Ethnicity and Scarring

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

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.

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.

New Cosmetic Procedures for Scar Revision

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.

Minimizing Scars in Hair Transplant Surgery

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

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

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.

Understanding Burn Scars

Man's severe burn scar revised

Quality of Life and Scarring
Scars are an inevitable part of most peoples’ lives. There is nearly a person on earth who does not have some type of scarring. Severe scarring though affects individual’s quality of life and often decreases their self image. Self image is so much a part of person’s happiness and success that medical science has gone a long way to reduce the adverse effects of scarring no matter how the scar occurred.

Uniqueness of Burn Scars
Burn scars are often very traumatic, disfiguring and they are the hardest to treat through revision. When a person has significant scarring from burns there is often associated trauma that takes priority prior to addressing the issue of scarring. Life saving measures, infections and other complications take persistent over issues that will arise from burn scars.

Pain management is very vital because the pain from burn is one of the most excruciating types of pain one can bear. Where healthy skin and burned skin intersect pain can be a life time issue. Psychological issues such as severe depression are a compounding factor for people disfigured from burns. Scar tissue does not maintain the suppleness or laxity of healthy skin. As scars mature the fibrotic tissue composing it shrink and becomes more rigid. The location of such scars near joints of the hands, feet, limbs and neck can adversely affect the mobility of the joints.

Another issue with burn scarring is the need for skin grafting and the associated healing and scarring with those procedures. In addition burn scars because of the severity often are comprised of a combination of types of scars. This includes:

• Hypertrophic scarring
• Hypotrophic scarring
• Hyper-pigmentation scarring
• Keloid scarring

The Treatment
Traumatic burn scars necessarily are to be treated in absolute sterile clinical conditions, usually in specialty “burn centers”. Pain management is one of the important reasons as well as reducing the risk of infection to a minimum. Topical numbing creams do not penetrate burn scar tissue sufficiently and medical needling must be done under general anesthetic in most cases. Treatment for burns is a long process that can easily reach up to one year and intervals of specialized care are scheduled through a close monitoring process. It is during these interval medical treatments that the patient and doctor can discuss the possibility or revisioning scars.

Scar Revision Primer

The skin is the largest organ of the body covering it in its’ entirety. Serving as the body’s protective barrier it also makes the skin the most vulnerable part of the body. There is probably no human on earth whose skin does not have a mark or scarring from some incident of disorder. The process of healing from injury or surgery leaves scarring on the skin. This can be from the tiniest of insect bites or blemish to a life saving surgery.
Breast Scars Revision

The amount of scarring may be determined by the size, depth, and location of the wound; the age of the person; heredity; and skin characteristics including color (pigmentation). No scar can be removed completely. The degree of improvement will depend on variables such as the direction and size of the scar, the age of the person, skin type and color, and hereditary factors that may precondition the extent of the healing process.

Scars can be a lasting a giveaway of cosmetic surgery. Thus, one of the concerns for many patients when they consider elective surgery is the possibility of scarring. Scar revision can help to mitigate the appearance of a scar through several options. A doctor can offer a topical to help a scar to fade and, in some cases, minimally invasive procedures or even perform revision surgery to help obscure a scar.

While there is no procedure that allows for complete removal of a scar, there are several types of procedures that improve the appearance of your scar. Scar revision surgery treatment methods include injections, skin grafting, Z-plasty, laser and lightening techniques that can drastically diminish the appearance of your scar.

There are several things to consider before undergoing a procedure to help improve the appearance of a scar. If the scar is a problem, you don’t smoke and you are otherwise healthy, scar revision may be an option. Also, a doctor can help you determine if you have any acne or other problems that may impact an attempt to improve the scar. Patients need to have realistic expectations. While scar revision can help minimize the aesthetics of the scar, it usually cannot remove the scar completely.

An Overview of Burn Scars

Burn Reconstruction

Burns caused by heat, chemicals and fires can result in the most traumatic types of scaring. The severity of burns is classified as first, second and third degree burn. This designation is based on the dept of damage to the outer and deeper layers of the epidermis (skin) and dermis (inner skin) tissue.

