Treatment of scars in the post-traumatic period: aesthetic non-surgical options

Kristina Musikhina , ENT surgeon, plastic surgeon, specialist in contour plastic surgery, cosmetologist, postgraduate student of the Department of Otorhinolaryngology of the National Medical University. A.A. Bogomolets (Ukraine)

A meta-analysis conducted by scientists from the universities of Cardiff and Swansea (Wales, UK) showed that patients with scars are prone to developing anxiety and depressive disorders. And yet scars are not a death sentence

The cause of any scar is a violation of the integrity of the skin. This can occur as a result of surgery, thermal or chemical burns, bites, mechanical trauma, gunshot wounds, tattoo removal, that is, any aggressive physical impact on the skin. Scars can also remain after some infectious diseases (chicken pox), as well as acne (acne). Not only women are not immune from this, but also men, for whom scars after acne or chickenpox can cause no less inconvenience.

Any practicing doctor strives to ensure that wound healing leads to the formation of a so-called normotrophic scar. Such a scar does not differ in color from the surrounding tissues, does not protrude above its surface, and usually suits the patient cosmetically. But, alas, not all scars are like this, which is why there is a need for their correction.

Atrophic scars form something like “pits” on the skin. For example, atrophic scars are scars after acne or chickenpox, as well as so-called stretch marks that form on the skin (most often on the abdomen and thighs) after a sharp fluctuation in the patient’s weight. Hypertrophic scars pose an even more serious cosmetic problem: on the contrary, they protrude above the surface of the skin. These scars are “thick”, dense, and often bright red in color. But the most difficult problem can be keloid scars - shiny, dense, smooth, clearly defined, pinkish formations that rise above the surface of the skin. Unlike hypertrophic scars, keloid scars extend beyond the edges of the injured skin area and are prone to proliferation. Interestingly, scientists and doctors have still not come to a consensus as to why some patients are prone to this pathology and others are not.

I never promise patients miracles and I honestly warn that it is impossible to completely get rid of a scar. However, with proper and timely selection of therapy, you can reduce the scar by up to 85% and achieve such a result that it is practically not noticeable from the outside. But I want to emphasize an important nuance: correction of scars should be carried out by a specialist with a higher medical education - a dermatologist, surgeon, and not a graduate of a two-week course like “Become a cosmetologist from scratch.” “Treatment” from a non-professional will, at best, not produce results, and at worst, it will lead to complications, for example, a chemical burn or scar growth.

Unfortunately, most people do not know how important it is to start treatment and correction of scars on time and often think something like this: “I’ll wait two or three years and then I’ll cure the scar.” But this approach complicates the work of the attending physician, who will then have fewer effective treatment methods in his arsenal. It is most productive to correct a scar in the first year after its occurrence. We, surgeons, call such scars “fresh”, and they are more amenable to treatment.

Patients also suffer from the opposite myth: “It’s too late, so there’s no point in trying to fix the scar.” In fact, 5-year and even 20-year scars can be successfully treated. Yes, it will take more time and there may be fewer effective methods in the surgeon’s arsenal.

Modern surgical methods for scar correction are very effective, and the decision on the choice of treatment method is made by the surgeon depending on the type, depth, size and location of the scar. However, a competent specialist is able to select a therapy that will “work” in a particular situation and will help to significantly reduce the scar using non-surgical methods, thus improving the patient’s quality of life.

In this article we will focus on the treatment of scars using non-surgical methods.

Non-surgical options for scar treatment

Non-invasive methods

Creams and gels based on silicone. These drugs are the drugs of choice recommended in accordance with international standards for the treatment of scars. Silicone-based preparations are most effective in the first 3-4 months after injury. This is the period when the scar is just forming and cannot yet be corrected. Their later use will be useless, no matter what the commercials promise us.

Also, silicone-based preparations can be used as prophylaxis to combat pathological scars. The main properties of these products are the creation of a waterproof and gas-permeable film, which, in turn, protects and moisturizes the scar from chemical and bacterial exposure, allowing the scar to normalize collagen synthesis.

Invasive scar treatment methods

Contrary to popular belief, invasive scar treatment methods include not only surgical correction, but also laser dermabrasion, mechanical skin resurfacing, and injection methods for treating scars. All these methods are very effective if they are prescribed and performed by an experienced specialist with higher medical education who has practice and experience in treating this pathology.

The mesotherapy procedure involves the injection of specially selected drugs with a high concentration of bioactive substances into the middle layers of the skin in the area where the scar is located in order to improve its quality. Recommended drugs: unstabilized hyaluronic acid, plasma therapy (especially effective for fresh scars), polynucleotides, as well as multivitamin cocktails, etc. The drugs can be used as monotherapy, as well as in the form of cocktails.

The administration of steroids by injection reduces collagen synthesis not only by inhibiting the division of fibroblasts (cells that synthesize collagen), but also by increasing the concentration of collagenase (an enzyme that decomposes collagen). In addition, steroids have a strong anti-inflammatory effect.

Let's not forget about the classics: injections of drugs based on hyaluronidase are a universal means of influencing pathological foci. This enzyme has a huge number of advantages, such as antifibrotic, anti-inflammatory, angioprotective, antioxidant, and deoxification effects. Preparations with hyaluronidase are characterized by prolonged action, have a high safety profile, and are also approved and effective in the acute and chronic phases of inflammation.

No less effective from the list presented is the administration of botulinum toxin type A preparations. It inhibits the release of acetycholine at the neuromuscular junction, which leads to a decrease in muscle contraction.

First published: Les Nouvelles Esthétiques Ukraine 1 (125)/2021