In dermatology, there are many methods of scar smoothing that can improve the appearance of damaged skin.

For some patients, a single type is sufficient, while for others, a combination of different methods must be used to achieve the best result. The choice depends on the size, colour, thickness, anatomical location and position of the scar, previous therapies and the quality of the surrounding area.

Chemical peeling

In dermatology, chemical peeling refers to a procedure designed to visibly improve the texture of the skin by using exfoliating chemical substances. In the case of very mild and superficial scars, alpha hydroxy acids such as AHA, pyruvic acid and trichloroacetic acid (TCA) can be applied, while the appearance of medium and deep scars is improved by the use of a phenolic solution. In recent years, chemical peels to improve mature scars are increasingly being replaced by fractionated methods using lasers or radiofrequency, as they have fewer side effects and a better result.

PDL laser

It works by closing tiny capillaries in immature, red coloured scars. Thus, excessive collagen production, which causes raised scars that are hard to the touch, is reduced. The healing process should therefore be started early after surgery or trauma although no sooner than the day the stitches are removed, which will help to speed up healing and reduce the visibility of the scar. If the early period is missed, the scarring should be closely observed for at least the first one to two months after the injury. Itching, a sensation of one’s skin being too tight and pain that does not subside indicate an exaggerated response and thus either the formation of a keloid or a hypertrophic scar. And the longer we delay treatment, the more collagen is produced, the bigger and harder the scar. The process towards healing can only be controlled and stopped, as mentioned above, by an early PDL laser therapy and ointments, with compression therapy, silicone patches and by applying other treatment measures.

Dermabrasion

It is a method that can be used to smooth small hypertrophic scars.

Use of fillers

Hyaluronic acid, caprolactone and calcium hydroxyapatite are suitable for atrophic scars on the face and other parts of the body. Their greatest advantage is undoubtedly the immediate effect, while their disadvantage is the limited duration of the effect, depending on the mode of action of the filler.

Punch excision and grafting

These are two surgical methods used in dermatology and plastic surgery to correct atrophic scars, such as some acne scars. It can be performed before medium or deep chemical peels, laser resurfacing or sublative rejuvenation. A round knife is used to cut out the scar, which is then sutured with a thin thread. If the scar is larger, the plastic surgeon performs a skin graft.

Microdermabrasion

Suitable for very shallow atrophic and/or minimally hypertrophic scars. The device creates a vacuum which attracts sand grains. Depending on the indication, we can use different sized grains which travel at high speed from the reservoir through the nozzle to the skin surface, where they exfoliate some of the skin layer. The underpressure in the nozzle sucks the peeled skin and sand into the waste tank. The process must be repeated several times.

The so-called non-ablative methods, which do not damage the skin, can also be used to smooth scars. These include skin rejuvenation with certain lasers and a combination of laser and radiofrequency current. In the latter, by heating to a certain temperature, changes are achieved in the deeper layer of the skin or dermis, which in the short term triggers collagen remodelling and in the long term the formation of new collagen. The procedure is suitable for shallow atrophic scars, but several repetitions over a period of several weeks are needed to achieve the best result. The disadvantage is again the limited duration of the effect.

Laser resurfacing

The procedure is performed with lasers that can remove individual layers of skin. The most common are the Er:glass and superpulsed CO2 laser. On its way out of the device, the laser beam first damages the top layer of the skin or the epidermis, which is not enough to smooth scars in the long term. What is needed is controlled damage to the deeper layer or dermis, where healing mechanisms are triggered and new skin building blocks such as collagen, intercellular and elastin fibres are created. The latter is observed as a reduction in the depth of the scar and a smoothed edge.

The healing period lasts for different lengths of time. It depends on whether the entire top part of the skin has been removed or only certain areas have been removed in the form of a regular grid, which is called fractional photothermolysis. Thus, in the case of total ablation, healing takes a few weeks, while in the case of fractional photothermolysis it can take up to a week. The intact skin between the ablated areas allows for faster healing compared to a total ablative procedure where the epidermis is removed completely. The fractional photothermolysis procedure needs to be repeated several times, whereas total ablation is usually only performed once. The fractional superpulse CO2 laser CO2RE can be used on scars as young as one month old or on mature scars. Periodic repetition of the treatment gradually smooths the scar to the point where it becomes less noticeable.

Sublative rejuvenation

This is a newer method of smoothing wrinkles, scars and stretch marks, rejuvenating and restoring skin tone. It is a combination of non-ablative and fractional ablative methods. By contacting the electrodes with the epidermis and due to the bipolar radiofrequency that flows between the positive and negative electrodes, we achieve skin overheating in the exact place where we want it – in the dermis. The result is a direct, significantly higher and more extensive overheating over the surface, which causes thermal contraction of collagen molecules and the formation of new collagen, as well as intercellular tissue. Thus, in acne, trauma or surgery scars, we can expect blurred edges and reduced depth after several repetitions, and in stretch marks, a less papery appearance and increased skin elasticity.

Fractora

This innovative and advanced technology delivers radiofrequency (RF) energy to the subcutaneous tissue via pins that are heated to positively influence collagen formation. The result is healthy, radiant and rejuvenated skin, with restored tone and visibly reduced wrinkles, pores or scars. It is most commonly used on acne scars on the face and torso, laugh lines, cheeks, lip lines and stretch marks on the body. It is also suitable for smaller areas, such as the upper lip, where vertically running wrinkles occur.

Before the procedure, which takes between 45 and 120 minutes depending on the intensity of the energy used and the surface area, you will have a thorough discussion with your dermatologist about your expectations and preferences. You may notice small red spots, redness and/or slight swelling after the treatment, but these will disappear in the following days. It is important to follow the care instructions given to you by your dermatologist.

Compared to ablative lasers, the recovery time is shorter as the device’s fine needle tip works below the skin’s surface, which means that the epidermis is almost intact or only tiny red dots are visible, which gradually fade.

Fractora also allows for more intense results, however in this case the recovery also takes a few days, while less intense treatments need more repetitions, but the recovery is shorter.

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Appointments and further information

To book an appointment, contact us Monday to Friday from 8:00 to 16:00 on the following telephone number: 064 12 80 15 or send an e-mail: info@derma-rogaska.si