Burns can leave patients with severe physical disfigurements.
The emotional trauma can often exceed the physical trauma as self image is an integral part of an individual’s self esteem. Scar revision surgery for all types of scars is often elected to positively affect the patient’s emotional well being.

Burn treatments usually involve skin grafting and cosmetic reconstruction, and may be performed in an emergency facility or later on. These treatments also focus on restoring function to the burned skin to reduce the risk of complications such as loss of mobility or a loss of one of the senses.
Acute Burn Care

Any type of burn on the skin requires immediate medical attention to stabilize the patient, clean the wound and reduce the risk of complications such as infection, scarring, breathing problems and limited bone and joint mobility. Initial burn care focuses on assessing and treating the initial burn symptoms, prevents infections and other potential further risks. Additional treatment may be required at a later time for skin reconstruction. It is also important for patients to remain hydrated after a burn, so fluids may be administered intravenously to prevent dehydration.

Comprehensive burn care that includes an evaluation of:
• the burn and any related conditions
• thorough wound care
• proper dressing
• pain mitigation through medications
• emergency surgery as may be required.
Burn Scars

Most burns will usually leave a scar,The appearance of the scar depends on the size, location and severity of the burn. Scars usually become less noticeable over time, however when they scar is obvious patients seek reconstructive treatment to improve their appearance of scars that are physically unattractive or disfiguring. Reconstructive procedures are most often performed after the burn has fully healed, which may be nine months to a year after the original injury.

Scar reconstruction is usually performed through an outpatient surgical procedure that may involve skin and tissue grafts, skin flaps or injectable fillers to restore a more natural appearance, while also correcting any functional problems caused by the scar and improving the patient’s self-confidence as well.


A contracture is a complication of burn scarring that involves a tightening and thickening of the burn scar that in turn restricts movement of the affected area. It is important for patients to take precautions to prevent contractures from occurring, by exercising, wearing a splint and continuing to promote everyday activities that require movement.

Treatment for contracture scars often involves surgery to release the contracture and restore normal movement to the skin. A skin flap or graft may be used to restore the appearance of the skin in the treated area, while also improving movement and flexibility that may have been affected by the contracture. Physical therapy will often be needed after surgery to stretch the joints and restore movement and function.

Scar Revision Insurance Coverage

The unpredictability of scars is a part of the human experience. Many scars are unobtrusive and we often forget about them. It is not uncommon especially among machismo male culture to embellish the history of a scar as a rite of passage. Unfortunately for many people a scar can be a debilitating phenomenon emotionally and physically. It is for these reasons that some insurance programs will cover scar revision for patients.

The formation of a scar depends as much upon the way your body heals. Likewise your individual healing process combined with the surgeon’s skill affects the success of a scar revision surgery outcome.

The factors that affect scarring are:
• the size and severity of the wound,
• its shape and direction
• the original color and thickness of your skin
• the blood supply to the injured area.

The merits as to the need for plastic surgery are a highly personal decision, and are different for each person.

Types of Scars
• Stretch Mark Removal
• Keloid scars
• Hypertrophic scars
• Contractures

Common Scar Revision Surgeries
• Z-plasty
• Flap surgery
• Skin grafting

Medical Insurance May Cover Cost of Scar Revision

Scar revision cost may include:
• Surgeon’s fee
• Hospital or surgical facility costs
• Anesthesia fees
• Prescriptions for medication
• Post-surgery garments
• Medical tests

Though many health insurance plans will not cover scar revision surgery for cosmetics alone. If the surgery if for complications related to the injury and the scar can be revised through the procedure it can be covered. Some policies also include coverage for scarring that is limiting body functionality. You must carefully review your health insurance policy.

It is impossible to remove a scar completely. However, plastic surgery can often do much to lessen the severity of a scar, making it less noticeable by applying or injecting steroids or through scar revision, a commonly used surgical procedure. Many people assume that as elective surgery it has to be an out of pocket expense. This is not necessarily true. Check with your medical insurance provider to see if this is the case; don’t assume. Many people improve their self image and quality of life through scar revision surgery.