SCAR TISSUE; THE THERAPIST'S DILEMMA!

Methods of In-Clinic Scar Revision

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Article By Dr. Danné Montague-King

As we progress toward the twenty-first century, more and more is expected of the Beauty Therapist. A good part of this expectation from the public is the fact that advertisements such as a power peeling and a non-surgical face lift have lead the public to believe that a modern therapist can do practically anything!

The good news is, quite a lot can be done as compared to the pampering, cleansing facials of yesteryear. Those of you who have read me over the years have become a little more aware of what sound science has done for the Aesthetic field.

Many of you that have taken courses from our international training centres have participated in treatments whose results, based on a non-medical approach, have astounded many plastic surgeons.

Recently one of our therapists in New Zealand was showing a local Doctor her “before and after” book. The Doctor looked at one particularly astounding photo of old women of 80 who appeared a youthful 60 after three months of enzyme lifting treatments! His immediate comment was “This is impossible!”

The therapist became very indignant at this scepticism and said “I can call this lady right now to come over here to your office so you can look at her!”

But in addition to anti-aging skin or acne disorders, there is one more problem every therapist has to face at least one time in his or her career and that is SCAR TISSUE

To add to your arsenal of expertise when confronted by scars, my best advice is that you diagnose the type of scar and let the client know their medical and non medical treatment options. To properly diagnose a scar, become familiar with the appearance of the scar and the category it falls under.

Medical Category

Scars, whether they're caused by accidents or surgery are unpredictable. The way a scar develops depends as much on how the client's bodies heal as it does on the original injury or the surgeons skills. Here are the variables that affect the severity of scarring:

  1. The size and depth of the wound
  2. The blood supply to the area
  3. The thickness and colour of the skin (including ethnic aspects)
  4. The direction of the scar on the skin. (Across or with the grain of the skin)

Types Of Scars For Proper Diagnosis

Keloid Scars

Keloids are thick, puckered, itchy clusters of scars that grow beyond the edges of the wound or incision. They are often red or darker than the surrounding skin. Keloids appear when the body continues to produce collagen long after the initial wound healing has taken place.

Keloids can appear anywhere on the body but are more common over the breastbone, earlobes and shoulders. Black persons, who heal very rapidly, and have a much thicker skin than Caucasians are the most Keloid prone. The tendency to Keloid however, lessens with age.

Physician's Treatment: Injections of steroid material directly into the scar tissue reduces redness, itching and sometimes shrinks the scar. Also, scar tissue can be cut out and the wound closed with one or two layers of stitches. Skin grafts are occasionally used if another Keloid develops after the revision surgery but the donor site for the graft risks Keloids as well.

No matter what approach is taken, Keloids have a stubborn tendency to recur, sometimes even larger than before. In these cases the surgeon may combine the scar removal with direct steroid application during surgery or radiation therapy. Pressure garments worn over the area for a long as a year are commonly prescribed by the physician in sever, recurring Keloids.

Hypertrophic Scars

These scars are often confused with Keloids since both appear to be thick, red or dark brown and raised. The difference is; hypertrophic scars remain within the boundaries of the original incision or wound. They often improve on their own in a year or two.

Physician's Treatment: Surgical removal of the excess scar tissue will involve repositioning the scar so that it re-heals in a less visible manner.. Steroid injections at the time of surgery and at intervals for up to two years help to prevent the thick scar from reforming.

Contractures

Burns or injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together by a process called contraction. This contraction could affect the muscles and tendons restricting normal movement.

Physician's Treatment: Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or flap. Z-Plasty may be used in some cases. Z-Plasty is a surgical technique used to reposition a scar so that it more closely conforms to natural lines and creases of the skin where it will be less noticeable. This procedure also frees up the tension on the skin and relieves the lack of movement in the area.

In Z-Plasty, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a "Z" pattern. The wound is then closed with very fine stitches.

In Flap Surgery, skin, along with underlying fat, blood vessels and sometimes muscle, is moved from a healthy part of the body to the injured site. In some flap surgery the blood supply remains attached to one end of the donor site; in others, the blood vessels in the flap are reattached to the new site using micro vascular surgery.

