Author Archives: Michael James

What Can Be Done About Scarring?

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ScarScarring is the result of tissue fibers replacing normal skin after a trauma. Scarring can result from surgery, burns, open wounds, or any other abrasion of the skin. Scars are caused when the deep thick layer of skin, also known as the dermis, is damaged. Once trauma occurs, the body forms a collagen fiber which aids in the healing process of the wound and causes a scar. Because the tissue is a different consistency and quality the scar becomes visible.

Some scars can be easily hidden, while other will always be visible. Even though scars can never be removed completely, there are procedures offered that will improve the appearance of the scar. Laser resurfacing can be used to remove the surface layers of the skin, resulting in a less visible scar. If a person has a larger scar, surgery is an available option to reduce the size of the scar. Scalp Micro Pigmentation is a new method being offered which uses dermal pigments to camouflage the scars on hair bearing areas of the scalp or face.

If a scar leaves an indentation in the skin, you can use filler injections to raise the scar to the level of the surrounding skin. This type of treatment will be temporary, meaning it should be done a few times a year. If you have a keloid scar, scars that are raised, steroid injections can help flatten the scar giving it an enhanced appearance.

To reduce heavy scarring, topical creams and ointments can be used directly after trauma. Certain scars will fade away after a year and will not need any special method of treatment. For all other cases, it is best to see a specialist who can further assist you.

Scalp Micro Pigmentation

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The new innovative non-surgical procedure, Scalp Micro Pigmentation also known as SMP is becoming a very popular procedure. SMP is done using dermal pigments. The Doctor finds a compatible pigment to the patient’s hair and introduces it into the scalp, through the use of the SMP machine. The insertions of the pigments are very superficial, which will reduce the level of pain and discomfort the patient may feel.

The many benefits of this procedure are:

SMP Before and After Procedure

Left: Before Procedure, Right: After Procedure

-No recovery time
-More cost efficient than a surgical procedure
-Most cases local anesthesia is not needed
-Eliminates appearance of baldness without hair

The only disadvantage that this procedure has is its non-permanence. The procedure will require touch ups in the future, but will vary among different individuals.

Scalp Micro Pigmentation can be used to cover a full head that is bald or it can be used to cover a small area. SMP is also used to minimize and camouflage the visibility of scars on the scalp. SMP gives the impression of a shaved head appearance. This procedure is also great for women who do not have enough donor hair and would like to have this procedure done with having a hair transplant to fully cover their hair loss.

This new innovative procedure has helped many patients overcome the stress that they live through daily that is associated with their baldness. As with any other procedure, choosing an experienced Doctor is vital to achieve desired results.

New Science Helps in Healing Victims of War

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Traumatic Injures of War

A young child in Mosul, Iraq is playing in a war torn neighborhood. Chasing a ball made of newspaper in tape she inadvertently steps on an IED. Outside Kabul a coalition humanitarian worker and a soldier a bring aid to an Afghan family. There vehicle hits a landmine they are severely burned and scarred from burns and loss of muscle. New technology promise hope for such victims.

University of Pittsburgh doctors have helped a soldier injured in Afghanistan regrow muscle to restore his strength and range of motion in his severely injured leg. McGowan Institute for Regenerative Medicine, at the University of Pittsburgh is headed by Stephen Badylak, doctors there are pioneering cutting edged treatments for recovery of traumatic battlefield wounds. These injuries include burns and blast injuries. These amazing treatments include wound healing, craniofacial reconstruction, and limb regeneration.

Wounded Soldier Facial Reconstruction

“Wounded Soldier Facial Reconstruction -Midway through surgical series.”

A new therapy developed at the institute is called the “skin gun.” It is actually a spraying device used to spray wounded areas with skin cells over burns on the ears and face. Skin can regrow over the affected burn areas in just a matter of days. The Bioreactor Group is under the direction of Professor Joerg Gerlach, they are the developers of this exciting restorative treatment.

There are three innovative treatment programs headed by the McGowan medical team. Extensive research on biominerlization (scaffolding) and bioceramic nanoparticles in non-viral DNA gene delivery. Professor Charles Sefeir leads the studies focused on the role of extracellular matrix in tissue engineering and biominerliazation.

One of the most critical areas of the centers work is the reconstruction of soldiers’ faces with the most normal looking appearance as possible for the patients. A cross functional team led by Professor J. Peter Rubin coordinate their complimentary expertise to bring about positive results with the advancement medical treatments of the McGowan Institute.

A Scars Story

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Scar Truths and Tales

Scars, who doesn’t have one? A little annoying insect bite gets scratched obsessively becomes infected and though not deep it scars. The athletic endeavors of youth, life threatening accidents, surgery or to the catastrophic injuries of war can all leave our bodies scared. Scars can be the source of pride for some an icebreaker to tell an embellished tale at a family event or hob-knobbing with friends.

