Despite the advent of isotretinoin more than 20 years ago, many patients still present with acne scarring. Because of recent technologic advances and the development of creative techniques by today's cosmetic surgeons, there has never been more hope or options for these patients. This article is designed to inform primary care clinicians about the advances that have been made in the treatment of acne scarring, so that they can better advice patients and provide appropriate referrals. It will begin by reviewing the types of acne scarring patients may have and highlighting important considerations, such as the patient's skin type.
The article will then summarize the different procedures that can be offered to patients: dermabrasion; microdermabrasion; laser resurfacing; chemical peeling; subcision; soft tissue augmentation; suture-assisted resurfacing; and punch elevation, punch excision, and punch grafting. These techniques require advanced dermatologic surgical skill and full knowledge of their risks and benefits, of which types of acne scars respond best to which modality, and of how different skin types may respond.
Acne is the most common cause of facial scar in the world.1 Patients with acne scars are often frustrated by their attempts to mask their appearance. Makeup may collect around the rim of widened "saucerlike" indentations and actually make the scars more noticeable. The technique of scar correction will be dictated by the type(s) of scarring present and the patient profile.
The number of scars is also important. For example, a few atrophic scars may be treated with a local injectable filler substance, whereas a large area of scarring may require a more invasive resurfacing procedure. Additional considerations include the patient's budget, expectations, and Fitzpatrick skin type. Patients with Fitzpatrick skin types IV, V, and VI (typically, Asians, Hispanics, and blacks, respectively) may not be good candidates for certain resurfacing procedures, given the risk of postinflammatory hyperpigmentation.
It cannot be overstated that the patient and clinician must have realistic expectations when considering scar correction techniques. Because of acne scarring, a patient may have been suffering for many years and may often feel tormented, self-conscious, or depressed, or may even be more seriously disturbed. These powerful emotions can result in low self-esteem and unrealistic hopes for the procedure. Any corrective procedure helps acne scarring, but it does not give the patient perfectly smooth skin.
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Sabtu, 13 Februari 2010
Jumat, 12 Februari 2010
Expecting after surgery
Collagen Injections The result is immediate. Pitted scars look smooth and even. However, these results are not permanent. Periodic treatments are necessary to maintain results. Dermabrasion After the procedure, the treated area may be covered with an ointment, a wet or waxy covering, and/or a dry covering. The skin may feel as though it is severely sunburned. Moving facial muscles and eating may be uncomfortable. Oral pain medication may be taken to ease the discomfort. In some cases, antibiotics may be taken in order to prevent possible infections. The skin is usually swollen for around 24 to 48 hours after the procedure. During this time, a scab begins to form over the treated area.
Vascular Laser The treated area may show purple discoloration, which should fade in 5 to 10 days. Generally after this period the scar should be less red and raised. Laser Skin Resurfacing You may experience some swelling and discomfort. Cold packs are usually recommended to reduce the swelling. If a bandage was applied after the surgery, it will be removed after approximately one week, and an ointment will then be applied. Some surgeons use a moisture retaining tape to bandage the treated area. Because this bandage must remain dry, you will not be able to shower until the bandages are removed.
If the treated area is not bandaged, you will need to wash the area several times every day. After each washing, you will need to apply an ointment, such as petroleum jelly, to the treated area. You will need to use caution in caring for the treated area. Scabs may form and last for about 10 days. If you are experiencing discomfort, an over-the-counter oral pain medication can be taken. Punch Grafting – The new skin is taped into place for about seven days to permit healing.
Skin Grafts and Flap Surgeries You can expect to feel some discomfort after facial scar revision surgery. Some swelling, bruising and redness are generally unavoidable. Any sutures will be removed within days after the surgery but your skin needs more time to heal. In general, surgeons suggest limiting activities -- especially any activity that places undue stress on the area of the incision. Silicone Gel Sheets After 2 to 12 months scars should look flatter and smoother. The procedure may have to be repeated after several years since keloid scars have the tendency to return.
