I've tried to read from the start so apologies if i haven't considered anyone's responses ^^
Dermaroller works well for most atrophic-style scarring - however, it does little to improve the visual impact of Grade IV scars and is generally ineffective for ice-pick style as well - that is where all the medical reasearch points to.
Fraxel, other fractional lasers, and IPL for hypertrophic scarring work on a variety of levels - they attempt to coagulate the blood vessels that are feeding the scar, break down the fibrotic scar tissue, and plump out the indented area with more collagen, to reduce the 3-minensional abnormalities of the atrophy.
Radiofrequency is a paired treatment that creates thermal damage in the superficial layers of the skin... similar to but still different from laser. thermal damage by radiofrequency results in a higher proportion of elastin regrowth - the tissue that gives your skin its elasticity. monopolar RF has an infinite penetration depth technically... you don't need that. bipolar RF penetrates to half the depth between the RF poles, normally about 4-5 mm for an 11mm bipolar spacing. More than enough to trigger an appropriate response in scar tissue. Not meaning to plug any specific device but Syneron make ELOS machines which have both RF and laser at the same time.
LED phototherapy... the jury is still out on this one. Sitting under 660-670nm red light does improve collagen regeneration but this effect essentially stop 48 hours after your last treatment, so this is much more effective as a home therapy than anything else. Blue light 435nm is excellent for its bactericidal qualities in acne, but this is a prevention method - it will do nothign for already-formed scars. Green, yellow light... sorry, there is some really weird stuff coming out of the generic factories in CHina and even some local manufacturers and distributors have jumped on the bandwagond for these. No evidence, and i've yet to encounter even plausible anecdotal evidence.
low-level-laser therapy - this one is a bit dodgy, but actually close to my heart becasue it was my firt time to use laser as a professional. Cell histology studies show that using LLLT on repairing skin helps to order your collagen more effectively (scar tissues are one big clumped up mess) to make it more accurately resemble skin. Unfortunately, while the microscopic evidence is compelling, there are no real world results I can speak of. I still do use LLLT in cases of delayed wound healing, where it has strong evidence of benefit.
I think Quirky mentioned that the results fomr laser and dermaroller are permanent... well, that depends. It depends on where the scar 'node' is located. For example, i can use microdermabrasion to slough off the very superficial layers of the stratum corneum, but that would only improve appearance temporarily, because most of the damage is another 2-3 mm into the skin. Similarly, because atrophic scars result from lost volume in the skin, the collagen-boosting effect of fraxel and dermarollers help to mask this volume loss. As your skin continues to age and collagen depletes, these scars may resurface slowly. If you are lucky enough that the scar mass sits at the epidermal-dermal junction, it is theoretically possible that needling under this mass will push the scar tissue up into the stratum corneum, which will subsequently get expunged as your SC renews itself. I say theoretical becasue even though i have done this on myself, i'm not 100% sure if this is the accurate physiological reasoning behind what I see.
subcision is, for want of a better word, the economical gold standard for most ice-pick scars. there is simply no other treatment on the market that can selectively target fibrous scar connections underneath the surface of the skin. To extrapolate what I mean to another area of cosmetics, this is exactly the problem we face with cellulite, which are scar adhesions that anchor your skin to underlying tissue.
subcision followed by dermal filler and supplemented with needling is great if you are confident enough to do it yourself, although probably not cost-effective if you trie d to get professional intervention. Using a dermapen or any of those variants, treatments RRP at 300/session. AN alternative is getting saline injections just un the subcised area - this stimulates the same inflammatory/collagen creating response the plumps your skin. The same technique, practised in other parts of your body for tendon and cartilaginous joint healing , is loosely called prolotherapy.
I sell Dermaquest and while I disapprove of their marketing, there is some solid science backing most of their product lines. Not too sure what they woudl do for scarring specifically but post-laser procedures I use a Dermaquest post laser lotion containing copper, silver and zinc that suppresses bacterial activity and excessive inflammatory responses.
Silicon sheeting and silver/aluminium/copper impregnated dressings help with wound healing in general. Bad scarring results from excess protein production in injured tissue due to excessive stimulation by or an excessive response from inflammatory chemicals in the local area. Suppressing bacteria and suppressing inflammation therefore have flow-on positive effects for wound healing and scar formation. Silicon sheeting is used quite extensively in burns scarring but obviously it is more impractical for facial areas. I have been trying to obtain silicon gel for scarring for almost six months now and cannot find anyone who is able to produce it cost-effectively.
With the exception of LED, i have used all modalities on myself and on clients previously. Ii'm not aware of too much more out there... alot of focus is being given to cellular signalling, which is a form of scar prevention. There could be other treatments out there in the wilderness but I have not found them, or found them unremarkable
Edited by tedde, 01 July 2013 - 05:35 AM.