Aesthetic Modalities for Different Types of Scars

Scars, the natural aftermath of skin injuries, come in various forms and colors, each requiring a tailored aesthetic treatment approach. The color and physical presentation of a scar significantly influence the choice of treatment, making it essential to understand the different options available.

When dealing with pigmented scars which presents with no other characterizations (such as atrophic or hypertrophic), a broad range of treatments are effective. These include Radiofrequency (RF) microneedling, Intense Pulsed Light (IPL) therapy, Pico and QSwitch lasers in both 1,064nm and 532nm, ultrashort pulse Nd:YAG lasers, and occasionally, fractional or full field ablation using CO2 or Er:YAG lasers. These methods help in targeting the pigmentation, aiming to even out the scar's color with the surrounding skin.

Vascular scars, characterized by their red or pink coloration, necessitate a different approach to target the abnormal vasculature that causes the red or pink colouration. Traditional long pulse or ultrashort pulse Nd:YAG lasers, Pulsed Dye Lasers (PDL), RF microneedling, dye VL, and IPL therapies are effective in these cases. These treatments focus on reducing the vascular nature of the scar, helping it blend more seamlessly with the surrounding skin.

For scars lacking pigment, known as hypo-pigmented scars, RF microneedling and laser resurfacing are recommended. These techniques aim to stimulate collagen production and to create a more uniform, healthy appearance to the skin with less of a demarkation between pigmented skin and hypo-pigmented skin. Additionally, paramedical tattooing can be employed to match the scar to the surrounding skin color, effectively camouflaging the lack of pigment.

Indented or atrophic scars present a unique challenge. If these scars have strong adhesions, a procedure known as subcision may be necessary. In cases where adhesions are less pronounced, injectable Hyaluronic Acid (HA) can be used to temporarily reduce their appearance. For long-term remodeling, biostimulants can be beneficial. Furthermore, RF microneedle, fractional or full field laser resurfacing can smooth the skin’s surface, making the scar indent less noticeable.

Hypertrophic scars, which should not be confused with keloids, can also be aesthetically treated to reduce their irregular appearance. RF microneedling, full or fractional laser resurfacing, and Kenalog injections are effective in addressing these types of scars, helping to flatten and blend them with the surrounding skin.

Keloid scars require a different approach. Due to their tendency to worsen with treatments that are effective for other scar types, surgical intervention is often considered for keloids. It's crucial to approach keloid scars with caution, as inappropriate treatment can exacerbate their condition.

Many scars will present as more than a single physical characteristic such as a raised red scar post c-section. The approach in these cases is to be cautious and address the pigment or vascularity first. After the skin colour has evened out, address the atrophic or hypertrophic nature. Some energy-based treatments such as RF microneedle, can address pigment, vascular and texture concerns with scars so this makes RF microneedle an excellent single modality treatment to address multiple concerns.

It's also important to consider timing; when did the scar happen? Scars that are recent (less than a year), should be allowed to heal completely prior to deploying an energy-based treatment such as RF, laser, or light. Early scar treatment may include silicone gel (sheet or ointment), polyurethane dressing or cortisone injections.

In summary, the aesthetic treatment of scars is a nuanced field, requiring a deep understanding of the cause, type and characteristics of each scar. By selecting the appropriate treatment, it's possible to significantly improve the appearance of scars, aiding not just in physical healing, but also in enhancing confidence and psychological well-being.