SCARS

Why is it that after a wound or cut the skin responds with a thick, anti aesthetic scar?

Upon a wound the body’s natural physiological response is through inflammation and then a second phase in which the skin is repaired by forming a scar that resembles the skin. When this process does not occur easily such as on the back or neck where the skin is stiff (taut), taking medications such as anabolic steroids is advised to avoid an infection or any other genetic factors.

Are these scars prominent or sunk?

They are prominent simulating a macaroon. There are two types: hypertrophic which is reversible. The repair fibers are arranged in order. Then there is keloid, which is progressive, painful and can be disfiguring. These repair fibers are arranged in disorder forming tangles. Fibroblasts multiply and impair healing.

Are scars left by a severe acne easy to treat?

Patients frequently visit our institute because of this nature. Despite being a challenge we get good results. It all depends on the aggression of the wounds. There are different surgical techniques: lifting them, using a dermo roller (works great with certain type of scars) fillers, laser, etc.

As far as keloids, is cosmetic surgery a reliable treatment?

An experienced dermatologist knows that there is no room for error. Otherwise the problem will get worse. The dermatologist must provide a correct diagnosis and not confuse it with cutaneous muscle tumors. We have optimized our protocol due to my experience by defining age of keloid and location. If it is active (itching and erythema) we will choose the best treatment to obtain optimal results: cryosurgery + steroid injections, injections of bleomycin, vascular laser, radiotherapy, preso-therapy, etc.

What are the surgery risks for those patients who have a history of anti aesthetic scars?

The surgeon must conduct deep sutures in his intervention and grip the superficial cutaneous tissues to eliminate tension. In addition the application of compression bandages and a silicone gel is completed. A follow up visit is scheduled to control wounds at 1 and 2 months to treat scars immediately if they are healing inadequately.

Protocol

Pablo Umbert Institute Corachán Clinic (CC)
Beauty Derm Service (Annex CC): laser, surgical and dermoaesthetic technologies

INTRODUCTION

Dr. Pablo Umbert and collaborators perform a prior examination, age, location, degree of pigmentation, age of the scar or scars and their etiology.
Observe other body scars
The emotional and psychological state is important
We evaluate the different options, specifying the different techniques.

Months of little sunshine.
Explanation of the procedure to be carried out with images of similar cases.
Number of sessions.
Time required for post-treatment (“Day time”).
Possibility of mixed treatments.
Different technologies, which we adapt to each patient.
Costs.

PROTOCOL DESCRIPTION

General clinic visit, assess mentioned parameters.
What medications do you take.
Seasonality.
Dermatological assessment: pigmentation, skin aging, previous treatments.
Pretreatment preparation.
Preventive antiherpetic treatment.
Informed consent.

TYPE OF SCAR

Individualized treatments depending on: Shapes: point or peak, valley, square, triangular, linear.
Depth; papillary, medium, deep dermis.
Hypertrophic, hard or keloids: LASER COLORING is the star associated with infiltrations, topical application of silicones and compression methods.

PROCEDURES

	Day Time	Duration	Anesthesia	No. Sessions	Cost
Peelings	+- 2 – 4 days	30 min	+- topical	1	+
Dermoroller	1 day	30 min	+- topical	+- 3	++
Laser Resurf. non-ablative	+- 1 day	20 – 30 min	+- topical	2-3	+++
Laser Resurf. ablative	4- 6 days	40 min	topical	+- 2	++++
Plastic surgery	1 day	+- 45 min	Local	1	Variable
Refill	+-2 days	10 min	No	+- 1-2	Material and quantity
Dye Laser; hypertrophic scars	No	5 min	No	+- 2-3	+++

CONCLUSION

Dermatologists are experts in the biology of the skin, the anatomical structures, such as the reactivity of the skin in scar formation. Each scar must be assessed individually. In most cases we use mixed techniques.

CASES: BEFORE AND AFTER

Dr. Pablo Umbert Millet

Director of Instituto Pablo Umbert · Dermatologist and Dermatopathologist

Dr. Pablo Umbert is one of the leading experts in clinical dermatology, dermatopathology, and Mohs micrographic surgery in Spain. With over 30 years of experience, an international career at the Mayo Clinic and Saint-Louis Hospital in Paris, and more than 100,000 biopsies signed, he remains active as an emeritus professor at Hospital Universitario Sagrat Cor, where he supervises clinical cases and trains new generations of dermatologists.