar Revision

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Acne Scar Revision

Acne is most often associated with the angst and turbulent adolescence; at least that is the common perception. In the United States alone the American Academy of Dermatology reports that 40 to 50 million peoples suffer from acne to a level of requiring medical treatment. The numbers appear to be growing and the reason for this unclear.

In a study of 1,013 people, 15% of women and 7% of men over 50 reported having acne. The negative effects on self image are as strong in adults as in teens. Often adults use over the counter treatment that aggravate the condition even further.

WATCH VIDEO of One Acne Scar Revision Technique Below


Women appear to have increased risk


A survey from the University of Alabama was published a study in 2008; significant numbers on women suffering from acne was reported. This study found that acne affects more than 50% of women between the ages of 20-29 and more than 25% between the ages of 40-49. A Massachusetts General Hospital research survey in 2011 reported similar numbers though slightly lower than the University of Alabama report. The hospital study revealed that 45% of women 20-29 and 12% of women 41-50 had acne.

Treatments


Long term acne can leave substantial levels of scarring that require medical intervention to improve the appearance of the skin to enhance the well being and safe image of patients. Myriad treatments from a range of chemical peels, to non-ablative and ablative lasers, to injections, all the way up to surgical techniques. Sometimes the best treatment for may include a combination of these modern procedures. As in other scar revision the goal is to make the scarring less noticeable.

New Cosmetic Procedures for Scar Revision

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Scarring negatively affects a person’s self image. Advancements in cosmetic procedures surgical and non-surgical provide alternatives in revising hair transplant scars or scars in other areas of the body that have hair.

FUE and SMP Transplant for Scalp Scar Revision
Follicular Unit Extraction (FUE) allows a hair transplant surgeon to individually remove donor grafts without a measure incision in the patient’s scalp. This means a small number of grafts can be used and placed within recipient sits within a scar. This means scars in other places that have hair (eyebrows, pubis etc…) can be treated by transplanting of a small number of follicular units into the scar and on its margins to blend it to the surrounding area.

Scalp Micro-pigmentation is used to simulate stubble hair making it also good for obscuring scars.
Scalp Micro-pigmentation is used to simulate stubble hair making it also good for obscuring scars.

Scalp Micro-Pigmentation
SMP for Scar Revision

Scalp Micro-Pigmentation (SMP) is a non surgical cosmetic procedure that can be used in scar revision. It can works well with scalp scars. Special pigments are injected into the scar. The appearance is like stubble hair. It is injected into the scalp in a manner to obscure the scar or make it blend into the surrounding area.

These more recent advances in cosmetic procedures; FUE and SMP are performed in Los Angeles hair transplant centers like US Hair Restoration.

Understanding Scarring and Scar Revision

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The role of scar revision is to restore self-esteem and improve the quality of life. The skin is actually the largest organ of the body and vital to not only our physical health but also it’s health and beauty important to our emotional well-being. Scars have a natural process or progression towards a mature scar. This represents the completion of the healing process.

There are individuals who heal with very little scars and others who scar from the slightest of skin injury. Any injury to the the skin, that is a rupture to the integrity of its’ surface or that results in an opening or damage to the dermis, will heal with a scar.

Facial Scars effect self image.
Life changes that effect our hormones can effect the way our skin heals. Childhood to puberty, adulthood and finally to old age can represent significant changes in how our skin heals. Predicting how a person heals cannot be done with medical certainty. It is a persons observation of their own healing history and familial history that provides the best indicators.

However through observation of certain skin types that we understand their tendencies to produce abnormal scarring and formation:

  • Pigmented skin and Celtic skin have a higher risk of Hypertrophic and Keloid scarring
  • the chest and shoulders, eyelids, lips or labia heal with inconspicuous scarring

    • The goal of scar revision surgery is to make the scar to blend or making it inconspicous. Scars that result from injuries, burns or cancer excision can have a major psychological impact. This impact from the scarring can be profound adversely effecting self-esteem, self-confidence and social interaction. If you suffer from such issues a cosmetic surgeon can often help.

    Minimizing Scars in Hair Transplant Surgery

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    The modernization of hair restoration has made it an option for many men. The scarring from follicular unit transplantation which is a natural permanent solution to hair loss is a concern for many patients.
    Fortunately a number of techniques have been developed to minimize donor scarring when using a strip excision during this surgery, as well as, post surgical solutions that can be done even years later.
    Linear Follicular Unit Transplantation Scar
    Surgical Solutions

    Solutions that a surgeon can utilize during the procedure include:
    • the use of tumescent anesthesia
    • undermining
    • absorbable sutures
    • buried sutures
    • staples, and
    • trichophytic closures.

    These advances in minimizing scarring makes FUT one of the best hair transplant treatments for men.
    Scar minimization from the donor incision is an important component of a successful hair transplant procedure. A fine donor scar gives the patient more flexibility in hair styles post surgery. When the scar is fine the close cut military type hairstyles chosen by men and women can still be worn after hair restoration.

