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Scars and stretch marks are some of the most difficult cosmetic conditions to treat, but can be the source of frustration for many people. At the Dermatology Institute of Southern California, Dr. Daniel Behroozan and his dermatology team offer a variety of options to help treat the most stubborn stretch marks and scars that may be bothering you.
The formation of scars is a natural component of the body’s healing process after an injury. Scarring develops as the body proceeds to rapidly close an opening in the skin. Damage to the top layer of skin often only requires the production of new skin in its place; however, for damage deeper than the first layer, new scar tissue develops since the body must form new collagen fibers to mend the damage and bring the skin back together. Because the body is rushing to heal the wound, this collagen that forms scar tissue is thicker and less flexible than the rest of the skin. Initial scarring may be minimal, but scars can become enlarged and discolored over the next 4-6 weeks.
Some scars can fade over time, and the narrow bands that appear may eventually sink beneath the skin. Scars are reddish in color when they first appear but may become lighter and looser as time goes on. The development of a scar can take up to one year to fully mature. The healing process is complete when a scar is light in color, smooth, and is no longer sensitive to the touch. The outermost layer often loosens a bit while the deeper layers remain intact.
The appearance of the scars depends on a myriad of factors:
Because there are many factors that can determine the appearance of a scar, two similar scars can look very different due to the cause, wound, body part, and how they were cared for.
The type of scar that develops can be classified into one of 6 categories:
1) Hypertrophic scar: Raised scars that are often red. The body produces high amounts of collagen, which in turn causes the scar to be a bit raised. The amount of scar tissue that forms does not extend beyond the initial wound site or injury. These types of scars tend to flatten a bit over time, but this can take several months or years.
2) Keloid: An overly aggressive healing process that causes the scar to be much greater in length and scope than the initial injury. Keloids will never go away without treatment. These scars extend beyond the initial wound site or injury.
3) Contracture Scar: These kinds of scars cause the skin to tighten and can affect movement if they are located near a joint. They can extend beneath the skin’s surface, and can possible impact muscles & nerves. Contracture scars are very common after burn injuries.
4) Atrophic scar: These scars are sunken or pitted in appearance. They occur when underlying structures, such as fat or muscle, diminish over time, or when inflammation causes damage to the skin’s collagen. These kinds of scars are prevalent with surgical scars and acne scars. These scars are also common with chicken pox as well. Acne scars in particular can be divided into separate subcategories of their own, and can get more pronounced with age as the skin loses even more collagen and elastin.
5) Cicatrix scar: These scars are flatter in appearance, and tend to be pink or reddish in color when they first begin to appear. They can be a bit itchy or painful as well. As the skin continues to heal, they will begin to smoothen out. Flat scars are very similar to the color of the skin, although they may be slightly paler or darker. Proper wound care may facilitate the development of a cicatrix scar as opposed to a hypertrophic (raised) scar.
Striae, commonly known as stretch marks, are the sixth type of scarring. They appear when the skin is rapidly stretched in a short amount of time, such as growth spurts or pregnancy. The abrupt change causes the collagen and elastin that supports the skin to rupture. The body then proceeds to fill in these sudden gaps with scar tissue. Stretch marks can also appear when the skin is under tension, such as near a joint during the healing process. Multiple breaks between the connecting skin tissue causes a series of these wounds, and they may appear red, purple, or dark brown when new. Fluctuating hormone levels can play a role in their formation as well. Those who have a family history of stretch mark development also have a higher risk of stretch mark development. Common locations for these include the abdomen, thighs, upper arms, buttocks, and lower back.
They can lighten over time, and it is possible for these stretch marks to be raised or sunken a bit on the surface of the skin. Stretch marks tend to form in areas where fat is commonly distributed, and are most commonly associated with pregnancy, rapid weight gain/loss, and growth spurts during puberty. Those with certain medical conditions such as Cushing’s Disease and Marfan Syndrome can also be more susceptible to stretch marks. Stretch marks can also develop from those who have excellent workout regimes that result in fast muscle growth!
Scars and stretch marks become more difficult to treat the older they are. Getting them treated quickly and early allows for the best chances of obtaining the best results.
