 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
Coming soon.
A scar represents the body's attempt to heal itself. There are many factors involved in determining how a wound heals. These include the person's age, how healthy the individual is, whether the wound becomes infected, how quickly the wound is closed, the site of the wound, and whether the person has a tendency to form heavy scars ("keloids"). In many instances, an injury heals with minimal evidence of a scar. Unfortunately, in other cases, the prominence or the site of a scar detracts from a person's appearance. Though a scar cannot be removed completely, it is possible to make it appear less obvious. Often, this can be accomplished with an injection or application of medications (e.g., steroid creams). Alternatively, scar modification can be achieved by performing minor surgical procedures. Surgical revision can change the size of a scar, raise depressed areas, or lower elevated scars. While it is not possible to remove all evidence of a scar, revision procedures improve the appearance while leaving another (though less obvious) scar in its place. The redness associated with a scar ("erythema") will usually fade over weeks to months. Because every scar is different and requires a different approach, a consultation with Dr. Wall will determine the best approach to treat your scar. Most methods of scar revision are performed in our clinic using local anesthesia. During surgical revision, the scar tissue is excised. Next, the surrounding skin is carefully brought together, to minimize tension and to maximize contact at the healthy surfaces. In this manner, wider scars are narrowed, and longer scars are shortened. An alternative method involves creating irregular or zig-zag incision lines (rather than a straight incision). When this incision heals, the new line is harder to recognize. This is because our eyes are not drawn to an irregular line, as they are to a long, straight scar. Dr. Wall employs this method to camouflage scars in less obvious sites, such as the hairline or a natural fold in the skin. Punch grafting is often the best treatment for deep acne scars ("icepick" scars). This method utilizes a small
instrument to remove the scar. Then, the site is filled with a new plug of skin. The new skin is secured into place for
about seven days to permit healing. In other cases, the edges of the wound are re-approximated closely with sutures.
With either method, the new scar will have a smoother contour and will be less apparent than the depressed scar.
Some individuals with significant acne scarring may Laser light is used to remove fine scars, wrinkles and sun-damaged skin. Patients can return to work within two weeks, though residual redness can last up to six months. This treatment option can be extremely effective at reducing scars and in rejuvenating skin affected by the aging process. The chemical peel is employed to treat superficial scars, sun-damaged skin and irregularly colored skin. There are many different peeling agents available. The lightest peels (with fruit acids) can be performed by aestheticians. However, the stronger peels, designed for more prominent wrinkles and skin damage, can only be administered by physicians. The chemical is applied with a cotton-tipped applicator to the affected areas. The area may be red and tender afterwards. These symptoms vary with the strength of the acid used. Little healing time is needed after a light peel, although deeper peels can require up to several weeks to heal. Redness or "erythema" can persist for several months. People with dark complexions may not be candidates for the laser or chemical peels. This is because they are more likely to develop irregular pigmentation or "blotching" after these procedures. Your ethnic background, and the ease with which you tan, can influence response to the laser treatment. Dr. Wall will review these considerations during your consultation. Injectable substances ("temporary fillers") can be used to raise depressed scars. The agents most commonly used in the United States are collagen products (e.g., Zyderm and Zyplast). While improvement is apparent immediately after the injection, the collagen is absorbed by the body in 12-16 weeks. For this reason, follow-up visits are usually necessary. Other temporary agents have been used safely in Europe and Canada for the past decade (Artecoll, Perlane Restylane and Hyaluronic Acid) . These agents last much longer than collagen and are extremely safe. These products are currently undergoing review by the F.D.A. If they are approved for use in the U.S.A., they will represent an important treatment option for patients. See Non-Surgical Procedures for additional discussion of fillers.
Mole Removal
Most moles and blemishes are "benign", or non-cancerous. However, because some moles can transform into a cancer, it's always a good idea to have a physician evaluate a suspicious lesion. The overwhelming majority of skin cancers are curable, and the key to success is to receive early treatment. Unfortunately, many patients have a concern about a mole, and yet wait months before seeking medical attention. Are there indications which suggest that a mole may be malignant? Yes, there are. These characteristics include a sudden change in size, shape or color. Other concerning features include bleeding, itching, swelling or pain. Even when moles are not cancerous, some individuals want them removed. Sometimes, the mole is unattractive, in other instances, the mole becomes irritated by clothing. The coarse hair (which sometimes grows in a mole) can only be removed by removing the entire mole. Procedures for removal of skin lesions require only a few minutes and can be performed during an office visit. Typically, skin lesions and moles will not recur after removal. The most common methods for removal are shave biopsy and excision with closure. To view before and after images, please click here. The shave biopsy is a simple procedure used to treat protruding growths. First, the skin is numbed with a local anaesthetic. Then, a scalpel is employed to take off the portion of the mole that lies above the skin surface. Usually, a flat white mark remains after healing. Sometimes the color is the same as the original mole, but the new surface is level with the surrounding skin. Therefore, it won't be irritated by clothing or undergarments. Also, it's much easier to conceal with make-up. Excision biopsy is necessary when the mole is flat, or when a cancer is suspected (e.g., melanoma). The full depth of the mole is removed and the wound is sutured. The specimen is then sent to a lab for pathological examination. The scar that results from excision may be only a thin line. If there is a high suspicion of cancer, then a margin of clean tissue is removed around the lesion. This ensures that all parts of the lesion have been removed. With a mole on the face, Dr. Wall may close the site using extremely fine sutures on the surface, and absorbable sutures beneath the skin. Stitches are usually removed after 4 or 5 days. This prevents the development of unsightly scars ("railroad tracks"), which can occur of stitches are left in for too long. Moles can also be removed with lasers or with electric current. Because blood vessels are sealed as the tissue is removed, the need for sutures is eliminated. This reduces the risk of scarring. After electrosurgery, a scab will form, and then will fall off within 2 weeks. The area is kept clean and is coated with antibiotic ointment until it heals. The slight redness that is initially present will fade with time.
|
Scar Revision 
