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Scar Revision after a Head Injury
By: Edward Lack, M.D. (Cosmetic Surgeon)
Head trauma has the potential to produce devastating cognitive consequences, so the last thing people tend to think about is external scars. Yet scarring of the face and neck can destroy one’s self image and lead to anxiety, depression, and social isolation.
It is important to consult with a Cosmetic Surgeon that is trained in laser therapy – early in the healing phase – so that scar revision planning can begin while there is an ability to prevent permanent, unsightly scars.
Scars come in three heights, and all types of shapes:
1. Atrophic scars are thin scars that invert below the surface of the skin.
2. Hypertrophic or even keloid scars are scars that are elevated above the skin and may spread horizontally.
3. Flat scars are usually visible because of color changes, either darker or lighter than the surrounding skin.
| Linear and Atrophic Scar |
Keloid Scar |
Atrophic Scar |
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Regardless of the skin wound, healing takes place in three phases: the inflammatory phase where the body cleans out the wound and prepares for wound healing; the proliferative phase where a scar is created to bind the tissue together, and finally a remodeling phase where the scar is remade so that it functions well and holds the tissue together.
The remodeling phase begins at about the 12th week and I like to compare it to a spider spinning its web. The spider creates the web and then repeatedly revises it until it functions as it was designed to do. The scar has 85% of its wound strength at the 12th week and that is the time when medical intervention can diminish or even erase a scar.
Conventional medical wisdom teaches that we leave a scar alone for at least 12 months after wounding before seeking scar revision. Nothing could be further from the truth. More than 3 decades ago Dr. John Yarborough demonstrated that facial scars following head trauma after an auto accident could be virtually erased with dermabrasion 6-12 weeks after the accident. At the time his findings were greeted with skepticism and amazement. We now know that the reason this works is that we are modifying the remodeling phase of wound healing.
In the late 1980’s numerous research showed that low level laser therapy could modify wound healing, and on a microscopic level could alter the action of the cells, fibroblasts and endothelial cells, during all the phases of wound healing. By 1990 Goldman and Fitzpatrick showed that a specific laser, the pulsed dye laser, could reduce the size and color of raised scars.
Shortly thereafter, Dr. Edward Lack published a paper demonstrating erasure of a traumatic facial scar and filling in of tissue loss by combining low level laser energy using a pulsed dye laser. In the late 1990’s Fitzpatrick demonstrated that 5- fluorouracil injections combined with laser therapy could erase scar tissue. Since 2006 fractional lasers have been used to erase thin and indented scars.
The state of the art today is to intervene early, between the 12th and 24th week after head trauma that results in facial scars, with a combination of laser and chemical interventions. Even earlier, after the 4th week, patients can apply a variety of over-the-counter silicone based products (such as Scar Fade) to the newly forming scars. This will minimize the scar growth and promote good wound healing.
Proper planning and treatment can result in the erasure of most or all of tell-tale signs of previous scar producing injuries. Family members can help a loved one early on by getting a consultation with a cosmetic surgeon trained in laser therapy.
Dr. Edward Lack, MD is the medical director at MetropolitanMD. Lack is a double board certified dermatologist with several decades of experience in dermatology and cosmetic surgery.