Every scar is different. The cause of the scar, the age of the scar, the scar size and site, the timing of treatment, degree of response to treatment and patient’s individual’s genetic all play a role in the management decision process.

With scarring process that is complex and still not yet fully understood, the “Cookie Cutter” approach to scar management is less likely to achieve best outcome. Multi-modalities treatment approach has also be shown to be more effective than single treatment method.

The Scar Clinic offers a full range of different evidence-based treatment modalities to tailor the management regime to suit the scarring condition and the patient. Regular reviews also ensure the regime is modified over time as the treatment demands changes.

Scar Revision Surgery / Scar Excision Surgery

Often the simplest way the improve the scar is to perform surgical scar excision and a direct repair. A meticulous wound closure, combined with non-surgical scar care and regular review may all that is required. The timing of surgical repair has traditionally been focus at delay approach, 6 to 12mths after the initial injury. This approach has now been challenged and in appropriately selected cases early revision may be a more effective and efficient approach.

Local Flap Repair

Flap is a method of reconstructive technique utilising spare / loose tissue near the scar to resurface a defect after the scar has been excised. This is often required to treat larger or severely contracted scars, usually in conjunction with deeper scar release. Local flap repair is a more complex surgical procedure than simple excision, so the flap design and execution are generally performed by plastic surgeons.

Fat Grafts / Liposuction

Some scars have a more complex 3-dimensional deformity and fat grafts &/or liposuction can be an effective way of addressing contour deformities. Fat grafts typically involving liposuction from areas of abundance and injected subcutaneous into or under the scar to improve texture. In combination with laser therapy, it can be a powerful way to improve some contracted scars.

Laser and Energy based Devices

Laser and other energy-based devices are increasingly utilised treatment modalities in scar management. Laser encompasses a wide range of machine each with different wavelengths and energy level focusing on a specific part of the skin. In scar management, each wavelength or wavelengths targets a different component of the scar to produce the desired results. Depending on the scar characteristics, a single or combination of devices are utilised over several sessions.

Commonly used laser and energy based devices are

• IPL
• Nd:YAG
• ResurFX (fractional non-ablative laser)
• CO2

Intralesional Steroid injection

Intralesional steroid continues to be one of the most effect way to treat or control a problematic scar such as keloid scar. Dose and frequency varies depending on the severity, and often utilised in conjunction with another treatment modality. Injection technique is important to minimise associated pain or avoid complication such as fat atrophy.

Other types of intralesional injection such as 5-FU are occasionally implemented depening on the scar type.

Silicone Therapy

Silicone gel or tape are the most commonly available scar management on the market. Exact mechanism of action is not fully understood but maintaining a stable barrier to increase moisturization of the scar is the current theory. Useful for many but not all the scar type, the timing frequency and length of application is discussed during a consultation.

Radiotherapy

Generally not the first line of treatment, radiotherapy in scar management is considered for high risk patients with complex keloid formation, or recurrent keloid or failed previous management. Timing of its use and choice of combination therapy such as surgery requires careful clinical consideration and a precise planning.