ACNE , MOLES & OTHER SCARS

A) Acne Scars

Teenage acne is a very common reason for many adults having unsightly acne scars, even after taking best treatment for active acne. Acne affects up to 80% of people in their teens and twenties, and up to 5% of older adults.
Acne scars occur because of abnormal & excessive collagen production during healing. We offer a whole range of special acne and acne scar treatments to smooth away those tell-tale signs.
Though acne scarring can be very hard to treat, but the appearance of acne scars can be improved with cosmetic treatments. Mild acne scarring can be improved with some topical creams, lotions & Dermarollers, but most acne scars need treatment with a combination of surgical procedures and skin resurfacing.

1) Early Acne Scars

After healing of an acne lesion , sometimes it leaves a red or hyperpigmented scar mark on the skin. The best way to prevent post-inflammatory changes caused by acne is to prevent acne lesions from occurring. This is done by understanding the factors that cause acne and using the appropriate treatments for the different acne types.

Non surgical Treatment of Early Acne Scars

The post-inflammatory changes caused by acne are part of the skin’s natural healing process. There are certain skin care techniques and medications that can help this healing process.

Unprotected exposure to the sun causes more skin damage and delays healing, therefore wearing a good sunscreen with SPF 30-50 is helpful.
Use of tretinoin under guidance speeds up the skin’s remodeling process and helps to reduce post-inflammatory changes.
Picking at scabs should be avoided at all ,otherwise it interferes with the healing and remodeling process, prolonging the time that post-inflammatory changes will be visible.
Antioxidants help to treat post-inflammatory changes & even mild permanent scars.

Skin Peels:
Skin peels are ideal for the treatment of superficial acne scarring. Peels works by removing the outer layers of skin.
Appropriate formulations of Alpha-Hydroxy Acids (AHAs) and Beta-Hydroxy Acid (BHA) that contain the correct concentrations and are at the appropriate pH also help the skin’s remodeling process.

Permanent Acne Scars:
Those acne scars which remains even after one year of its appearance are termed as permanent acne scars. Most of such scars need surgical treatment. True acne scarring is a permanent depression, elevation, or pigmented area on the skin. Acne scarring follows cystic acne (hard, tender, deep lesions) or sometimes very inflamed pustular acne (plugged pores with pus in them). The texture of a true scar is usually firmer than the surrounding skin.
There are also different types of acne scars. The treatment recommended would vary according to the type of scar and the amount of scarring. The most common treatments for acne scarring are simple excision, subcision; punch grafting, laser treatments, dermabrasion, and hyaluronic fillers like Restylane and Juvederm.

Surgical Treatment of Permanent Acne Scars

Ice pick scars – are narrow, sharp scars that make the skin appear as if , it has been punctured with an ice pick. They are usually narrower than 2 mm and extend into the deep dermis or subcutaneous layer. Ice pick scars are usually too deep to correct with skin resurfacing treatments such as dermabrasion or laser resurfacing.

Acne Scars – Box Scars

Box scars are round to oval depressions that have sharp vertical edges. Shallow box scars are 0.1-0.5 mm in depth and can usually be treated with conventional skin resurfacing techniques.

Acne Scars – Rolling

Rolling scars occur as a result of tethering of otherwise normal-appearing skin to the subcutaneous tissue below. This process gives the skin a rolling or undulating appearance. They are corrected by breaking up the subcutaneous fibrous bands by subcision.

Dermabrasion

Dermabrasion surgery is one of the most effective surgical treatment for severe acne scarring.
Indication of Dermabrasion are Pitted & Multiple acne scars.
Dermabrasion can be done on the whole face or on a desired facial unit. It is usually done using a local anesthetic or under general anesthesia. A diamond burr is used to remove the layers of scarred skin in a very controlled manner in order to remove the acne scars.
It is done in one or more stages depending on the depth.It does not require stitches. Also no bed rest is needed.
Initially there is dressing and pads on the face for a week. New skin grows from underneath in a weeks time, which is pinkish initially. The skin gradually becomes darker to reach the normal skin color in usually one to two months.
Special matching makeup can be done to match the skin during early days so that you can join your work in a week or 10 days
Precautions – sun protection for next 6 months, in form of sunscreens, scarfs, goggles and umbrella etc. Best results are seen within 6 months to 1 year. The skin become more even with natural look.

Dermal Fillers

Dermal fillers can be injected into acne scars to raise the surface of the skin and give a smoother look. Examples of dermal fillers are Autologous fat, bovine collagen, human collagen, hyaluronic acid derivatives, etc.
Restylane and Juvederm injections are quite useful for shallow, broad-based acne scars & not fordeep scars with a narrow opening. The effect is temporary. It has to be repeatedapproximately every four to six months depending on that individual and area offace being injected.

Punch Excision

This method of surgically correcting acne scars is used on deep scars such as ice pick and deep box scars. This procedure uses a punch biopsy tool of 1.5 mm to 3.5 mm diameter which is basically a round, sharp “cookie-cutter” tool. Under local anesthesia the scar is excised with the punch tool and the skin edges are sutured together. The newly produced scar eventually fades and may not be noticeable. If it is noticeable, it can be treated with
resurfacing techniques.

