Center of Dermatology and Laser Surgery of Philadelphia
Written by Dr. Ringpfeil
Scars can be minimized or even prevented by almost any energy-based device or laser while immediate wound healing is not yet complete. This is the 3-week window after an injury. An additional treatment is typically performed 3 months later.
Since 2017, we have routinely and successfully performed acne scar prevention with pulsed dye laser treatment. Persistent redness is known to hinder complete healing and is responsible for many pockmark-like scars that have traditionally been thought to only occur after cystic acne.
This is limited to skin where botulinum can safely be used without creating disfigurement, such as the area between the brows, the upper sections of the nose, the forehead and the sides of the eyes. Botulinum toxin is injected 14-28 days prior to the planned surgery for the best results.
You may choose to completely cover a wound with densely woven clothing or an opaque band aid. Mineral based tinted broad spectrum tinted sunscreens with SPF50 afford the best possible protection against the sun when total coverage is not possible or not desired. Sunscreens require reapplication every 2 hours when outdoors. Topically applied peptides
Developed for burn victims, topically applied powerful oligopeptides assure the speediest wound healing and re-epithelialization of skin. Nurture by RAD has what it takes to assure that sunburns, abrasions from an accident or intentionally induced by lasers or peels heal miraculously fast. This also reduces the chance of bacterial or viral infection hence preventing the risk of scarring.
Avoidance of elective surgeries, piercings, or tattoos.
Topical silicone sheets right after medically necessary surgery.
Scars are inevitable with injuries that are not just affecting portions of the upper most layer of our skin. Factors such movement, skin or fat or muscle deficit, or tension determine the final look of a scar. Unprotected sun exposure after the injury might add undesired darkening of a scar. It can take several year for a scar to show its final outcome but a scar is present as early as 3 weeks after the injury.
When a scar has formed, considerable effort is needed to improve its appearance and blend it into its surroundings. Patience is needed to improve scars to the best level that current therapies allow.
Scar treatments are among the core procedures performed at our practice.
We combine lasers, energy-based devices, punch grafts/punch elevations, excision, subcision, fillers, and chemical peel treatments to offer you the most effective and most cost-effective solution for your condition.
Treatment goals include improved texture, flattening or elevation of scars, pigment balance, or diversion of the healing vector, as well as other nuances. Every scar is different, and the context of every scar is unique. Therefore, treatment must be customized not only to the type(s) of scars but also to the surrounding skin as well as the ability to tolerate downtime. We offer experience and we offer every technology that is state of the art for scar treatment, including permanent and temporary options. We combine treatments for best results. We use experience rather than pre-formulated plans when treating scars. We adjust treatment plans at every step of the way based on the outcomes that are achieved over time.
Schedule a consultation with our dermatologists or a complimentary screening consultation with our aestheticians to learn which treatment options are most suitable for you.
– Permanent repairFractionated lasers, ablative and non-ablative, help to smooth and retexturize scars, blend sunken or elevated acne scars to their surroundings, disrupts faulty collagen that pulls scars down, induced fresh collagen as a matrix to elevate scars. Fractionated ablative lasers might even repigment some depigmented scars. These lasers, once taunted to be only safe for light skin, can be safely adjusted to all skin colors.
Fractionated radiofrequency treatments are color blind because microneedles deliver treatment under the skins surface. They sever faulty collagen that pulls scars down by creating precise layers of horizontal interruptions to improve box car scars and untethered rolling scars.
Laser peel (CoolPeel) creates a smooth surface in skin color of all ethnicities.
Picosecond lasers treat acne scars of the ice pick and box car scar type and improve post inflammatory hyperpigmentation. They afford safe inclusion of all skin colors.
Punch excision removes isolated ice pick scars. This technique is followed by preventative laser treatment.
Punch grafts are usually followed by superficial resurfacing to achieve smooth results after filling large ice pick scars or small box car scars.
Subcision frees up tethered rolling scars.
TCA CROSS – Chemical Repair Of Skin Scars uses high percentage trichloracetic acid to shrink facial ice pick scars in areas where skin can contract.
Tattoo pigment can be placed to conceal a scar.
Z-plasty refers to excision of scars that occurred under high tension and is used also prevention for tension. This technique is followed by preventative laser treatment.
– Temporary repair
Filler – temporary and permanent fillers can achieve beautiful results in sunken scars for a period of a 6 months to 3 years. In rolling scars, they can achieve a smoother contour through redraping the skin. Permanent fillers do not adjust to our facial skin and contour which is bound to change over time. Hence, we prefer temporary fillers that allow precise correction every time and when results have faded after filler has been fully metabolized.
Make up primer – a nifty tool that not only the pros use to erase deep scars for a flawless photo ready face.
Microdermabrasion- a series of 3-6 treatments every 2-4 weeks down-regulates oil production and upregulates collagen production for a few months.
Microneedling +/- exosomes or PRP/PRFM – a series of 3 treatments every month makes your skin plumper looking for 6+ months. Exosomes will rejuvenate skin at the same time.
Peel (glycolic acid and TCA)- a series of 3-6 glycolic acid peels will even shallow contour irregularities, reduce pigment irregularities, and superhydrate skin for several months. A moderate percentage TCA peel will shrink pores and fine ice pick scars for about a year.
| Fractionated RF | Fully ablative CO2 laser | Picosecond laser | Fractional CO2 laser | Non-ablative fractionated laser/FRAXEL | TCA Peel | Photodynamic Therapy | Subcision | Fillers | Punch grafts | |
| Hypertrophic scars | – | ++ | – | + | +++ | – | – | – | – | – |
| Ice pick scar | + | + | +++ | + | + | +++ | – | – | – | ++ |
| Box scar | +++ | ++ | ++ | +++ | + | + | + | + | ++ | ++ (if small) |
| Rolling scar | +++ | ++ | ++ | ++ | + | – | + | +++ (Tethered rolling scars only) | ++ | – |
| Large pores | + | +++ | + | +++ | + | ++ | +++ | – | – | – |
| (uneven) Texture | +++ | +++ | +++ | +++ | + | ++ | +++ | – | – | – |
| Days downtime | 1-3 | 7-14 | 0 | 4-7 | 2-8 | 5-7 | 2 | 7-21 | 0 | 7 |
| # Treatments | multiple | 1-2 | multiple | multiple | multiple | multiple | 3-6 | 1-2 | 1 | 1 |
| Lasting results | permanent | permanent | permanent | permanent | permanent | 1-2 years | permanent | permanent | 6-18 months | permanent |
| Price per treatment | $550 | $3000 | $550 | $550 | $550 | $550 | $650 | $550 | $680+ | $250+ |
For most individuals, acne should be controlled before embarking on treatment. Acne conglobata treatment may start while acne treatment is ongoing. Most non-ablative laser or energy-based device treatments can be started 30 days after completion of isotretinoin treatment.
Patients ask Dr. Ringpfeil answers
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