Scars can just be minor footnotes to our lives or major source of emotional and psychological angst. One on my right palm once stretched the full width; now, it is barely noticeable unless pointed out. It marks a dramatic bloody incident of falling in a 2nd grade foot race at recess. Then there is the one near my right eye a story that I don’t often want to recount. The visible one on my right shoulder blade always invites comment in a shirtless pickup game of basketball. Scars can be mileage markers on the amazing journey of our life. Sometimes, those scars bare even more tragic consequences to some people. They can infringe upon their well-being and devastate their quality of life.

View Amazing Scar Revision Surgery on Young Girl

The more I reflect my hands begin to braille my body through my clothing and my mind shuffles through vignettes of memories of burns and bruises, scrapes and scabs; bumps and lumps. Limbs and torso marked by stitches and scratches, gashes and slashes; all with the requisite blood; some of these scars bleeding more profusely causing parental angst and a flood of tears.
My active childhood, athletics and sporting lifestyle have given my dermis a lifetime of stories and embellished tales to share. Not a one would I remove. They are my story for better and worse.

By now you’re asking the purpose of this tale. My many scars have left to date only memories to be romanced and morphed into heroic tales. This is not true for many people. Scarring can deeply mar the psyche of a person and impact their life at every level.

Scar revision provides an opportunity to effect positive change on such people’s self image and esteem. The effect of scarring can be compounded by the onset of depression; a too often debilitating life-cycle if untreated.

It can be a vitally important step in their journey to inner and outer healing to treat the scar through the wonderful advancements in scar revision treatment. If you or a family member or friend struggle with issues regarding scars; consult with a dermatologist and or cosmetic surgeon. Scar revision in the 21st century has come a long way in providing wonderful results for many.

Preventing Scars

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Preventing Scars

Whether it’s a child bumping his head on the edge of a table or an adult slipping with a kitchen knife while cutting up vegetables, accidents happen no matter how careful you are being. Injuries and scars often- abound. After a cut it is impossible to not have a scar, but there are things you can do to lessen the severity of any lasting marks. Some scars are called sexy at times but for the most part people don’t like scarring.

Scar Prevention: Do’s and Don’ts

To help heal the skin with as little residual scarring as possible, there are steps you may take, and mistakes to avoid. “The key to lessening scarring is to decrease the amount of work the body has to do to heal the scar,” Krant says. Here’s how:

  • Stitches can be used if needed. Often times when you have a cut that is spread apart or deep its always better to have them stitched by a medical professional. Always keep in mind that when the wound or injury is fresh, stitches must be sewn as soon as possible. If you let too much time pass by since the injury, the wound can become contaminated with bacteria, germs, and the doctor will not want to stitch it closed because of the risk of infection. But the wound may start to heal, which can obstruct successful suturing. When having doubts if whether stitches are in order, contact a doctor in a timely manner and let him decide the best treatment for the wound.
  • Applying petroleum jelly to the wound and covering it with a non-stick bandage, and alsokeeping the wound moist, can speed up the healing and minimize scarring, says Krant.
  • Scar Creams and Ointments – There will always be advertisement for scar creams, don’t fall for them. You may have herd that vitamin E can help with reducing the scarring, but this actually has been proven in high-quality studies (a double-blind, placebo-controlled trail). As a matter of fact, there is no over-the-counter product claiming to prevent scars that has been scientifically shown to significantly improve scarring.
  • Massage the wound – Krant claims, that by massaging the scar daily with vitamin E may help promote a less visible scar.
  • Avoid the sun – By keeping the scar away from sunlight it can help minimize discoloration.
  • Let it heal naturally – When using hydrogen peroxide constantly on a wound it would cause irritation and slow down the healing process. Krant says “Scabs are nature’s biologic dressing, Picking off a scab repeatedly when a wound is trying to heal will slow healing and increase scarring.” So it would be best to not pick on scabs.
  • Healing takes time, perhaps a long time. So be patient. The first stage of healing takes three months, followed by the second stage that lasts another three months. One year after the injury the injury has already been formed, but the scar still may change in the following year. “The truth is, that scars never stop changing and improving unless they are keloid scars, which continually worsen unless treated by a physician,” says Krant.

Types of Surgical Scar Revision

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Description of Types of Surgical Scar Revision


Listed below are the most common surgical techniques utilized in scar revision.
Z-plasty Before & After

Z-plasty is a reconstructive surgery procedure. Its utilization is for improving the functional and aesthetics of scars.  Functionally refers to the lengthening of the scar the lengthening of a scar which helps relax or release linear burn scar contractures. The availability of mobile adjacent skin is a predicator for the use of this medical procedure. Z-plasty can procedurally make the scar less noticeable. Re-alignment of the central element can place the scar in natural skin tension lines and thereby disguise it. Utilizing this procedure the surgeon can rotate the tension line of a scar and or make a contracted scar elongated. In Z-plasty the midline of the Z-shaped incision is made along the meridian of highest tension or contracture. Triangular flaps are raised on the opposite ends of this incision. The flaps are than transposed and closed.

