Cooper Center for Dermatologic Surgery: The Latest Options for Scar Revision

Trauma. Surgery. Acne. Burns. Regardless of the cause of a scar, today there are more options than ever to improve its appearance. And they’re all available at the Cooper Center for Dermatologic Surgery.

“Once skin is structurally scarred, it’s permanently altered,” says dermatologic surgeon Naomi Lawrence, MD, head of the Division of Dermatology, Section of Procedural Dermatology at Cooper. “But we can improve the texture and appearance of a scar, helping it blend better into the surrounding skin so it’s harder to find.”

“There are two main types of scars we treat,” explains dermatologic surgeon Ashley B. Decker, MD. “A hypertrophic scar is raised and bumpy, while an atrophic scar is depressed, like a pockmark. With either type, treatment involves re-wounding the skin in order to get collagen to form down in a more organized fashion.”

Treatments fall into two categories as well: invasive and non-invasive.

“Invasive scar revision involves cutting out a scar in such a way that it leaves a better scar,” says Dr. Lawrence. “For example, we can perform serial excisions to change a depressed atrophic scar into a fine-line linear scar. And Z-plasty is a surgical technique that can elongate a contracted scar or rotate a scar’s tension line, improving its functional and cosmetic appearance.”

Lasers play an important role in nonsurgical scar revision.

“We find the best lasers to be the fractionated lasers, particularly the fractionated CO2 laser,” Dr. Lawrence notes. “It re-wounds the scar in such a way that it stimulates deep collagen, which reheals so that the scar line is less obvious.

“We use this laser not only to treat typical scars, but also burns and severe traumatic scars,” she continues. “It helps soften and improve the quality and texture of the skin, making the scar less apparent.”

“The pulsed-dye laser is another type of laser that can cause changes in the distribution of fibroblasts, helping a scar to form flatter,” says Dr. Decker. “It also can help to minimize redness when that’s an issue.”

Drs. Lawrence and Decker note that people with darker skin have a higher risk of hypo- or hyperpigmentation from laser treatment because the laser energy can damage melanocytes.

“But it doesn’t mean they can’t undergo treatment,” Dr. Lawrence says.

“We often prescribe hydroquinone to help minimize post-procedure hyperpigmentation,” Dr. Decker adds.

Other nonsurgical options include microdermabrasion and steroid-solution injections that may help scars form flatter. Micro-needling, or collagen induction therapy, is another option in which a device with fine needles creates tiny punctures in the skin, triggering new collagen and elastin production which, in turn, can improve texture, firmness, and the appearance of scars.

“The better micro-needling devices are those restricted to medical practices since they go deeper and produce a better result than at the spa,” Dr. Lawrence says.

A nonsurgical treatment specifically for depressed acne scars is subcision, in which a special hypodermic needle is inserted through the skin to free the scarred skin from underlying subcutaneous fat, relieving the depression and improving the skin’s appearance.

“There really is a lot available for treating scarring,” Dr. Lawrence stresses. “Even if a patient had a scar evaluated in the past, there are newer techniques all the time, and it could be worth a second look.”

“Patients don’t have to feel discouraged,” Dr. Decker adds. “There are options to minimize scarring and help patients get their confidence back. The sooner we see the patient, the better opportunity we can provide for positive long-term results.”

To refer a patient for scar removal to Drs. Lawrence and Decker, or for
questions concerning procedural dermatology, call 856.596.3040.

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