Let's talk about Scar Revision, a solution to your annoying scars!

It is normal to experience minor injuries, accidents, and surgeries as we go through life. Scars are the memories we have left behind after all of these things have healed. Maybe it was a cut we made while playing as a child, or it could be a scar left after a C-section. Whatever the reason, these scars can sometimes cause us a little discomfort and embarrassment. You may have thought, "Oh, how much better it would be if we didn't have these." So today, let's talk about treatments that can reduce the appearance of these scars and make them look better. In medicine, we call this 'Scar Revision.'

Simply put, what is this scar reduction treatment (Scar Revision)?

When you hear the word 'Scar Revision', some people might think that it can completely erase a scar. But that's not the truth. No treatment can completely make a scar disappear. What it does is significantly reduce the appearance of the scar. That means making the color, texture, and thickness of the scar as similar as possible to the healthy skin around you.

Most of the time, this is done for cosmetic reasons. That is, to increase confidence in our appearance. But there are times when scars cause us pain or prevent us from moving that part of our body properly. Imagine that you have a hard, stretched scar on your elbow or knee. If it makes it difficult to extend or bend your arm, it is a medical problem that goes beyond a cosmetic issue. In such cases, this treatment becomes essential.

Are there different types of scars?

Yes, absolutely. Not all scars are the same. To choose the right treatment for you, it's important to know what type of scar you have.

In fact, when a wound heals, the protein in our skin called 'collagen' fills the gap. Sometimes, this collagen production increases a little more than necessary. That's when thick, raised scars form.

There are several main types of scars:

• Hypertrophic scars: These are scars that are confined to the area of ​​the wound, but are raised above the skin, thickened, and sometimes red.
• Keloid scars: These are the ones that are a bit more troublesome. These scars grow beyond the wound and spread to the surrounding healthy skin, forming a large lump. They can be itchy and painful. Some people are genetically predisposed to developing keloids. Many people in our country have experienced keloid formation after piercing their ears.
• Atrophic scars: These are scars that have sunken into the skin's surface and look like pits. Most of the scars left on the face after acne fall into this category.
• Contracture scars: These types of scars can develop, especially after burns. As these scars heal, the skin becomes tight and has a slight stretchy feel. This can limit movement in the area.

Your doctor will examine your scar, identify exactly what type it is, and recommend the best treatment.

Who usually needs this treatment?

Anyone who is uncomfortable or unhappy with a scar on their body can consider this treatment. Some common causes of scars are:

• Acne scars on the face and body
• Burns (from accidents or radiation therapy for cancer)
• Abdominal scars after cesarean section (C-section)
• Scars after any other surgery
• Injuries caused by accidents (cuts, scrapes)
• After ear or nose piercings (especially for those who develop keloids)
• After severe skin infections

How should I prepare before treatment?

How you prepare will vary depending on the type of treatment you're undergoing, but in general, your doctor will likely give you some advice like this:

• A nutritious diet: Good nutrition is essential for wound healing. Include foods rich in zinc, vitamins A, C, and E, such as vegetables, fruits, legumes, and nuts.
• Avoid smoking: If you are a smoker, you should definitely stop smoking a few weeks before your treatment. Smoking constricts blood vessels, which slows down wound healing, and increases the risk of infection.
• Stopping certain medications: If you are taking certain medications, such as anticoagulants, you should inform your doctor. Depending on your doctor's advice, you may need to stop taking these medications a few days before surgery or other treatment.
• Other medical conditions: Tell your doctor if you have diabetes or are taking immunosuppressants. Also, some scar treatments may not be suitable while you are taking medications such as isotretinoin, which is used for severe acne.

What are the treatments for scars?

Okay, now let's look at the main treatments for reducing the appearance of these scars. One thing to remember is that you can get better results by treating a scar after it has been a little longer (about 12-18 months) than by treating a new scar. By then, the scar has already 'matured'.

Treatment methods can be divided into four main categories.

Now let's look at each of these methods in a little more detail.

1. Topical Treatments

These are the simplest and least risky treatments. They do not involve needles or incisions. They are most effective for new, mild scars that are still healing or are still developing.

• Silicone gel/sheets:This is the most effective and most commonly recommended method in this category. These come in the form of transparent sheets or gels with a silicone gel layer. These are left on the scar for several hours a day for several months. This helps reduce redness and itching of the scar, prevents the formation of raised scars (keloids, hypertrophic scars), and helps flatten existing scars.
• Pressure therapy: Especially after burns, special garments are worn to apply constant, even pressure to the scar. This pressure helps to control the scar from rising.
• Vitamin E/A: Sometimes, some people advise using vitamin E or A oils and creams. However, there is still no clear scientific conclusion on how effective these are for scars.

