Scars come in all shapes and sizes, some are physical, others are emotional, some we are proud of, some carry history, and others we’d rather just be without.
I have one on my knee, one I got when I hurried home for dinner as a 7 year old (I’ve always been a little food- lover). I slipped, and cut my knee, and although I wasn’t very happy at the time, the scar left from it always puts a smile on my face as I remember the sunshine of that day, the stones in our drive-way, and how I was 100% sure I had cut myself to the bone and needed surgery (a food- lover and a drama-queen).
Other scars that have left their mark on me, like the colored small depressions on my jaw line and upper lip from my acne era, brings no smile to my face what so ever, but rather serves the sole purposed to aggravate me in my moments of self- scrutiny. However most have gone now, due to my many times mentioned retinol regime, but as I can’t help squeezing the new pimples that appear, there’s always one or two there to complain about.
There are 3 phases of cutaneous wound healing, also known as scarring:
1) The inflammatory phase of wound healing aims to contain the injury and prevent infection.
2) The proliferative phase is characterized by granulation tissue—composed of macrophages, fibroblasts, and epithelial tissue.
3) The remodeling phase is the lengthy process of extracellar matrix reorganization around the site of injury.
The abnormal architecture of collagen that results following the remodeling phase is the cause of the visible cutaneous scar. Within the abnormal collagenous network, there is a notable absence of hair follicles, sebaceous (oil) glands, and sweat glands. The extent to which this abnormal dermal appereance arises depends on the depth of injury; deeper cutaneous injuries give rise to more scar tissue.
There are many types of scars, and I’ll choose to focus on the ones caused by acne today.
Acne scars are most commonly- Atrophic scars:
They are flat and depressed below the surrounding skin. They are generally small and often round with an indented or inverted centre and commonly arise after acne or chickenpox.
There are certain things one could do to prevent the size and appearance of a scar, but the fact is, as a scar is the natural outcome of wound healing, there’s not a great deal prevention really can do to stop it. That goes for the treatment modalities as well, there are things to do that work, but always only to a certain degree. It’s important to keep expectations low, and bear in mind that results vary from person to person.
Acne scars can be approached with a number of non-invasive and invasive techniques.
1) Retinol topical treatment. Best used for mild to moderate acne scarring. Retinols increase the capacity of the epidermis to hold water through stimulation of glycosaminoglycan (GAG- a large water binding molecule in the skin) synthesis, plumping out depressions. It stimulates collagen synthesis through increases in transforming growth factor (TGF-beta) and procollagen. Resulting in both a reduction of fine lines and wrinkles, as well as a diminished appearance of scars. Burn scars have also responded somewhat positively to retinol treatment – link
Visit my post on Retinol-here.
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2) Microdermabrasion. Also best for mild to moderate scarring. By mechanichally removing the top-most layer of the skin, repetitive treatments will result in collagen production, increased water retention, increased skin-cell turnover, and a perky face with a diminished appearance of scars. With regular use shallow scars may even disappear completely. Visit my review article of the microdermabrasion technique-here.
3) Chemical peels. Superficial peels are the mildest type of chemical peel and can be used on all skin types. Superficial peels, best for superficial scars, usually use liquid containing a mild (dilute) acid, most often glycolic acid. Dry ice (solid carbon dioxide) is sometimes used. Medium peels penetrate the skin more deeply than superficial peels and cause a second-degree burn of the skin. Trichloroacetic acid (TCA) is the main peeling agent used for medium peels, though the peel may also be done in several steps using a different chemical solution followed by TCA. Deep peels penetrate several layers of skin and cause a second-degree burn of the skin. They are used only on the face. A chemical called phenol is usually used for a deep peel. Deep peels may not be used on darker skin types because they tend to bleach the skin (hypopigmentation). Even in lighter-skinned people, phenol peels-or any type of deep resurfacing-may bleach the skin. A deep peel can be done only once in most cases.
4) Needling (Collagen Induction Therapy): Skin needling is a procedure performed by either a qualified skin therapist or a doctor using a roller system with small acupuncture like needles puncturing the epidermis (surface) and dermis (second layer). The skin responds by creating collagen and elastin, firming up and smoothing over depressed acne scars. It also makes the creams you put on after reach the lower layers of your skin more effectively, and so let them work to their full potential.
Buy your own Derma/Skin Roller – For Wrinkles, Scars & Acne
5) Fillers. With this acne scar treatment, a doctor will inject collagen, PMMA (polymethylmethacrylate – the only permanent filler), your own fat, or another agent underneath and into the acne scars to give them a flat, even appearance. Fillers are fast and easy; they allow you to go back to everyday activities immediately. However, most fillers are temporary and require treatment every few months (collagen) up to a few years (your own fat).
6) Lasers: Perhaps the most effective treatment modality to scarring, judging by the research available. It involves destroying the top, outer layer of skin (epidermis) and heating up the inner layer (dermis). This will foster new skin growth and diminish the appearance of acne scars. Recently a comparison was made between the two types of lasers used, the YAG-laser and the fractional CO2 lasers, and the CO2 laser was found to be superior in treating atrophic acne scars. The fractional laser has also proved effective in treatment of burn related scars.
Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics.
Journal of the American Academy of Dermatology
Volume 66, Issue 1 , Pages 1-10, January 2012
Skin scarring- A Bayat, specialist registrar in plastic and reconstructive surgery,a D A McGrouther, professor of plastic, reconstructive and hand surgery,a and M W J Ferguson, professorb
Copyright © 2003, BMJ Publishing Group Ltd PMCID: PMC1125033 BMJ. 2003 January 11; 326(7380): 88–92.
Comparison of Q-Switched 1064-nm Nd: YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar*
Asilian, Ali; Salimi, Elias; Faghihi, Gita; Dehghani, Farideh; Tajmirriahi, Nabet; et al. Journal of Research in Medical Sciences16. 9 (Sep 2011): 1189-1195.
Clinics (Sao Paulo). 2011 November; 66(11): 1949–1954.