The Toronto Dermatology Centre is one of the best places in Canada to manage your scars. Our staff of outstanding dermatologists and estheticians can offer both a comprehensive assessment and diagnosis of your skin, and also discuss all the treatment options including: prescription creams, over the counter treatments, physician-grade skin products exclusive to our clinic, laser resurfacing with the Profractional laser, subcision, chemical peels, microdermabrasion, laser and light devices, cortisone injections and education on coverup/makeup and natural and alternative treatment options.
Scars result when the skin repairs wounds caused by trauma, diseases, or surgery. They are a natural part of the healing process. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar.
Typically, a scar may appear red and thick at first, and then gradually fade. Many actively healing scars that seem unsightly at three months may heal nicely if given more time since scars take a full year to mature.
The way a scar forms is affected by an individual’s age and the location on the body or face. Younger skin makes strong repairs and tends to over-heal resulting in larger, thicker scars. Skin over a jawbone is tighter than skin on the cheek and will make a scar easier to see. If a scar is indented or raised, irregular shadows will be seen, giving the skin an uneven appearance.
Keloids and hypertrophic scars are special types of scars that result in an overgrowth of tissue at the site of a healed skin injury. They are typically firm, rubbery, and shiny.
What Can And Cannot Be Done For Scars?
Several techniques can remove scars. Most of these are done routinely in the dermatologist’s office. Surgical scar revision can improve the way scars look by changing the size, depth, or color. However, no scar can ever be completely erased, and no technique will return the scar to its normal uninjured appearance. Surgical scar removal typically results in a less obvious mark. Because each scar is different, each will require a different approach.
Scar Treatment
Topical creams are useful for hyperpigmentation. These include vitamin A/tretinoin creams (by prescription), and also alpha hydroxy acids such as glycolic acid.
Cortisone (steroid) injections are effective in softening very firm scars (or keloids) causing them to shrink and flatten. This scar treatment is popular for hypertrophic scars and keloids. Less commonly, intralesional bleomycin may be used.
Cryosurgery involves freezing of the upper skin layers that causes blistering of the skin to remove the excess tissue of the scar.
Silicone-containing gels and sheets (e.g. Strataderm, Stratamed or Stratamark) have shown modest benefit in reducing scar thickness and pain. They must also be used regularly and results are variable.
Cosmetics applied correctly can be very good at covering up scars. Physicians encourage patients to wear make-up after scar treatments. Make-up will improve the appearance while nature completes the healing process. Oxygenetix, a leader in foundation and post-procedure makeup, Cover FX, Covermark and Dermablend are particularly good at covering up scars.
Surgical Scar Revision – Based on the ability of the skin to stretch with time, surgical scar revision is a method of removing a scar and rejoining the normal skin in a less obvious fashion. The surgical removal of scars is best suited for wide or long scars, those in prominent places, or scars that have healed in a particular pattern or shape. Wide scars can often be cut out and closed, resulting in a thinner scar, and long scars can be made shorter.
Laser Resurfacing and Pulsed Dye Laser – Another method of improving surgical, acne, chicken pox, and other scars is laser scar revision. High-energy light is used to remove or remodel unwanted, damaged skin. Patients can usually return to work or regular activity within one week, but skin may stay pink for several weeks or months, particularly after skin resurfacing with a carbon dioxide laser. Several different lasers are available depending on the skin defect requiring improvement. A pulsed dye laser, for example removes scar redness and flattens raised scars (hypertrophic scars or keloids). This laser can also improve itching and burning sensations in the scar. Acne scars or other indented (atrophic) scars can be improved with laser skin resurfacing. The newest lasers for acne scar resurfacing are the fractionated lasers (eg. ProFractional, Fraxel) which are showing very promising results.
Soft Tissue Fillers (eg. hyaluronic acid) – Various injectable substances are available to elevate indented soft scars. The amount of material injected will vary with the size and firmness of the scar. Improvement is immediate but is not permanent and treatments often need to be repeated.