2. Injections (Injectables)

In this method, special medications are injected directly into the scar. These are especially effective for raised, thickened scars (keloids, hypertrophic scars). Typically, these injections are given several times a week for best results.

• Corticosteroid injections: This is the most common treatment for scars like keloid scars. This steroid injection works by reducing the production of collagen, which is the main cause of scar formation, and controlling the swelling in the scar. This reduces the size, thickness, redness, and itching of the scar.
• 5-FU or bleomycin injections: These are actually drugs given for cancer. Because they stop cell growth, they are also used to stop the growth of abnormal tissue in scars.
• Dermal fillers: This is different from the others. This is used for deep, pit-like scars. This is very effective for acne scars. What is done here is to inject a special filler into the sunken area and raise it to the level of the surrounding skin. However, the results of this are temporary. You have to repeat it after a few months or a year.

3. Skin Resurfacing

The primary goal of these treatments is to remove the top layer of old, damaged cells from the scarred skin and reveal the healthy, smooth skin underneath.

• Laser therapy (Light or laser therapy): This is a very popular method now. Here, the doctor uses a special device to direct a high-energy laser beam to the scar. These rays gently vaporize and remove the top layer of skin. They also stimulate the production of new collagen, which goes deep into the skin. As a result, the new skin underneath becomes smoother and brighter. It can also correct discoloration of the scar.
• Chemical peel:Here, a special chemical solution (usually an acid) is used to remove the top layer of skin in a controlled manner. This is suitable for superficial, mild scars, especially those on the face.
• Dermabrasion: This is a gentle exfoliation of the skin. A special device, such as a rapidly rotating brush, removes the top layers of skin. This can treat both sunken scars and raised scars.
• Microneedling: Using a roller or device with very fine needles, thousands of tiny, invisible punctures are created in the skin. This stimulates the skin to repair itself and produce new collagen. This gradually improves the appearance of scars.

4. Surgery

Sometimes, especially for contracture scars that are large, painful, or interfere with movement, surgery is the best solution.

Here, a plastic surgeon completely cuts out and removes the old scar, then closes the wound with very fine stitches, leaving only a scar that is as invisible as possible, like a thin line.

• Z-Plasty and W-Plasty: These are special surgical procedures. Imagine a hard, stretchy scar that looks like a straight line. In Z-plasty, small incisions are made in the middle of the scar in the shape of the letter 'Z', and the skin is moved back and forth and sewn back together. This removes the tension in the straight line, allowing the skin to stretch and bend better in the area of ​​the scar. This also reduces the appearance of the scar.
• Skin grafts: Sometimes, especially in large burns, there may not be enough skin left to cover the scar after it has been removed. In this case, a thin layer of skin is taken from another part of the body (for example, the thigh) and grafted into that area.

After surgery, your doctor may recommend injections or topical creams to minimize new scarring.

What are the risks of these treatments?

As with all medical treatments, there are some risks involved. However, these risks can be minimized if done properly, under the supervision of a qualified physician.

• Skin rash: The risk of this is low. Some people may experience minor itching, redness, or allergic reactions (contact dermatitis).
• Injections and skin resurfacing treatments: Redness, swelling, blistering, and increased sensitivity to sunlight may occur at the treatment site. Sometimes, the treated area may change color (become darker or lighter than the surrounding skin).
• Surgery: The usual risks of surgery, such as infection and bleeding, are present here. Also, there is a small chance that a new scar may develop that is worse than the old one.

What to expect after treatment?

This is a very important issue. Patience is essential here.

• It can take months to see results from topical skin care products.
• To get good results from treatments like injections and lasers, you need to have multiple sessions.
• After surgery, it can take several weeks to several months for the new scar to fully heal and take on its final appearance.

What time should I see the doctor?

If you develop any of the following symptoms in or around your scar after undergoing any treatment, notify your doctor immediately:

• If there is bleeding
• If you get blisters
• If there are signs of infection (i.e. pus, excessive redness, swelling, or warmth to the touch)
• If it is unusually or severely swollen

Before deciding on this treatment, meet with an experienced dermatologist or plastic surgeon to examine your scar and discuss your options, their pros and cons, and costs.