#AskID : Prof Ryan about treatments for scarring

We ask Prof Ryan about the best treatments to improve the appearance of traumatic scars.

Time is the best healer – this is completely true when it comes to traumatic or surgical scars. The remodelling phase of wound healing during which time a thick, red, raised scar becomes a thin, flat, white scar can take 1-2 years. Complete scar removal is not possible, but most scars will gradually fade and become barely noticeable over time.

Topical silicone gel and topical retinoids have been shown to improve the appearance of scars when used in the early phases of scar formation.

At the Institute of Dermatologists we provide many options for the treatment of traumatic or surgical scars and the scars caused by deliberate self-harm (DSH). Often we combine different modalities for optimal results. Typically, we use a combination of Fractionated Laser, Microneedling, Intense Pulsed Light (IPL), Platelet Rich Plasma (PRP) therapy, steroid injections and occasionally dermal fillers to improve the appearance of scars.

Fractionated lasers use microscopic beams of light to penetrate into the deeper layers of the skin, breaking down scarred skin and stimulating the body's own natural healing processes to produce new, healthier skin. The laser targets a pixelated fraction of the treatment area during each treatment session, leaving the remaining microscopically untreated skin to help rapidly heal the treated areas. At the Institute we use the ResurFX from Lumenis, which is the only true fractional non-ablative laser, targeting damaged skin with microscopic laser columns that penetrate deep into the skin, stimulating new collagen and elastin formation, resulting in a smoother skin surface as the skin heals. Optimal results are typically achieved after 4-6 sessions at 4-6 week intervals but you will continue to see improvements in the scar for up to six months following the treatment. ResurFX can also be combined with our M22 IPL treatment as dual Photofractional Rejuvenation to improve the redness of the scar.

Microneedling is also very effective at treating traumtatic and surgical scars, working to stimulate the production of new collagen in the skin.
This is achieved by controlled micro-injuries to the dermis with microscopic needles that stimulate your body’s natural wound healing process, while minimising cellular damage. The result is effective collagen production and remodelling of scar tissue, while keeping the overall structure of the skin intact. At the Institute, we use SkinPen by Bellus Medical, which is the World's First FDA-Approved Microneedling Device.
PRP, or platelet-rich plasma, has been in use for years to help wounds heal faster by encouraging the growth of new tissue. PRP helps to promote collagen production and kick-starts the skin’s regenerative capabilities. Growth factors in the plasma increase collagen and elastin production, stem cell proliferation and vascular formation. This products a plumping and tightening effect on the treated area.
Sometimes lumpy “hypertrophic” or “keloid” scars are produced when too much collagen is produced at the site of a wound. In the case of keloid scars, the scar keeps growing even after the wound has healed and can be itchy or painful. Steroid injections into the scar can help to flatten and improve the appearance of hypertrophic and keloid scars.
Scar revision surgery can be a great option in some patients who have a poor cosmetic outcome or restrictive scarring after their initial surgery.