Scars presents a significant aesthetic problem that can affect the self-confidence and the day-to-day performance levels of the patient. Acne, wounds and burns can undergo inflammatory processes that result in an accumulation of bacteria around the affected areas which hinder ordered regeneration of the collagen fibers, which are normally arranged in a crisscross fashion. Scars are customarily divided into two categories: new scars, that have formed not longer than one year ago, and old scars. The younger the scar, the easier it is to treat it and improve its outward appearance. Scars change in several stages until they ultimately become stable, when any effort to mend them will produce only modest results. Stabilization of a scar usually takes from one and a half to two years, so that within this period it is still possible to improve the final appearance of the scar. Therefore, an injury should be treated as soon as possible so that scars can be obscured. However, in the case of old scars, there is often no option but to resect them by surgical intervention after which they can be treated as new scars. The quality of the final scar will depend on a number of factors. A principal factor is what technique was employed to treat the original wound or blemish and how quickly this was done after the injury. If the wound was closed correctly, the resulting scar will benefit from optimal conditions and be minimal. Other factors that have to be considered are: genetics, exposure to sunlight, the position of the scar relative to the muscles, how much movement the scar will be required to undergo, etc. Exposure to sunlight is one of the main causes of pigmentation and hardening of the scar tissue. If the scar is protected from sunlight, the quality of the collagen fibers will be preserved and a more elastic scar, one that is more conducive to treatment, will result. Unfortunately, we still have no way of obliterating a scar entirely. Nevertheless, current techniques are capable of upgrading the scar significantly and of obscuring it so that it is barely perceptible.
In the form of gel or as a patch, has proven to be excellent for flattening and curing scars. Silicone gel is transparent and easy to apply, but can be expensive, especially if the scar areas are extensive. The silicone patch provides results that are as good or even better, owing to the mechanical pressure that the patch exerts on the treated area, with the advantage that this method is much cheaper. The drawbacks of the patch are that it can cause discomfort and is aesthetically unattractive especially if has to be applied to exposed areas like the face.
Laser devices are available that are suitable for scar therapy without peeling off or harming the outer skin layer (the epidermis). In this method, a laser beam penetrates directly into the dermal layer where the collagen fibers are situated. In this way, the appearance of the scar is vastly improved without affecting the epidermal (outer) layer of the skin. Laser treatment will take place over a period of several months, since the effects are gradual and accumulative, but there are no side effects. However, the high cost of a course of laser treatments can be prohibitive.
An additional advanced treatment method is the injection of hyaluronic acid into the scar in order to improve it. This substance encourages the proliferation of collagen and elastin, which fill the areas where these fibers are lacking and make the skin more elastic. This method is suitable for scars that have become depressed below the surrounding skin surface, since the hyaluronic acid serves as a filler and expands the scar.
Fat is excellent for treating depressed scars, both in view of the role played by fat as a natural filler, and because of the adipose-derived stem cells that it contains, which have positive, long-term influence in improving the quality of the scar.
In the many years of Dr. Gronovich's experience, he has found that the optimum treatment for scars is a combination of fat injection and laser therapy. This method involves implantation of fat and stem cells from the fat source (adipose-derived stem cells - ADSC) that are capable of developing into new cells after they have been implanted into the body. This is how the method works: The plastic surgeon separates the scar fibers that have formed the depression characterizing the scar, and injects the fat together with the stem cells into the space that has been created. The fat immediately fills the space, while the stem cells gradually differentiate into dermal (skin) cells that upgrade the quality of the scar. The second stage includes five laser treatments using a beam having the exact wavelength that will penetrate into the dermal layer, thereby coagulating and freeing the collagen fibers. This method has given excellent results in cases of facial scars, both those that have been caused by acne and those that have resulted from contusions and wounds.
The decision as to which treatment is appropriate for scars is made after a consultation at which the scars are thoroughly examined and the patient's expectations are assessed. The suggested procedure, its limitations for improving the scars and its drawbacks are explained to the patient.