Steroid Applications and Injections You may experience mild soreness, as with any injection. The scar should reduce in redness and thickness. The procedure may have to be repeated after several years since keloid scars have the tendency to return. Tissue Expansion Expect some fairly mild swelling and possible bruising. Stitches are normally removed within a week of the procedure. Z-plasty and Related Techniques The treated area will be closed with fine stitches, which will be removed within a week of the procedure. As with most incisions, the area may swell or bruise slightly.
Vascular Laser The treated area may show purple discoloration, which should fade in 5 to 10 days. Generally after this period the scar should be less red and raised. Laser Skin Resurfacing You may experience some swelling and discomfort. Cold packs are usually recommended to reduce the swelling. If a bandage was applied after the surgery, it will be removed after approximately one week, and an ointment will then be applied. Some surgeons use a moisture retaining tape to bandage the treated area. Because this bandage must remain dry, you will not be able to shower until the bandages are removed.
If the treated area is not bandaged, you will need to wash the area several times every day. After each washing, you will need to apply an ointment, such as petroleum jelly, to the treated area. You will need to use caution in caring for the treated area. Scabs may form and last for about 10 days. If you are experiencing discomfort, an over-the-counter oral pain medication can be taken. Punch Grafting – The new skin is taped into place for about seven days to permit healing.
Skin Grafts and Flap Surgeries You can expect to feel some discomfort after facial scar revision surgery. Some swelling, bruising and redness are generally unavoidable. Any sutures will be removed within days after the surgery but your skin needs more time to heal. In general, surgeons suggest limiting activities -- especially any activity that places undue stress on the area of the incision. Silicone Gel Sheets After 2 to 12 months scars should look flatter and smoother. The procedure may have to be repeated after several years since keloid scars have the tendency to return.
Steroid Applications and Injections You may experience mild soreness, as with any injection. The scar should reduce in redness and thickness. The procedure may have to be repeated after several years since keloid scars have the tendency to return. Tissue Expansion Expect some fairly mild swelling and possible bruising. Stitches are normally removed within a week of the procedure. Z-plasty and Related Techniques The treated area will be closed with fine stitches, which will be removed within a week of the procedure. As with most incisions, the area may swell or bruise slightly.
Scar revision performed
Collagen Injections are used to raise, or fill in, sunken scars. Collagen is a natural animal protein, usually produced from purified cow skin. Before using collagen, you should take an allergy test to ensure that you are not allergic to the substance. The results of collagen injections are immediate but not permanent. The scars will eventually have to be re-filled as the body slowly absorbs the collagen.
Dermabrasion smoothes out surface irregularities such as deep lines or scars by removing the topmost layers of the skin. The afflicted area will be sprayed with a numbing chemical spray and then carefully “sanded” with a rotating wire brush or a diamond wheel until the desired amount of skin is removed. Vascular Laser Vascular laser works by shrinking the blood vessels that feed the scar. This treatment is done without anesthetic. During the process, the sensation is much like that of a rubber band snapping on the skin.
Laser Skin Resurfacing There are two types of lasers used for reducing the uneven surface of scars: the CO2 Laser and the Erbium:Yag Laser. The CO2 laser is typically used for deeper scars, while the Erbium is used for superficial scars and deeper skin tones. Both lasers remove the topmost layers of skin, allowing new, smooth skin to form. There are some color lasers that can be effectively treat the abnormal red pigmentation of hypertrophic and keloid scars as well. Punch Grafting Deeper scars can be filled in with skin grafted from other places on the body. A tiny instrument is used to punch a hole in the skin, removing the scar. Then a piece of normal skin, usually taken from the back of the earlobe, is put in the scar’s place. The “plugs” are taped in place until they heal. The grafts do form scars of their own but they are less visible then the pitted scars they replace. This procedure is often done in conjunction with dermabrasion or laser skin resurfacing.
Silicone Gel Sheets Silicone gel sheets can help flatten hypertrophic and keloid scars. These clear sheets are placed on the scar and wrapped firmly with tape. Skin Grafts In this procedure, doctors take skin from a healthy part of the body and transplant it to the injured area. Grafts aren’t always cosmetically pleasing because the grafted skin may not match the surrounding skin’s color or texture. The area where the graft came from will also scar -- but skin grafts can greatly restore function to a severely scarred area. Steroid Applications and Injections Steroids can help flatten and reduce the redness of hypertrophic and keloid scars. Steroids are applied or injected into the scar to break down the skin’s collagen. This is especially effective on hypertrophic and keloid scars, both of which continue to form collagen after the wound has healed. These injections can also help reduce the itching and/or pain associated with these scars.
