If there is trauma, there will be scarring. There are some areas that can form keloid scars without trauma, for example, insect bites on the chest can form keloid scars.
Scarring is the inevitable product of healing trauma. After birth, scar formation occurs when trauma, surgery, infection and other injury factors act deep below the dermal reticular layer of the skin. Moderate scar formation has a positive effect on the repair of trauma, which is called physiological scar, but the process of scar formation is often influenced by internal and external factors, and abnormal changes occur, such as “hyperplastic scar”, “contracture scar”, and “keloid scar”. “The treatment of keloid scars has always been a hot issue in plastic surgery research.
At present, there is no effective way to achieve “scarless” treatment (i.e. no so-called “scar removal”), but a comprehensive series of treatments can be used to turn large scars into small ones, and obvious scars into inconspicuous ones! This series of preventive and curative measures are used throughout the process of scar formation, growth and maturation. It specifically includes two categories: surgical and non-surgical.
I. Surgery
During the period of injury, it is extremely important to use the relevant techniques of plastic surgery to repair the trauma and precisely align the tissues as early as possible to prevent pathological scar formation. Even physiological scars can often achieve the greatest degree of “concealment” effect. When hyperplastic or contracture scars or even keloids have formed, large scars can be surgically transformed into small scars, and obvious scars into inconspicuous scars! These surgical techniques include: excision of keloid scars, scar reshaping, various techniques of flaps and implants to repair wounds and cosmetic suturing techniques, etc.
II. Non-surgical techniques
(i) Compression therapy
It is a more effective way to prevent and treat scarring, and is widely used in clinical practice. Early and continuous use of elastic compression therapy can reduce scar formation, promote scar maturation, and even alleviate pain and itch and other symptoms. Compression therapy is generally required to last for six months to two years, and the longer the daily compression time, the better.
(ii) Silicone gel treatment
Current research has found that the principle of silicone gel preparations inhibiting scar growth may be related to its hydration effect and a series of biological activities of silicone gel. At present, silicone gel products available for clinical use mainly include silicone gel film, coating and other types, with silicone gel coating being the most commonly used. Daily use time is 8 hours or more, the longer the better. Continuous use for 3-6 months. It can significantly reduce the symptoms of redness, bumpiness, contracture and itching of the scar, and also reduce the pigmentation of the scar.
(iii) Drug treatment
Intra-scar injection of corticosteroids after scar formation is the most widely used method to prevent pathological scarring. For keloid scars in the chest and upper arm deltoid area that are not suitable for surgery, intra-scar injection of hormones has become the preferred method, and other injectable drugs include calcium channel blockers, 5-FU, interferon, etc.
(iv) Laser treatment
Laser therapy is mainly used to inhibit the vascular proliferation of keloid scars and to remodel the skin, especially the latter, which is increasingly used to improve the unevenness and pigmentation of the skin caused by keloid scars. With the introduction of the fractional laser, laser treatment in this area has gradually replaced some surgical treatments as the first choice. For example, in the treatment of acne depressions, the fractional/pixel laser’s minimally invasive feature of “cutting the peaks and filling the valleys” is incomparable to surgery. In the treatment of post-trauma and post-implantation hyperpigmentation, fractional laser is particularly advantageous.
(V) Others
1.Radiation therapy
It is mainly used in the treatment of keloid. Early irradiation after surgical excision of keloid has certain effect, but there is a possibility of inducing malignant tumor, and it is generally only applicable to the treatment of small area keloid.
2.Physical treatment
Microdermabrasion, direct current ion introduction therapy, audio electric therapy, paraffin therapy, ultrasonic therapy, etc. can be used to flatten and soften the scar and loosen the adhesions with certain effect. UV therapy can be used to treat hyperplastic scars. Cryotherapy combined with intra-scar injection of corticosteroids for pathological scars has the advantages of convenient operation, no bleeding and low recurrence rate, but the incidence of hypopigmentation is higher than other methods.
In summary, the ideal scar treatment should be throughout the process of trauma repair, scar formation, and scar maturation. The treatment of scar is diversified, and the combination of several treatment methods at different times according to the specific situation can often achieve a more ideal effect of 1+1>2.
Although scar cannot be completely eliminated, it can make large scar become small scar, and make obvious scar become inconspicuous scar!