    Four aspects to having the donor incision heal in a fine line:

    1. placing the incision in the proper location
    2. using the correct donor strip dimensions
    3. removing the strip without damage to the tissue
    4. closing the donor area with impeccable surgical techniques

    Positioning the Donor Incision

    The ideal placement of the donor incision is in the mid-part of the permanent zone located in the back and sides of the scalp. This area lies in a band that starts above the occipital protuberance (the bump felt in the middle part of the back of the scalp) and extends to either side in a gentle, upward sloping curve that follows the contour of the scalp. If hair is harvested below this region, there is a greater risk of scarring from the wound stretching, since the incision will be too close to the muscles of the neck. If the incision is above this area, the hair may not be permanent and may fall out as the baldness progresses.

    Size of the Donor Strip

    The length of the donor incision is determined predominantly by the number of follicular unit grafts required for the hair restoration, the width (height) of the donor incision depends upon the patient’s scalp laxity. This is a genetic attribute of the patient’s scalp that must be carefully measured by the hair transplant surgeon during the initial evaluation. With good scalp laxity, a wider strip may be harvested from the donor area without the risk of scarring (although patients with very loose scalps may be at increased risk of a wide scar If the scalp is too tight, taking a normal size strip may be impossible.

    If the strip width is too narrow, the incision will need to be unnecessarily long to obtain an adequate amount of donor hair. If the strip width is too wide, the risk of having a widened scar will be increased significantly. Expert clinical judgment, acquired over years of experience, is needed for the surgeon to consistently set the appropriate length and width of the donor strip and achieve the minimum possible scar.

    Laser Technology in Scar Revision

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    Advent of Laser Technology in Scar Revision


    Who doesn’t have a scar? The natural healing mechanism following injury or surgery most often leaves some level of scar. Many individuals bear no adverse reaction to scarring. Of course the location of a scar and its severity can make all the difference to some people’s self image. While the scar appearance is usually quite acceptable, in many other instances the scar can raise, thicken, or become red. This type of scarring is called ‘hypertrophic scarring.’ Some individuals may even develop an extreme form of scarring called a ‘keloid.’

    Laser Scar Revision

    Laser technology Advances Scar RevisionIn recent years the use of lasers in medicine has enjoyed rapid development in medicine. Doctors and researchers are experimenting with the devices in a wide variety of procedures, like opening blocked coronary arteries and reshaping the cornea of the eye to correct poor vision, dissolving kidney stones and in scar revisioning.

    These advances in medical laser technology allows for easier revisioning treatment of scars. Applied in the right cases laser scar revisioning can have remarkable success and can bemore effective than ever.

    Lasers are used in two primary ways in scar revisioning:


    • to treat the surface color of the scar
    • to go deeper and break up the collagen bunches that cause the scar

    The result renders scars smoother, more evenly colored. The application of these new laser treatments appears limitless as doctors and researchers fine tune the levels of laser frequency for different medical applications. Lasers are effective on scars from accidents, dog bites, cesarean sections, orthopedic surgery, plastic surgery and skin grafts have proven quite successful and a large cross section of patients. It is important to note however because scarring is a highly individualized healing process that thorough medical consult is the best option. New laser therapies have ever proven effective on burn scars.

    Laser Scar Revision Results


    Scars cannot be completely removed from any treatment. Scar revision is meant to obscure the scar by making it blend better with your skin in colour and texture.; the more T the scar to blend s naturally with the surrounding skin The better the results. If the scar is uneven in texture, laser scar revision will help smooth out the scar so that the area is flatter. Additional treatments will continue to improve these effects.

    Pressure Treatment in Scar Healing

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    compression garment for torso When an imbalance occurs between the anabolic and catabolic phases of the healing process in a wound somtimes more collagen is produced than the is degradation of collagen in the healing process. This results in the scar growing in all directions. The scar is elevated above the skin and remains hyperemic. This is excessive scar tissue is medically classified either as a keloid or a hypertrophic scar.

    There are several nonsurgical options that are utilized to treat of these abnormal type scars. Pressure is a treatment that has demonstrated a level of success in some patients. The use of pressure to treat scars is thought to decrease tissue metabolism and increase collagen breakdown within the wound. Pressue is sometimes used preventatively in patients who have a history of keloid or hypertrophic scarring.

    There are various different methods for administering pressure to facilitate this type of treatment including:
    • elastic bandages (eg, Ace wraps) for the extremities
    • thromboembolic stockings for the feet
    • Isotoner-type gloves for the hands.
    • custom-fitted compression garments can be used for the more difficult areas ( lower neck and torso).

    ACE wraps or stockings are not useful for areas such as the head and face this is primarily because of discomfort and patient compliance Is not likely. Optimal results with latex-free compression garments are achieved usually in 6 -12 months during the maturation of the wound.