Punch Excision with Skin Graft Replacement

With this method the scar is excised with the punch tool as above. Instead of suturing the skin edges together, the defect is filled with a punch skin graft usually taken from behind the ear. With this procedure a color and texture difference may be noticeable, but a skin resurfacing technique can be used 4-6 weeks after the grafting to correct this difference.

Punch Elevation

This method of surgically correcting acne scars is used on deep box scars that have sharp edges and normal appearing bases. The same punch tool as above is used to excise the base of the scar leaving the walls of the scar intact. The excised base is then elevated to the surface of the skin and attached with sutures, steri-strips, or skin glue .This method lessens the risk of color or texture differences as can be seen with graft replacement, and lessens the risk of producing a visible scar as can be seen when wound edges are sutured.

Subcutaneous Incision-Subcision

Subcision is used to break up the fibrous bands that cause rolling scars. Subcision is performed under local anesthesia by inserting a specially beveled needle under the skin so that it is parallel to the skin surface. Staying in the plane between the dermis and the subcutaneous tissue, the needle is gently advanced and retracted in a piston-like motion cutting the tethering bands. Often, a small pocket fills with blood under the scar. As the area heals, the new collagen formation pushes the base of the acne scar up a little. This procedure causes bruising which fades after about 1 week. The subcutaneous nodules can be treated with injection of corticosteroids into the nodule. Subcision is often followed 6 weeks later with a gentle laser to stimulate collagen growth. It usually takes anywhere from one to four treatments depending on how deep the scar is to lift the scar area up close to level with the skin surface. Patient will usually see small improvements after each treatment.

Laser Resurfacing

The most popular laser types used for resurfacing of acne scars are the fractional carbon dioxide (CO2) and erbium:YAG (Er:YAG) lasers.

Fractional Lasers

Fractional Lasers are extremely effective for treating acne scars. It treats a “fraction” of the skin by creating thousands of tiny perforations, whilst leaving undamaged skin intact. These undamaged cells move into the “damaged area”, and heal the wounded area. The injury to the damaged skin causes collagen stimulation. Further collagen remodelling takes place for 3-6 months and the number of treatments will depend on the severity of the acne scars, but usually 1-2 treatments are required with the Laser.

Dermaroller (Skin Needling)

In patients who want little to no down time skin needling using the Dermaroller may be a better option. This treatment option is suitable for dark skins usually seen in Indians as the risk of hyper pigmentation caused by laser heat energy is removed. Dermaroller therapy provides advanced Micro-medical Dermal Needling, a procedure that tightens the skin surface and stimulates the production of Collagen and Elastin to create smoother, tighter, more even toned skin & improves the appearance of the acne scar. When skin needling is performed in combination with PRP it results in an accelerated improvement of the scar.

Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP) is blood plasma that contains a high concentration of platelets which activate collagen production in the skin. New collagen production improves the acne scar appearance. Platelets are a specialized cell involved in injury healing and cell regeneration that contain your own natural growth factors and stem cells. This treatment can be used alone to treat acne scarring or in conjunction with the Fractional Laser or Skin Needling.

Chemical Peels:

It is useful only for very mild, very superficial acne scarring, Trichloroacetic acid (TCA), Glycolic acid peels are commonly used.

B) Scars

Every person has some scars somewhere on their bodies, but the scars on faces & exposed parts of body bother us the most. These scars are due to surgery, skin infections, trauma or burns.

Surgical Scars

The wound healing & scar formation depends on many factors like tension on wound edges, area of body, age of the patient, etc. While a scar on your abdomen may heal into a nice neat line, a scar over a shoulder or a knee can spread and look quite wide. In old age skin is looser and less elastic hence less tension on wounds, which results in smaller, less obtrusive scars. In younger patients there is a lot of skin elasticity, which places more tension on the wound and tends to make the scars spread more.
Surgeons try to minimize the scar spreading by putting in absorbable stitches down in deeper layers of the skin. These deeper stitches support the skin while it is healing after the superficial stitches are taken out. Plastic surgeon may advise the patient to limit activity and wear surgical micro pore tape or steri-strips over the scar for many months to help keep the scar flat, soft, and narrow.

Scars due to Accidental injuries& Burns:

After repairing any wounds, we have to wait for minimum six to twelve months before attempting any scar revision. Scars attain only about 60 percent of their final wound strength at about six to eight weeks after surgery. Then, the scar will slowly mature on its own for even up to a year after the accident or surgery. Scars can be supported by using steri-strips or surgical paper tape .Reinforcing the wound by keeping the scar tightly closed and as flat as possible maximizes chances of a smaller scar.
Scars continue to remodel silently under the surface of the skin for up to a year after the injury. This is why many surgeons recommend waiting. The appearance of the scar will gradually improve over time. Most scars can be improved but scars will not vanish without a trace. It should be emphasized that, no scar can be removed completely; however, plastic surgeons can often improve the appearance of a scar, making it less obvious through application of certain medications or through various surgical procedures. Many scars that appear large and unattractive at first may become less noticeable with time. Some can be treated with steroids to relieve symptoms such as tenderness and itching.

