Scar Treatment

What are the causes of scars on our body?

Scars may occur due to traumas, previous injuries, previous surgical operations, diseases, infections, or burns.

What are the causes of impaired wound healing?

Many factors have been identified in the abnormal scar formation. Genetic predisposition, personal causes and wound-related factors are the most important of these. Genetically, your wounds may be healing abnormally. These individuals have a high risk of hypertrophic scarring and keloid formation. Personal causes are diseases, age, skin type, diabetes, vitamin deficiencies, smoking and protein deficiencies. In addition to these, the mechanism of the injury, the depth of the wound, the intervention after the injury, and whether there is an infection in the wound are factors related to the wound and affect the way the scars heal.

What are the methods used in scar treatment?

In the treatment of scars, in my own practice, I use scar revision surgeries, stem cell therapies, intralesional steroid injections (steroid injection into the wound), silicone-based creams and silicone sheets.

What is scar revision and how is it done?

Scar revision is the procedure to reduce the visibility and width of the existing scar/wound. In the scar revision, your existing scar that causes discomfort is removed, and it is re-sutured using the appropriate technique and appropriate suture material, in a better way. While doing this, attention should be paid to the atraumatic approach, proper closure of the layers, placement, and tension of the scar. It is usually done with local anesthesia (numbing the area where the existing scar is). However, depending on the size and location of the wound, sedation or general anesthesia may also be preferred.

When can scar revision be done?

Considering the physiology of wound healing, it takes 1 year for the scar to take its final form. Therefore, it is recommended to perform the scar revision procedure after this period has expired. There are some exceptions. For example, an acute injury caused by a sharp object can be treated as soon as possible.

What is the post-operative period after scar revision surgery?

Local anesthesia is generally preferred in scar revision, so you can go home and return to daily life after the procedure. You can take a shower 2 days later. After the effect of local anesthesia passes, there may be minimal pain in the treated area and these pains respond well to painkillers. Some movement restriction is important for scars in moving areas (joints, etc.). Depending on the method used, stitches may need to be removed after an average of 7-10 days.

What are the factors to be considered after scar revision?

Correcting the scar with scar revision alone is not enough. Any reason that impairs wound healing will cause poor healing of the wound after scar revision. Two factors are very important at this point. The sun’s UV rays cause the wound to heal poorly. Therefore, surgical sites in sun-exposed areas should be protected with +50 factor sunscreens. Another important factor is smoking. Smoking causes poor healing of wounds. Therefore, it is recommended to quit smoking for at least 1 month before the procedure and not to smoke after the procedure for better wound healing.

Will all scars disappear after scar revision?

The answer is “no”. None of the scars disappear completely. The aim of scar revision is to minimize the visibility, prominence, and the width of the scars as much as possible and to ensure that they become indistinct. There is no method that leaves no scar. After the scar revision procedure, the scar is thin, may be prominent and red in the first 3 months. If recommendations are followed, the desired result will be reached at the end of the 1st year. Genetic predisposition and personal factors are also extremely important in the way of healing of the scar, as it is mentioned previously.

What is “Stem Cell Therapy” used in scar treatment?

“Stem cells” are cells that have the potential to transform into many cells, such as repair cells, which are used in tissue regeneration due to their ability to renew themselves. Stem cells are found in the placenta, umbilical cord blood, bone marrow and adipose tissue. We prefer adipose tissue as a source of stem cells due to its ease of obtaining and abundance. Stem cells obtained from adipose tissue produce important proteins such as collagen/elastin, increase blood flow and nutrition to the area, thicken the dermis, and reduce melanogenic activity. Thanks to their repair, regeneration, and rejuvenation capacities, these cells are used in poor wound healing, bad scars, acne scars, in skin rejuvenation, hair loss treatment, treatment of under-eye grooves, hyperpigmentation treatment, lip &and genital mucosa dryness (See Stem Cell (SVF) Therapy Section).

From which region are the stem cells in the adipose tissue obtained?

Fat tissues can be taken from the abdomen, outer thigh, inner thigh, lumbar region and inside the knee. The obtained adipose tissue is subjected to some processes such as centrifugation, emulsification, filtration, and fractionation. After these procedures, this structure, which contains repair and stem cells, is called “Stromal Vascular Fraction (tSVF)” (See Stem Cell (SVF) Therapy Section).

Is “stem cell therapy” a difficult procedure?

Stem cell therapy is an outpatient procedure, and you can go home after the procedure. No side effects are expected other than edema, small bruises, and minimal pain that responds to painkillers. Edema and bruising can last up to 3 days in the area where the fat is removed. All prepared cells are your own cells, so there is no risk of allergy or anaphylaxis. (See Stem Cell (SVF) Therapy Section).

When does stem cell therapy start to show its effect?

Its effect becomes noticeable at the end of the 1st month, but the maximum effect is reached in the 6th-8th months (See Stem Cell (SVF) Therapy Section).

In which patients is intralesional steroid injection (injection of steroid with a needle into the wound) suitable and how does it show its effect?

Intralesional steroid (triamcinolone) application is suitable for raised, red and itchy lesions. Steroids show their effects by interfering with collagen synthesis. The application requires multiple sessions. After the treatment, it is expected that the prominence of the scars, redness and itching will decrease. A complete disappearance is not possible.

What is the mechanism of action of silicone-based creams and silicone sheets, and for which patients is this treatment suitable?

Silicone-based products increase collagenase activity, hydration, and polarization. It should be started to be used at the appropriate time and requires a long treatment period. It is generally used as a preventive method to prevent scars from healing abnormally.