Scars are areas of fibrous tissue that replace normal skin after injury, they result from the biological process of wound repair in the skin and other tissues of the body.
Scarring is a natural part of the healing process. With the exception of very minor lesions, every wound (e.g. after accident, disease, or surgery) results in some degree of scarring.
All scarring is composed of the same collagen as the tissue it has replaced, but the composition of the scar tissue, compared to the normal tissue, is different. Scars differ from other scars in the amount of collagen over expressed.
London Medical and Aesthetic Clinic is one of the leading clinics in Sculptra treatment in the UK and Europe. Dr Ayham Al-Ayoubi has invited and developed the advanced Sculptra technique to treat deep acne and traumatic scarring which has now been adopted by numerous plastic surgeons and cosmetic doctors worldwide.
There are two broad classifications of facial scarring: atrophic and hypertrophic. We expand upon the classification by dividing atrophic facial scarring into four main types: ice pick, boxcar, shallow/atrophic, and valley/rolling scars.
Ice pick scars are typically small (1-2 mm) and have a wide aperture with steep edges that taper to a single point at the base, as if the skin has been pierced by an ice pick. An epithelial tract forms along the sides of the opening within the scar. These scars may be shallow or deep, and may extend as far as the dermal-subcutaneous junction.
Boxcar scars are round to oval junctions. Boxcar scars are round to oval in shape with well-defined vertical edges and a flat base, as if the scar has been punched out of the skin. They typically range from 0.1 to 0.5 mm in depth and are usually widely spaced out on the skin surface, occurring as solitary scars. Unlike ice pick scars, this type of scar does not converge to a single point.
Shallow/atrophic scars present as a cluster of miniaturized boxcar scars. They usually emerge in groups of four or more and occur mainly on the cheeks.
Valley scars (“rolling” scars) are deeper and have an undulating appearance that is best appreciated in indirect lighting. Valley-shaped scars arise from a variable loss of dermis and/or subcutaneous tissue. Because acne and varicella scars are dermal defects, they require a treatment modality that reaches the dermis in order to achieve clinical improvement.
Sculptra is Poly-L-lactic acid which belongs to the alpha hydroxyl acid family. Sculptra is composed of crystalline, irregular sizes of microparticles of poly-L-lactic acid that are 40 – 60 um in diameter. Sculptra is packaged as a sterile freeze-dried preparation that is reconstituted with sterile water 48 hours before injection. After injection of the poly-L-lactic acid, a foreign body reaction occurs over several weeks to months, presenting itself as a volumetric expansion. It is important to note that there is no visual endpoint at the time of injection, and a waiting period of at least 4 to 6 weeks after initial product placement is recommended before subsequent injections.
Sculptra with Subcision
Subcutaneous incision following Sculptra injection is the treatment of depressed scars. After outlining, anaesthetising, and sterilizing the affected areas, a 22-gauge needle or a tribeveled 18-gauge hypodermic needle is inserted into the superficial fat with the bevel up just adjacent to the scarred area. The needle is turned so that the bevel is perpendicular to the skin surface, and the needle is moved back and forth in a fanning motion to break up the fibrous tissue that is depressing the scar. Audible rasping and popping is observed as the underside to the dermis is released from its subcutaneous attachment. Sculptra would be injected during subcision procedure which restores lost facial scar volume. Following the procedure, patients can expect bruising for up to 1 week.
Soft tissue fillers have been used for decades in the correction of surface deformities. Several factors must be taken into consideration when choosing a filling agent, including: duration of filler, anatomic location, depth of scar to be filled, risk of allergic or granulomatous reaction, and risk of infection.
Hyaluronic acid consists of alternating residues of D-glucuronic acid and N-acetyl-D-glycosamine that can bind up to 10,000 times its weight in water. It is found throughout the body in connective tissue as well as in synovial tissue and fluid. Hyaluronic acid is marketed as Restylane, Juvederm, Teosyal,Restylane SubQ, all of which have been approved by the FDA for superficial rhytides. All these formulations are composed of stabilized hyaluronic acid at 20 mg/mL but have varying sizes of injected particles.
Ellansé is made of Poly-caprolactone (PCl), which is a well-known totally bioresorbable soft medical polymer. Ellansé is dermal filler providing immediate results, as well as biostimulation inducing neo-collagenases, it has longer-lasting and sustained results.
We pride ourselves to be the very first leading clinic to introduce the revolutionary Ellanse dermal fillers which act as biostimulators of collagen; with the results lasting up to 2 – 3 years. Ellanse can help with deep acne scars and loose skin.
Radiesse is a Calcium hydroxylapatite (CaHA). It is a synthetic filler that typically lasts 12 – 18 months before subsequent injections are needed. Radiesse was approved by the FDA for the correction of moderate to severe facial folds, such as nasolabial folds, as well as treatment of HIV lipoatrophy. There is no need for a skin test prior to use, and the correction that is obtained is close to 1:1, meaning that no expansion of the implant will occur after injection. CaHA has been used for superficial depressed scars and acne scars.
Collagen Stimulation Therapy – Dermaroller significantly improves the appearance of facial and décolleté lines and wrinkles, sun damaged and ageing skin, acne scars and stretch marks. Dermaroller Therapy provides advanced micro-medical skin-needling, a procedure that stimulates the skin to regenerate and repair itself naturally and safely, creating smoother, brighter, healthier, younger-looking skin. Cosmetic needling achieves results through increased quantities and access of cell nutrients to the skin, scar tissue, thus optimising cell function. In addition, injury to the keratinocytes promotes the epidermal growth factor (EGF) and increases cell turnover.
CO2 laser resurfacing
Laser Performa fractional CO2 micro ablative laser skin re-surfacing laser can produce improvement in boxcar and shallow atrophic scars. Fractional CO2 micro ablative laser is a safe and effective way to treat acne scars, rough texture on the face, neck, chest, arms and hands and surgical scars, with essentially no downtime. Treated scar areas by the Performa CO2 fractional micro beams, called micro treatment zones, cause sufficient laser injury to promote new collagen production and result in facial skin rejuvenation.