Following trauma, fibrous tissue replaces normal skin, forming scars. This is a natural aspect of the body’s healing process of wounds. Scars develop as a result of traumatic accidents, disease or surgery, leaving an aesthetically unpleasant abnormality.
Scars are composed of the same collagen which supported the damaged skin, however, the composition of scar tissue differs from that of normal tissue. The amount of collagen formed during the healing process determines the appearance of the scar.
As one of the leading clinics in the promotion of collagen-stimulating products, such as Sculptra, the London Medical and Aesthetic Clinic offers advanced treatment of deep acne scars and traumatic scars. Dr Ayham Al-Ayoubi advocates the use and development of Sculptra treatments and his techniques have since been adopted by many plastic surgeons worldwide.
Many patients receive treatment at our leading aesthetic clinic for Scars. Common causes of scaring include trauma, inflammatory acne, viral infections and can also due to surgical procedures. Scaring is a biologically natural process as the body’s skin attempts to repair itself.
Most wounds, aside from very small lesions, usually result in the formation of fibrous tissue which replaces the normal skin.
Facial scarring can be divided into two main classifications: atrophic and hypertrophic. Atrophic scars can be subdivided into the following categories:
Ice pick scars Usually ice pick scars are small in size (1-2 mm) with a large aperture of steep edges that taper to a point at the base. The nature of this type of scar gives them their name, as they appear as though they have been pierced. Epithelial tracts form along the sides of the opening within the scar. Ice pick scars may be deep or shallow, extending to the dermal-subcutaneous junction.
Boxcar scars are round to oval in shape with vertical edges which are prominent but with a flat base. In terms of size, typically Boxcar scars range from 0.1 to 0.5 mm in depth and appear as singular scars.
Shallow/atrophic scars This type of scars appear as a mass of boxcar scars. Typically, they appear as a group of four or more and often appear on the face i.e. usually on the cheeks.
Valley scars are deep scars which appear most apparent in indirect light. Valley-shaped scars form as a result of damage to the skin’s dermis and/or subcutaneous tissue. Examples include acne and varicella scars, which affect the dermis of the skin and thus require more invasive treatment to the deepest layers of the skin
Sculptra – Collagen Stimulation
Sculptra consists of Poly-L-lactic acid, a component of the alpha hydroxyl acid family. Sculptra includes crystalline, which consists of microparticles which range from 40 – 60 um in diameter. The Sculptra product consists of a freeze-dried, sterile preparation that can be reconstituted with sterile water 48 hours before injection. Once injected, a foreign-body reaction occurs over a period of months, which results in expansion of facial volume. This process takes place several weeks after injection. It is therefore recommended to wait 4-6 weeks, once results have become apparent, before considering further injection.
Subcutaneous incision can be performed through Sculptra treatment to treat very deep scars. Once outlined, the affected area is anaesthetised with local anaesthetic, before a 22-gauge needle or a tribeveled 18-gauge hypodermic needle can be inserted into the superficial fat. The technique of subcision involves the needle being turned so that the bevel is perpendicular. The needle is then moved back and forth, releasing bonds between fibrous tissue that causes the depressing of the scar. Audible popping whilst conducting the procedure can be expected, as the subcutaneous attachment is broken. Whilst this process is undertaken, Sculptra is injected to restore the facial volume and promote the production of collagen. Due to the nature of this treatment, patients can expect to have bruising for up to 7 days.
Soft tissue abnormalities have been successfully corrected with fillers for decades. It is imperative to consider several factors when selecting the type of filler used to treat individual patients. Such factors include the location and depth of scar, expected duration of the filler and risk of granuloma or infection post-treatment.
The most frequently used fillers include:
Hyaluronic Acid – is found naturally throughout the body within connective tissues, synovial tissue and bodily fluids. It consists of residues of D-glucuronic acid and N-acetyl-D-glycosamine, which alternate, and are able to bind up to 10,000 times its molecular weight in water. Hyaluronic acid is commonly marketed as Dermal Fillers, Juvederm, Teosyal,Dermal Fillers SubQ.
Poly-Caprolactone – Ellansé is an example of a Poly-caprolactone-based product (PCl). Ellanse is entirely bioresorbable, meaning that treatment is safe and effective. Results are both immediate and long-lasting (from between 2-3 years) through its biostimulation of neo-collagenases. We pride ourselves to be the very first leading clinic to introduce the revolutionary Ellanse dermal fillers.
Calcium Hydroxylapatite -Radiesse is a synthetic filler, consisting of Calcium hydroxylapatite (CaHA). Results last from between 12 – 18 months before additional injections are required. Radiesse has been approved by the FDA to correct severe facial folds, such as nasolabial folds. Radiesse can also be used as treatment of HIV lipoatrophy. Superficial scars and acne scars may also be treated.
Collagen Stimulation Therapy – Dermarollers can be used to aid the improvement of the appearance of facial wrinkles and lines, damage caused by UV and ageing skin, acne scars and stretch marks. The treatment includes micro-medical skin-needling, which stimulates regeneration and repair of skin. It is both a natural and safe method of promoting skin reconstruction. Patients can expect skin to appear healthier, more youthful and brighter. By increasing the quantities and access of cells to nutrients, skin repair can be increased, which optimises cell function. Stimulation of keratinocytes also promotes growth factor (EGF) and thus speed in cell turnover becomes increased.
CO2 Laser Resurfacing
CO2 skin re-surfacing laser is used predominantly to treat boxcar and shallow atrophic scars. The SmartSkin CO2 micro beams are able to treat micro treatment zone through causing sufficient laser injury to promote the production of collagen. This method is an effective way to treat areas of the body which have a rough texture such as the face, neck, chest, arms and hands. It is also possible to treat acne and surgical scars. Patients can expect virtually no downtime.
There are several different types of peels which can help with scarring and are offered at the clinic. These include the following:
Medium or Deep Chemical Peel
Acid concentration, peel depth, the number of coats applied or “passes,” skin thickness, skin preconditioning, the surface of the body being treated, and the length of contact of the acid on the skin is considered when treating individual patients.
Superficial impact may be maximized through the use of Keratolytics on deep scars. Chemical peels which involve a medium-depth of treatment work by destroying the stratum corneum and epidermis. The procedure involves penetration into the papillary dermis which causes protein denaturation and inflammation of tissue. As a result, collagen regeneration occurs, which improves the appearance of scars and results in skin tightening.
We frequently use medium-depth chemical peels at the clinic, which include TCA, and variations of TCA peels such as the Obagi Blue Peel (Obagi Medical Products), TCA, or TCA combined with glycolic acid.
It is possible that a combination of therapies may be required to treat certain scars. Facial scars, for example, may have numerous different morphological and thus different treatments should be used to target the affected areas. Individual patients and scars respond differently to treatment, thus it is important to appreciate that improvement in scar appearance will vary amongst individuals. It is recommended to reassess treatment results after 3 to 6 months to assess whether addition treatment is required.
At the London Medical and Aesthetic treatment we recommend a general guideline when combining treatments for facial scarring:
- Chemical Peels and Laser Resurfacing
- Laser Resurfacing and Dermabrasion
- Sculptra with Subcision and Laser Resurfacing
- Laser Resurfacing / Dermabrasion / Sculptra with Subcision /Fillers/ChemicalPeel
Treatment plans are formed through thorough patient assessment and analysis of scar morphology. A pre- and post treatment skin-conditioning regime is recommended for all patients in order to optimize results.