Tissue Expansion In this procedure, a small balloon is inserted under a patch of healthy skin near a scar. The balloon is filled with a saline solution to stretch the skin. When the skin has been adequately stretched, which can take several weeks or months, the balloon is removed. The scar is then surgically removed, and the balloon-stretched skin is pulled over the previously scarred area and carefully closed. Z-Plasty and Related Tissue-Rearrangement Techniques Z-Plasty is a technique used on hypertrophic and keloid scars that do not respond to steroid treatments. The scar is surgically removed by cutting the skin around the scar in small triangular flaps. These flaps usually follow a Z-shape (hence the name), but the technique your doctor chooses will depend on the shape of the scar. The flaps are repositioned to follow natural lines and creases of the skin. The new scar is thinner and less noticeable. Z-plasty can also help relieve the pressure of contracture scars.
Dermabrasion smoothes out surface irregularities such as deep lines or scars by removing the topmost layers of the skin. The afflicted area will be sprayed with a numbing chemical spray and then carefully “sanded” with a rotating wire brush or a diamond wheel until the desired amount of skin is removed. Vascular Laser Vascular laser works by shrinking the blood vessels that feed the scar. This treatment is done without anesthetic. During the process, the sensation is much like that of a rubber band snapping on the skin.
Laser Skin Resurfacing There are two types of lasers used for reducing the uneven surface of scars: the CO2 Laser and the Erbium:Yag Laser. The CO2 laser is typically used for deeper scars, while the Erbium is used for superficial scars and deeper skin tones. Both lasers remove the topmost layers of skin, allowing new, smooth skin to form. There are some color lasers that can be effectively treat the abnormal red pigmentation of hypertrophic and keloid scars as well. Punch Grafting Deeper scars can be filled in with skin grafted from other places on the body. A tiny instrument is used to punch a hole in the skin, removing the scar. Then a piece of normal skin, usually taken from the back of the earlobe, is put in the scar’s place. The “plugs” are taped in place until they heal. The grafts do form scars of their own but they are less visible then the pitted scars they replace. This procedure is often done in conjunction with dermabrasion or laser skin resurfacing.
Silicone Gel Sheets Silicone gel sheets can help flatten hypertrophic and keloid scars. These clear sheets are placed on the scar and wrapped firmly with tape. Skin Grafts In this procedure, doctors take skin from a healthy part of the body and transplant it to the injured area. Grafts aren’t always cosmetically pleasing because the grafted skin may not match the surrounding skin’s color or texture. The area where the graft came from will also scar -- but skin grafts can greatly restore function to a severely scarred area. Steroid Applications and Injections Steroids can help flatten and reduce the redness of hypertrophic and keloid scars. Steroids are applied or injected into the scar to break down the skin’s collagen. This is especially effective on hypertrophic and keloid scars, both of which continue to form collagen after the wound has healed. These injections can also help reduce the itching and/or pain associated with these scars.
Tissue Expansion In this procedure, a small balloon is inserted under a patch of healthy skin near a scar. The balloon is filled with a saline solution to stretch the skin. When the skin has been adequately stretched, which can take several weeks or months, the balloon is removed. The scar is then surgically removed, and the balloon-stretched skin is pulled over the previously scarred area and carefully closed. Z-Plasty and Related Tissue-Rearrangement Techniques Z-Plasty is a technique used on hypertrophic and keloid scars that do not respond to steroid treatments. The scar is surgically removed by cutting the skin around the scar in small triangular flaps. These flaps usually follow a Z-shape (hence the name), but the technique your doctor chooses will depend on the shape of the scar. The flaps are repositioned to follow natural lines and creases of the skin. The new scar is thinner and less noticeable. Z-plasty can also help relieve the pressure of contracture scars.
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