In the case of highly visible facial scars, most that are not hypertrophic can simply be cut out after the initial wound is healed and re-stitched with fine stitches resulting in a finer, smaller scar that fades with time. If the scar lies along natural creases or lines in the face, Z plasty is often employed in the scar revision surgery.

Many physicians follow up these revision techniques with dermabrasion to smooth the skin, especially in the case of Keloids or hypertrophic scars but I have never seen a case where dermabrasion completely removed a scar.

Non-Medical Treatments The Therapist Can Perform

Scar tissue is still skin tissue although it has become scar tissue because the injury has caused the desmosomes to release new cells to surface much faster than the client's natural new cell proliferation (which is why we must never use cosmetic products claiming to "accelerate new skin cells"!).

Scar tissue, like normal skin can be softened, partially removed and de-pigmented to a large degree. Keep in mind however that the following techniques take times, very much like the time it takes a jeweller to tap away at a rough diamond to bring out a clean face that will give the diamond it’s sparkle.

Microdermabrasion

This is one of the main reasons to purchase a microdermbrador. Over time, continuous treatments do result in a planing down of hypertrophic scar tissue. But this is only opening the door to further treatment. Microdermabradors are very limited as to their use and are not considered: stand alone” treatment devices. The skin tissue under a scar many times needs to be re-built. Machines cannot do this, only the proper chemistry can!

Light Treatment

There is a new craze out that claims that certain wave lengths of light can not only remove signs of ageing but can also remove scars. The information included in advertising this craze is full of pseudo-scientific terminology and impressive graphics, but everything is anecdotal with no real research or data available that makes sense.

One could argue that laser skin revision (laser also being a form of light) can assist in scar revision but that is medical and still in the clinical trials stage to be depended upon 100% of the time (but looks very promising).

Electromagnetic Energy Treatments

The incredible repolarising powers of pulsing electromagnetic waves can be programmed like a computer for very quick post surgical wound healing. This can be performed by a therapist immediately after the physician has completed scar revision procedures.

Better yet, electromagnetic waves appear to regulate normal cell proliferation which is vital to keloid revision. I have seen unbelievable examples of what this approach to harnessing one of the four forces of nature can do if presented correctly to the tissues of the body.

Alkalizing The Tissues

There are water soluble compounds available that raise the pH of the skin to around 12 on the pH scale. Alkalizing the skin correctly softens the tissue via cell desquamation, many times creating a mild irritation that forms a light scab. When the scab falls off, the scar appears flatter.

Enzyme Skin Tightening Treatments

Scars on aging skin tend to look deeper or more predominant as the skin loosens with age, Particularly in the case of "ice pick" acne scars. Tightening the skin with enzyme treatments gives a temporary but progressive "lift" to the tissues which also smoothes out the appearance of scars as the skin becomes firmer. This would be like smoothing out wrinkles on a bed spread by pulling the corners tight.

Acidic Oils

There are some oils on the market from both the marine world and the botanical world that actually soften and flatten scars and reduce dark pigmentation. No one is really 100% sure why these types of oils work (I have my theories of course) but many wonderful results have been observed over the years, principally with the Rosa Mesquita Oil from Chile and many of its cousins.

These oils have to be applied at least three times a day directly on the scar tissue and they must be fractionated enough to enter the tissues.

Most of the work I have personally been involved with the past few decades regarding scar revision have involved all of the above methods, often used in tandem on each client. The main thing the therapist must remember with scar revision treatments is PATIENCE.

Skin can be mouldable like living plastic; it can be made to respond with chemistry, electromagnetic therapy and surgery. But commitment from the client that scar revision may be a long term project plus patience from the therapist to follow through are the two most essential components for success.

To learn more about DMK's scar revision treatment, visit the Treatment For Scars page on this website

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Danné Montague-King South Africa

DMK is THE ONE - World Leaders in Paramedical Skin Revision!