You guys have been asking, so here’s what I found to be the most interesting new information on scars and scar treatments:
Subcision plus suction. Subcision is where a needle is placed sideways underneath a depressed scar and moved around, thereby disconnecting the scar from the skin below and allowing it to float up to the surface. The hope is that a hemorrhage will appear under the scar, leading to new connective tissue and a permanent raising of the scar toward the skin surface. For those of you who have tried this, you may have noticed that it seems to work, but that a large portion of these areas tend to recede again. However, a new common sense treatment is now being added to some subcision treatments. After the initial subcision of the scar an initial hemorrhage forms. Then, 3 days later, a suction machine, normally the same one used in microdermabrasion, is placed over the scar area and “vacuums” the skin up, ultimately reintroducing another hemorrhage under the treatment area. This suctioning is repeated at least every other day for 2 weeks afterward in an attempt to produce more tissue under the scar. The Journal of the European Academy of Dermatology and Venereology concluded, “Frequent suctioning at the recurrence period of subcision increases subcision efficacy remarkably and causes significant and persistent improvement in short time, without considerable complication, in depressed scars of the face.” Pretty cool.
Need to wait until 6-12 months after Accutane (isotretinoin) to get aggressive scar treatment? This is a commonly held belief since isotretinoin has been linked to keloids and raised scarring, perhaps because of collagen accumulation. It remains a prudent stance. However, in one very small study, doctors dermabraded one square centimeter on 7 participants faces using a diamond fraise while they were on isotretinoin. After 6 months, the scar revision appeared successful and there were no signs of keloid or raised scarring. Although this is interesting, patients and doctors must continue to proceed with caution in this area until we get more evidence.
Why do we scar in the first place? Scars are the result of wound healing, which is one of the most complex biological processes, and includes the following 3 phases. Some new info below:
(1) Inflammation: Upon closer investigation through biopsy specimens, researchers found that the initial inflammatory reaction was stronger and had a longer duration in patients who scarred.
(2) Granulation tissue formation: Next, damaged tissues are repaired, new capillaries are formed, and new collagen begins forming. Researchers are noting, “The balance of collagen types shifts in mature scars to be similar to that of ounwounded skin, with approximately 80% of type I collagen.” This one is a bit above my head. If anyone knows why this might be interesting, please comment.
(3) Matrix remodeling: As the healing process moves on, extracellular matrix metalloproteinases (MMPs) take on the job of deciding how much tissue will be built. Too much MMPs and you may see a raised scar. Too little and you may see a depressed scar. However, why some people have too much or too little MMPs remains a mystery.
I’ve read all the other scar related research that has been published as well. Basically it’s mostly the same stuff we have known before. The bulk of the evidence continues to show (1) significant improvement with ablative lasers (CO2 and Erbium;YAG) with pretty severe down time afterward, (2) somewhat less improvement with fractional lasers and needling but with less down time, and (3) the never-ending search for the perfect filler. If anything remarkable comes out in the near future I will let you know.