W-plasty is another reconstructive plastic surgery technique used for the excision of unaesthetic scarring. The excised edges of the scar are cut in a zig-zag pattern is like a connected row W’s. The borders are interdigitated for suturing. This method is very effective in rendering a linear scar irregular and less visible.

W-plasty Diagram

W-plasty revisions the scar into a ‘pinking shear pattern; which will interlock when sutured. Optically, it is more difficult for the eye to follow an irregular line. This makes W-plasty a favored method for revisioning linear scars. Often there is no discreet skinfold to hide a scar. Think of areas such as the forehead, the side of the face or cheek. Still is the irregular pattern is uniform visibility is not obscured. For that reason W-plasty is most often combined with

Geometric Broken Line Closure (GBLC).

W-plasties are not usually employed on their own throughout the entire scar. Visibility of the scar can be better reduced by combining other patterns with the W pattern. This is a more sophisticated procedural technique of scar revision is known as geometric broken line closure (GBLC).  W-plasty is the basic technique and then other shapes besides triangular flaps are utilized for interdigitation creating a very irregular irregularity. This procedure offers the optimal potential for camouflaging the scar. Added to this is also dermabrasion which is done approximately two to three months after the surgery.

M-plasty

The object of electing M-plasty in reconstructive surgery is to better preserve healthy tissue and to reduce the chance of secondary tissue deformity.  Proper technique in M-plasty reduces the loss of surrounding health tissue by nearly fifty percent.  The M-plasty is performed by creating two separate thirty degree angles instead of a single one.

 
 

Adjunctive Techniques of Scar Revision

 

Dermabrasion

  • precisely and in a controlled deliberate manner superficial abrading of the scar and surrounding skin. The end result is a smooth texture and in some cases further reduced visibility.
  • Abrasion can be used in a process that will improve the appearance of uneven scar edges including: scar edges, grafts and or flaps.
  • Dermabrasion works best on lighter complexions because of the lower risk of dyspigmentation.

Intralesional Steroids

  • Hypertrophic linear scars, bulky grafts and flaps, can be treated with intralesional corticosteroids. Injections can be instituted at approximately 1 month postoperatively.
  • A small amount (as little as 0.1 mL) of low-dose triamcinolone acetonide  at 5 to 10 mg/mL is injected into the scar; this dosage can be repeated monthly until the scar has flattened.
  • Side effects include atrophy (if the injection leaks out into healthy skin ),  hypopigmentation and telangiectasias when injected in higher concentrations into the dermis.

Contraindications

The reasons for a patient not to undergo scar revision include:

  1. The present psychological status of the patient does not prepare the patient for a positive outcome.
  2. The patient’s expectations are unrealistic limiting the opportunity for a favorable visible outcome.
  3. An individual’s history for hypertrophic and or keloid scarring represent a poor risk for a pleasing aesthetic result.
  4. Patient’s with thickened skin from the trauma reducing compliancy endure the risk of a compromised scar revision.

Understanding Scar Revision

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Purpose of Scar Revision


Psychological and physical considerations

Many patients who present themselves for reconstructive surgery suffer from PTSD (post traumatic stress disorder.) In order to provide the best solution for the patient a cosmetic doctor will address the psychological trauma with a therapeutic adjunctive consult. In such cases it is paramount that therapist have exceptional experience in PTSD for the patient negotiating serious psychological trauma. Though elected the scar revision surgery can exacerbate the patient’s fears.

Scar revision in most instances requires a waiting period. This time allows for patients not suffering from PTSD to psychologically adjust to the prospect of one or more additional surgeries to bring about reasonable consideration of their proposed surgical treatment plan.

Realistic perspective is critical in scar revision and reconstructive surgery. Healing time is quite often lengthy; the patient’s understanding of this is important to their well being. Many cases present the need for adjunctive medical treatments such as dermabrasion, steroid injections or laser resurfacing.

Preparation for Scar Revision

Timing of scar revision

The location of injury and type of scar combined with an individual’s psychological readiness are all critical to the timing of scar revision. Following the initial injury a six to twelve month wait is not unusual. Surgical intervention can only take place after a thorough consult an assessment. This assessment will most often define the following five major factors:

  1.  the characteristics and nature of the initial injury
  2. the relationships to anatomic location and relaxed skin tension lines (RSTLs)
  3. likelihood of pathologic healing (such as  hypertrophic scar , keloid )
  4. any regional functional impairment by deformity ( such as  oral or ocular impairment)
  5. surgeons should also recognize that conservative nonsurgical methods may be applicable as a primary treatment method

 
These are just some of the general factors in scar revision. This is a complex and highly individualized medical treatment. Availing oneself for scar revision takes expert medical consult. It is best to research the best cosmetic surgeons in this area and interview with several.

