Texture
About Texture
Scars can form an uneven texture when the dermis (deep, thick layer of the skin) is damaged. The body forms new collagen fibres to mend the damage, resulting in a scar. The new scar tissue will have a different texture and quality than the surrounding tissue, due to excessive production of collagen. An injury with damage to various skin depths which heals by secondary intention also causes abnormal collagen synthesis; this leads to a variety of thicker and thinner bundles. Eventually this results in an irregular scar surface often seen in large surface burn injuries. Irregularities of the scar surface (surface roughness or texture) are also seen after split skin autografting, especially if the skin graft is meshed (holes are made in the skin graft). With a meshed graft, the irregularities result from secondary healing of the interstices (holes) of the meshed skin graft. To improve scar texture, especially in older scars, semi-invasive or invasive treatments are required. Treatments like micro-needling and laser therapy often have very effective results.
Treatment options for Texture
Injectables
There are many treatments for keloid and hypertrophic scar. In addition to corticosteroid injections many other chemotherapeutic agents have become popular as injectable anti-scarring agents.
Micro-Needling
Micro-needling is a semi-invasive technique that can be used on the face and body to achieve collagen induction (production). In this technique the skin or scar is pricked with needles to cause percutaneous collagen induction, this builds up connective tissue underneath retracted (contracted/stuck) or hypertrophic scars and wrinkles.
Pulsed Dye Laser (PDL)
The Pulsed Dye Laser (PDL) is a highly effective and low risk laser for the treatment of a wide range of vascular lesions. PDL releases brief pulses of selectively absorbed optical radiation which can cause selective damage to pigmented structures (blood vessels) and cells. The PDL is used to treat port-wine stains, facial telangiectasias and haemangioma. Newer PDLs with longer wavelengths and extended pulse durations have made deeper tissue penetration possible and improved clinical outcomes with reduced risk. PDL treatments are performed with a topical anaesthetic.
Non Ablative Fractional Laser (NAFL)
A Non-Ablative Fractional Laser (NAFL) is a non-wounding laser, it does not damage the integrity of your epidermis. NAFL uses a wavelength that does not evaporate the water in the tissue, and the energy from the laser heats the tissue in a controlled manner. Therefore, many patients prefer NAFL to ablative laser treatment. The rise in temperature stimulates the production of new collagen. By producing new collagen, the remodelling of the scar tissue is improved. Although NAFL is less invasive, requires less recovery time and has less complication risks, is not as effective as ablative laser resurfacing.
Ablative Fractional Laser (AFL)
The Ablative Fractional Laser (AFL) is a wounding laser, which delivers micro fractional columns of laser light to the top layers of the skin. This treatment works by creating thousands of microscopic areas, through heat, where the top layer of the skin is ablated (removed). These tiny areas of damage are surrounded by untreated skin, this allows healing of the skin. Traditional ablative laser resurfacing can take on average up to three weeks to heal. Types of ablative treatments include the carbon dioxide (CO2) laser and the erbium laser. AFL is performed under local anaesthesia.
Surgical Scar Revision
Annually, 200 million incisions (surgical cuts) are performed worldwide. The treatment of aesthetically unacceptable scars can be challenging, although several options are available. These options vary from non-invasive options to invasive scar revision. As there are lots of options along this spectrum it is important that you seek advice for your specific concerns from a surgeon specialised in scar.
Patients often see a plastic surgeon once they have tried lots of other non-invasive options. However, sometimes there are non-invasive options that could be more appropriate than surgery; again, an assessment by your scar specialist is important.
While various surgical options exist, all surgery carries risk and therefore a full assessment is important so that you can let the surgeon know what your concerns are. The surgeon can explain all the possible procedures, the pros and cons of each one and what can or can’t be achieved with surgery. Sometimes more than one surgery will be needed and follow up after surgery is also important.