Scar improvement

Question 1

How long does it take for a scar to mature?

Answer 1

At least 2 years

Question 2

After how long can an intervention be considered if scar appearance is not favorable?

Answer 2

Usually 60-90 days

Question 3

In general, how can surgical excision orientation improve scar formation?

Answer 3

Placement along relaxed skin tension lines and borders of aesthetic subunits

Question 4

What types of scars are amendable to massage?

Answer 4

Mild depressed scars, mild webbing, mild pin cushioning

Question 5

How does pressure therapy help improve scars?

Answer 5

Thins the epidermis, decreases edema, decreases blood flow and oxygen

(loses effect after 6 months)

Question 6

What is the mechanism of topical steroids improving scars?

Answer 6

Decreases activity of fibroblasts and decreases collagen production

Question 7

What is the mechanism of imiquimod helping with scar formation?

Answer 7

Stimulates IFN-alpha which leads to decreased TGF-beta

-IFN-alpha also increases collagen breakdown

Question 8

What can imiquimod be tried for in terms of scars?

Answer 8

Can be used after excision to prevent keloid (results mixed)

Question 9

What is the mechanism of intralesional 5-FU for scars?

Answer 9

Blocks TGF-beta2 which decreases collagen production

Question 10

What types of lasers can be used for scars?

Answer 10

Pulse dye (585-595), Nd:YAG (1065), Resurfacing (CO2 fractionated, vs ablative)

Question 11

When should a pulsed dye laser be considered for scars?

Answer 11

Red, hyperemic, pigmented, or hypertrophic scars and keloids

Question 12

What is the function of pulsed dye lasers on scars?

Answer 12

Promotes scar remodeling gas a result of nonspecific heating of dermal collagen. With redness, some improvement 2/2 dermal vessels

Question 13

What is the purpose of Nd:YAG laser for scar treatment?

Answer 13

Noted to improve pigmentation, vascularity, pliability, and height of keloids, and hypertrophic scars

Question 14

What is the mechanism of scar improvement using ablative lasers?

Answer 14

• Ablates stratum corneum and some of superficial dermis
• Is good for re-contouring > dermabrasion, dermal heating leads to remodeling

Question 15

How is radiation used for scars?

Answer 15

Shouldn’t be used in monotherapy, used with excision often (15-20 Gy in 5-6 sessions)

Question 16

What is the mechanism for scar improvement using dermabrasion?

Answer 16

Ablation of the epidermis and superficial papillary dermis–> wound re-epithelialization from adnexal structures/surrounding skin

Leads to increased epidermal cell migration into the wound

Question 17

When is the best time to use dermabrasion for scars?

Answer 17

6-8 weeks postop

Question 18

What are the 3 main forms of dermabrasion?

Answer 18

Wire brush, diamond fraise w/ hand engine, and dermasanding

Question 19

What is the geometric broken line excision for scar revision?

Answer 19

Irregularization technique –> cut connected random geometric figures like squares, rectangles, triangles down the incision line creating a jagged looking incision line, follow by dermabrasion

Question 20

What are some important side effects of dermabrasion?

Answer 20

Hyper/hypopigmentation, milia formation, persistent erythema, paradoxical worsening of scars

Question 21

What is subcision for scars?

Answer 21

Utilized for depressed facial scars

Use a 18-20 gauge tribeveled needle inserted in the skin and sharp edges are maneuvered to release fibrotic scar bands in the dermis and subcutaneous tissue

Question 22

What is a w-plasty for scar revision?

Answer 22

Similar to the geometric broken line, except being random “w’s” are drawn down the incision line on each side. These are offset such that the triangles are opposite and come together in a zig-zag line

Question 23

What is a V to Y repair on a scar?

Answer 23

Basically a “V” shaped incision is made, then extensive undermining in the middle part of the V is done so that it is free. This triangular part is pushed up towards the opening of the V with the wound being closed behind it in a line, this forms a Y when closed

Question 24

What affects the length of scar increase w/ a Z-plasty?

Answer 24

The larger the angle of the lateral arms of the drawn-out initial Z