Scar Revision Surgery

Scars tend to improve by themselves over time, surgery to revise a scar is not usually carried out for at least six months after the original injury or operation. Scar revision is designed to improve the appearance of an existing scar.
Scar is cut out and removed and skin is stitched with fine materials
in One or more stages depending on the type & size of scar usually under local anesthesia.If the scar is flat and soft but just wide, sometimes re-excising it may be a good solution. Plastic surgeon puts extra reinforcing absorbable sutures deep in the layers of the skin to help hold the wound together. Paper tape or steri-strips may be used on the scar for several months to help keep the scar from spreading.
Patient may need to refrain from certain types of exercise, which stretches the scar as well. Also Paper Tape, Silicone Sheets, Silicone Gel, pressure garment, etc. are used for better results of scar revision surgery. The results of scar revision surgery takes at least 6 months to stabilize. Therefore realistic expectations are important for patient satisfaction.

Z-PLASTY for Scars:

This is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture. Not all scars lend themselves to Z-plasty, however, and it requires an experienced plastic surgeon to make such judgements.

acnescars

Keloids:

These are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision. They are often red or darker in color than the surrounding skin. They can be the result of pimples, insect bites, scratching, burns, or other skin trauma. Keloids can appear anywhere on the body, but they’re most common over the chest, back, shoulder & earlobes after ear piercing. They occur more often in dark-skinned people than in those who are fair. The tendency to develop keloids lessens with age. Many patients are genetically predisposed to developing keloids. Individuals of African or Asian descent also tend to be more susceptible.
Treatment: Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar. This treatment is repeated several times with intervals of 3- 4 weeks in between treatments. If steroid treatment is inadequate, in some selected cases the scar tissue can be cut out and the wound closed with layers of stitches. A skin graft may be is used in some cases.
No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, the surgeon may combine the scar removal with steroid (triamcinolone) injections, direct application of steroids during surgery. Also patients are asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may reappear in some cases. We have extensive experience with surgery for keloid removal with rather low rates of recurrence.
The pulsed-dye laser can be effective at flattening and making keloid scar look less red. Laser treatment is safe and not very painful, but several treatment sessions may be needed. Laser treatment may reduce and get rid of a keloid without shrinking them. Also laser scar treatment can help to prevent keloid following surgery.

Hypertrophic Scars:

Hypertrophic scars remain within the boundaries of the original incision or wound. They are often confused with keloids, as both tend to be thick, red, and raised. These often improve on their own, though it may take a year or more. These may need steroid (triamcinolone) applications or injections for improvement.
Treatment: If a conservative approach doesn’t appear to be effective, hypertrophic scars can often be improved surgically. The plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anesthesia, depending on the scar’s location. Patient may need steroid injections during surgery and at intervals afterward to prevent the thick scar from reforming.

Stretch marks

Stretch marks are a special kind of scar that occurs from inside the skin. When skin is stretched too far too quickly, the collagen and elastic fibers that holds the deeper layers of skin together rupture, creating a deep tear but no surface tear. The most common situation for this is over the abdomen in pregnancy, especially with twins or triplets. Stretch marks are also common in teenagers during growth spurts, particularly over joints like the shoulders in boys or over areas like the hips in girls. Rapid weight gain in adulthood can also cause them.
There is no complete cure for stretch marks. Massage with Vitamin E oil or other creams may help. Microdermabrasion and or Retin A may help. Some stretch marks will fade with time on their own without any treatment. Lasers may help for improving the stretch marks.

Lasers for Scars

Lasers will not get rid of scars, but they can help to reduce redness and blend the scar into the surrounding skin. The IPL lasers target the red, and can make the scar look more like the color of your skin. Lasers can also make the border of the scar less distinct, which helps the scar blend in with the surrounding skin.

C) Moles

Moles are dark spots or irregularities found in the skin. They come in various shapes and sizes. Moles are most common on face but can appear anywhere on the skin, from the nose and other facial area, as well as arms and chest areas, in groups, or by themselves. They can be present at birth, or can begin to appear over time. Some moles go unnoticed, and some, like facial “beauty marks,” are actually considered attractive. However, moles are bothersome to some people, and can even lead to dangerous health risks. Mole removal, whether by laser or other surgery procedures, is a cosmetic surgery procedure that provides a solution to people wanting to improve their appearance and reduce associated health risks.

Surgical Mole Removal

Mole is cut out and skin is stitched with fine materials. If mole is suspicious then it is removed with a margin of healthy skin and sent for biopsy. If mole is too big or close to eye/nose/mouth then procedures like flap or full thickness skin grafting may be required. In case of simple small moles only shaving with knife or radiofrequency without any stitches is sufficient. Mole removal typically takes less than an hour to perform, depending on the amount of moles to be removed.
This surgery has a fine line like scar which improves over next 6 months to one year. Therefore you should plan this surgery much in advance of any important event like marriage. The resulting scar is very fine and visible only on closer look.