If a scar is established, there are multiple conservative, minimal-invasive (Peeling, LASER, Dermabrasion, Filler (Hyaluronic acid), Fat transfer, Stem cells ) and operative treatment options to improve it.  Very often several treatment option are used in combination. The choice of treatment option(s) is determined by the type of scar

There is a high rate of patient satisfaction . But keep in mind that the scar healing process takes about a year. Scars typically start out as red, then tighten, and finally relax into a more subtle color. The patient has to participate actively in the scar suppression treatment (→ fresh scar treatment). The skin above the surgery area may be slightly less sensitive for 1-3 months.

Conservative Treatment

Scar massage is the basis of each and every scar treatment. There are different techniques delivered by physiotherapy

Goals of the scar massage are:

• Desensibilisation (reduction of hypersensitivity)
• Reduction of scar volume
• Reduction od scar redness
• Removal of scar adhesion

The massage is crucial, not the ointment“: Scar massage with refatting crème (Vaseline, Mebo Scar, e.t.c.) 3 – 5x/day by the patient.

Minimal-invasive Treatment

Correction of the scar surface is mainly done with any kind of skin-resurfacing techniques techniques such as

• Peeling
• Laser
• Dermabrasion

Surgical Treatment

Correction of the scar width, pattern, course and scar contracture can only be achieved by surgical scar correction.

• Scar excision & Plastic-surgical skin suture
• Scar excision & shifting the course of the scar
• Scar excision & Tissue Transplantation

While for most patients, acne heals completely without leaving scars, for others these are a lasting reminder of the skin disease.

If the course of the disease is particularly severe, scars can characterize the skin and become a psychological burden for those affected.

The following basic principles have proven effective:

• The best treatment of Acne scar is prevention 

→ early onset of adequate local and systemic acne treatment

• If acne scars cannot be prevented, the must be treated early

→ reduce/stop of any residual acne disease activity (→ Dermatology)

• Once acne scars are established, the aim is to make them less noticeable

→ rule out any residual acne disease activity before starting invasive local scar treatment (reduction of infection risk).  

→ Lines of treatment (Subcision, LASER, injections, Biostimulator, Peeling, Microneedling, Plasma, Growth factors, Stem cell, fillers, fat injection, RF)

Note: in severe cases autologous fat cell transfer (Lipofilling) has proven a reliable method to significantly improve the appearance.

Skin-resurfacing

Compensation of unevenness by “thinning” the skin down to the superficial dermis with spontaneous regeneration. Procedures need to be repeated 2 – 3 times with a minimal distance of 6 – 12 weeks.

• Peeling
• Laser
• Dermabrasion

Scar Release (Subcesion) & Fat grafting

In severe cases autologous fat cell transfer (Lipofilling) has proven a reliable method to significantly improve the appearance.  The treatment is divided into 3 steps:

• The liposuction for harvest of fat graft is performed under local anesthesia, if desired also combined with a light twilight sleep. The main donor region is the inner thigh (one surgical field). After suctioning, ensure adequate wound drainage. A highly absorbent bandage is applied.
• Scar release (subcision) is also carried out under local anesthesia.
• The fat transfer (autologous fat injection, lipofilling) Then a certain amount of autologous fat is inserted into the respective skin layer with a fine needle. Small dressing (Steristrip) may be necessary in rare cases.

A stretch mark is a type of scar that develops when our dermis ruptures. Dermis rupture is likely to occur, when:

• family disposition
• periods, were our skin stretches quickly (i.e. growth spurts in puberty, pregnancy, rapid weight gain)
• in case of high cortisone level for longtime (medication, Cushing disease, …)

There are several treatment option available. It’s important to understand that no single treatment works for everyone — and many products don’t seem to work at all. The following basic principles have proven effective:

• The best treatment of Stretch marks is prevention
• If stretch mark cannot be prevented, the must be treated early

Burn scars are thick (hypertropic) scars covering the area of the burn injury with a scar plate:

1. Treatment of fresh burn scars
2. Treatment of old burn scars
3. Treatment of scar contracture

Scar contractures are functionally more important the closer they are to a joint and the more perpendicular they are to the Skin Lines. Basic principles of surgical scar correction are:

• Interruption of the scar by inserted tissue
• Change in the course of the scar (parallel to the skin tension lines).

Pigmentation problems are a common consequence of deep partial- and full-thickness burns, other skin trauma, and surgical procedures. Altered skin pigmentation in scars, can result from increased or decreased pigment (melanin), abnormal pigment (melanin) distribution, or deposition of exogenous substances.

In principle, a distinction is made between too much skin pigment (hyperpigmentation) and too little skin pigment (hypopigmentation). In scars, both conditions often occur at the same time.

Both hypopigmentation and hyperpigmentation can cause esthetic and psychological issues, which may influence quality of life.

Too much Color (Hyperpigmentation)

• Stop Squeezing and scatches (e.g. Acne)
• Sunscreen
• Topical whitening (use combined treatments)

Too few (Hypopigmentation)

Some scars can no longer be improved by any conservative and surgical measures (e.g. pigment changes). Appropriate scar cover can make these scars appear less noticeable.

Temporary Scar covering

Temporary Scar covering is indicated at any point in the scar therapy, it is at the beginning of every scar therapy and is at the same time the icing on the cake of a successful scar therapy. There are 2 main options:

• Camouflage is used up in areas, in which conspicuous color differences need to be “covered up”
• “Corrective make-up” is and advanced form of camouflage used at the face. With the help of a few practical make-up tips, pigment changes can be concealed, and the patient’s social acceptance can be significantly improved

Permanent Scar Covering

Permantent scar covering by micropigmentation (tatooing) is routinely done by medical tattoo artist in oncological breast reconstruction patient for the nipple reconstruction. In Scar treatment there are 2 main option:

• Discretion, i.e. try to even out the color difference (→ skin micropigmentation)
• Distraction, i.e. try to cover up the scar with a tattoo

“Body and Soul”: Tissue damage not only leads to an externally more or less visible scar (Body Scar) but often also to psychological trauma (Soul Scar).

“Stress and Coping”: The reality of a serious physical illness (cancer, transplant, stroke, etc.) leads to extreme human situations that the sick person, their family and their psychosocial environment have to cope with.

The task of medicine is to keep the sick not only “alive”, but also “in life”.