That cream you are applying won’t lighten your scar. It requires deeper treatment

The physiology behind the formation of a scar explains why a topical cream, in my experience as a dermatologist, does not work.

Recently, I saw the work of Cinta Tort Cartró, a Barcelona-based artist who has been on a mission to pick natural skin changes such as pigmentation, scars, stretch marks — things one often tries to ‘fix’— and turn them into art.

The work she does is inspiring and is steering the conversation into a space where we understand better what we should address and what we should let go of to become more comfortable in our skin.

But Cartró’s art will become popular only with acceptance. As for now, most people continue to rely on scar removal cream. But, as a dermatologist, this is not what I would recommend. There are better and more effective options.

What are scars?

Scars are either an elevation or a depression of the skin. The elevation is due to the accumulation of the extra tissue on the epidermis of the skin; the depression is formed because of certain collagen fibers, which pull the skin down. The physiology behind the formation of a scar explains why a topical cream, in my experience as a dermatologist, does not work. Other treatment options such as chemical peels and derma rollers will not help in scar removal either. Derma rollers are often used for skin rejuvenation, but it’s just a temporary fix. It may seem that the scars are gone, but they tend to come back a few weeks after derma rolling. At best, the scars will be lightened by 20 per cent.

If scar removal is something you’re researching, the best way forward are surgical or invasive treatments.

• TCA Cross: It is an abbreviation for chemical reconstruction of skin scars (CROSS) using trichloroacetic acid (TCA) and is one of the most effective treatment choices for scar removal. In fact, a paper I wrote in 2010, showed that 70 per cent improvement was seen in 8 out of 10 patients, and a transient improvement (50-70 per cent improvement) was seen in the remaining two patients when using TCA for treating ice pick acne scars.This concluded that the CROSS technique with 100 per cent TCA is a safe, efficacious, cost-effective and minimally invasive technique for the management of ice pick acne scars that are otherwise generally difficult to treat.
• Lasers: Lasers are the go-to for dermatologists when trying to prevent a scar from forming after surgery, reducing scar pain and increasing the range of movement if it is limited by the scar. Lasers make scars a lot less noticeable.Within lasers, you have different options. CO2 lasers are fractional resurfacing laser systems that show significant improvement. The flipside is that the downtime is increased, so if you’re a working professional or have a busy social life, this may not be the best option for you.
• Subcision: Subcision is a minor surgical procedure that involves inserting a needle into the skin to allow it to rise, in turn, releasing the acne scar. I have perfected my own style of subcision — I restitch the scar by giving another scar, perpendicular to each other. Due to this particular style of restitching, the scar is not visible any longer, almost like a Tyndall effect.

In addition to the more permanent ways of scar removal, there are some temporary methods too such as fillers, punch grafting, excision, fat transfer, filler injections. All of this depends on many factors.

1. Age of the scar: A scar from 5 years ago will be much more treatable than a scar from 10 years ago. This is due to the collagen released and the deep extent of scarring.
2. Overall collagen health: Anything that affects the collagen health of the body can affect scar healing. Smoking, a bad diet, dehydration — all have an adverse effect on the collagen production in the body.
3. Type, shape and size of scar: The different types of scars need different types of treatment and results

• Fine line scars: Seen after a cut or a surgery, these thin scars are due to raised skin. Over a period of two-three years, this fades into a very slight shadow of its former self.
• Keloid scar: When there is excess of collagen growing at a site of a wound, it results in a keloid scar. Notoriously itchy or painful, these scars are raised above the skin and have a tendency to come back often.
• Hypertrophic scars: Similar to keloid as they are also due to increase collagen growth, that is where the commonality ends. Hypertrophic scars do not extend beyond the boundary of the wound. They tend to thicken up for 6 months, before gradually improving over the next decade
• Depressed scars: Ice pick scars or depressed scars are due to acne or injury that leads to loss of underlying fat.
• Box scars: These are oval shaped scars that is left behind after acne heals.
• Rolling scars: Due to bands of tissue that form under the skin, these scars are 4-5 mm wide and look like a ‘M’ shape.

Thus, when opting for scar treatment, it’s better to know the history and spread of your scar before choosing the correct treatment.

So if not scars, what do bio-oil treat?

A common misconception is that scar removal creams work wonders. At best these creams help with marks, not scars.

Marks are flat, often red or brown and do not arise due to skin regularities. It’s why these creams may work on them.

Whereas a scar is due to either elevation or depression of the skin tissue and are harder to treat with creams.

So when my patient has a mark, I would suggest a chemical peel, vitamin C, azelaic acid or Bio Oil. But for scars, it’s only lasers, subcision or CROSS that work.

What I loved about scar-based artwork was the appreciation for the human body. So if and when you decide to start your scar-healing journey, don’t get oils and expect a miracle. It disappoints you while also holding your body to a standard it doesn’t deserve. Instead, go to your dermatologist and discuss the best options, keeping your unique history in mind.

Dr Deepali Bhardwaj is a dermatologist, anti-allergy specialist, laser surgeon and internationally trained aesthetician. She tweets @dermatdoc. Views are personal.

(Edited by Anurag Chaubey)

Source: The Print