Scar Revisions New Horizons with Lasers

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Laser Instrumentation for DermatogistsScars are immensely varied and come in all shapes and sizes. Surgery remains the best option for more severe scars, other scars can be treated with the advance development of lasers for dermatological use. Treatment of scars with laser has steadily grown, giving both patients and physicians more flexibility to determine the best method of treatment.

Two Main Goals of Treatment
Scars appear different, depending on the injury sustained. According to some experts the color be it, white, red, or brown, can be an indicator of the type of texture the scar will show.
• Make the scar smooth without the is not depressed or elevated
• Blend the color around and within the scar so that it blends with the outlying pigment

Ablative Technology

For larger and more severe scars, such as burns and contractions associated with scars, ablative technology is a better option. Ablative technology is a process of placing tiny holes in the skin with lasers that allow tissue to bend more easily, thus potentially increasing the range of motion in severe scars. This technology continues to improve through the enabling deeper penetration of the lasers.
With lasers now offering the ability to go deeper into the skin scar treatment will continue its dramatic changes.

Some dermatologists and researchers theorize that deeper treatments will allow for more range of motion in scars that restrict movement; this may open up whole new possibilities for scar treatments. Lasers in the future will allow for even deeper penetration of the dermal layers.

Given the nature of scars, there will likely never be a definitive treatment for all scars, no matter how much the technology advances. Still the current levels of laser therapy provide wonderful new treatments to diminish scarring; with greater promise on the future.

Innovative Treatment for Scalp Scar Revision

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Follicular Unit Extraction (FUE)

Innovative Treatment for Scalp Scar RevisionFUE for Scar Revision

Follicular units (FUs) are the individual removal of the tiny organs that produce our hair shafts. Hair loss is a growing elective surgery but very beneficial for people who are suffering from low self image and quality of life issues from hair loss.

Like all surgeries hair transplants leave a scar. Dr. Parsa Mohebi, medical director of US Hair Restoration center is pioneering method of combining two procedures to render these scars virtually undetectable in many cases. The combination of FUE and SMP are small procedures that can be used in the revisioning of a hair transplant scar.

Donor Hair Scar Revised

The surgeon can extract a small number of grafts from the permanent zone and artistically and strategically place them in the scar. This process of using FUE uses hair to obscure and blend the margins of the scar to the surrounding scalp. Scalp Micro-pigmentation (SMP) can be used to further blend the scar in many cases.

Scalp Micro-Pigmentation

SMP for Scar Revision

Scalp Micro-Pigmentation is the process of using special pigments and fine needles to create the shade of stubble or shaved hairs on the scalp. SMP utilizes dermal pigments that match the patient’s hair color. Used in scars like FUE it can artistically applied revises the margins of the scars. This revision results in the obscuring or blending of the scars margins to the surrounding scalp.

FUE and SMP

FUE and SMP are a very non invasive way of revisioning a hair transplant scar. Patients can consult a hair transplant surgeon for recommendations on achieving the best results. These modern advances in scalp scar revision are performed in Los Angeles leading hair transplant centers like US Hair Restoration.

Abdominal Scars

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Abdominal Surgical Revision

Abdominal scar tissue is forms through the healing of the connective fibers surrounding incision sites or traumatic wound. These are the natural fibers the body creates to heal tears in the skin. Abdominal scar removal is a way to repair or replace damaged skin. The severity of the wound surgical or traumatic helps determine the realistic level of success of any abdominal scar removal technique or revision.

Surgical Revision

Surgical scar revision is often used to reduce the abdominal scar. Surgical revisions work by moving the scar toward a natural crease in the skin. Scarring is ofthen cause by too much tension on the wound. In an abdominal surgical scar revision a less prominent scar will result because of he conrol of the woud tension which is lessend by the surgeons expertise.

View an actual abdominal scar revision with dermabrasion.

Punch Graft Scar Revision

A punch graft is a surgical technique designed to minimize the appearance of a scar. By removing an area of tissue from another area (normally less visible area of the body) and replacing it where the scar was located. If the abdominal scar is severe, a punch graft may be used and the skin is placed over the abdomen and stitched in place. Again, the tension in the stitching or closure of the surgical wound lends to a more aesthetic or less obvious scar. In addition after full healing of the punch graft dermabrasion or laser resurfacing can be utilized to diminish the appearance of scars.