Despite the amount of products available, there is NO treatment currently on the market that can get rid of these, or any of the other forms of scarring quickly. Scar and stretch mark reduction require consistent treatments over a long period of time, and often require more than one treatment method used in conjunction with one another – in addition to proper skin care maintenance. Be *very* cautious about any products or providers that can claim otherwise.
For patients who have an unsightly scar that they don’t want, there are many treatment options available. Acne scars in particular are difficult cosmetic conditions to treat, and these scars will never disappear on their own even when acne is under control and breakouts no longer appear.
A myriad of research has been conducted on treatment options for scar removal and stretch mark reduction. As you may have noticed, there is no shortage of creams, lotions, and gels available that say they can treat these conditions. While some of these products can help, no single product is universal, and what is effective for one person may not yield the same results for another.
Some rules of thumb are:
Some body types are more prone to different scar appearances. For instance, those of African American descent are more likely to form hypertrophic scars, and are also more susceptible to the formation of keloids. Individuals with fair skin are more likely to have differently colored scars that stand out when compared to those with darker complexions.
Wounds that are larger and deeper in size require a longer healing process, which in turn makes a higher opportunity for scarring. Larger incisions are more prone to movement stress. This causes the healing process to require more time to complete, and the scar may be more noticeable due to the constant movement interrupting the process.
Smoking not only slows down the healing process, but also increases the risk of larger scars. Frequent consumption of alcohol while the wound is healing dehydrates the body and skin.
Those who are overweight are also at risk for larger scars, as the fat underneath the skin can impede the skin’s ability to close the wound tightly and seamlessly.
Scars are one of the most difficult cosmetic conditions to treat. Generally, the older a scar is, the tougher it is to get rid of. Because scar development is a natural bodily function, there is no way to stop a scar completely; however, their formation can be limited in the beginning stages as the body heals.
Stretch marks in particular are rather tricky to treat. These become a lot more difficult to treat later on, so it is advised to get these treated as soon as possible for the best chances of obtaining the best-looking results.
Microdermabrasion – This treatment uses an abrasive surface to gently sand away the thick outer layers of skin. The skin then begins to form new tissue that smoothens out the treated area and provides a more uniform appearance. This is an option for small scars on the face that aren’t very deep. In addition, microdermabrasion can be used to treat fine lines wrinkles, age spots, sun damage, and acne as well. Microdermabrasion usually does not require anesthesia or numbing agents.
Laser Skin Resurfacing – lasers help break up the fibroblasts on raised scars in order to make them flatter and lay more evenly with the skin. These are aimed directly at the scars so that surrounding skin is not affected. Collagen is stimulated and then grows to remodel the area. The new repair of the fibers creates a smoother appearance, and a visible reduction in the look of the scar and stretch marks. They can also increase the ability to move in instances where a scar may limit movement. Treatments last approximately 30 minutes. Multiple treatments are often required depending on the age and size of the scar/stretch marks. Redness, tenderness, and some swelling is common, and will clear up on its own within 1-3 days. Some slight bruising is possible as well, and this will also clear up on its own within 3-10 days.
While lasers can be used to treat almost all types of scars, patients with conditions such as psoriasis, dermatitis, and cystic acne may not be the best candidates for lasers, and will require other methods.
Dermal Fillers – these are an option for acne scars. They can help fill in the appearance if sunken pits and grooves in the skin.
Microneedling (Collagen induction therapy) – Microneedling can be an effective treatment for scars that are lower in the skin, such as acne scars and stretch marks. Microneedling breaks up the collagen on the existing scar, and stimulates new collagen growth in the affected areas in order to add more volume and a smoother consistency in the skin. This treatment is widely used for patients who are prone to hyperpigmentation. In addition, microneedling also has the benefit of being able to treat fine lines and provide overall rejuvenation of the skin on the face.
Chemical Peels – Chemical peels remove the top layer of skin in order to regenerate new tissue. This treatment is best for surface level scars and scars that aren’t very large in size. In addition to improving the appearance of these surface level scars, it also reduces the appearance of sun damage, color irregularities, and can provide overall brightening of the face.
When performed correctly, the side effects from most of these treatments are minor and temporary. After a treatment, you can expect redness and swelling, which disappears and fades in a few hours to a couple days at most.
*Remember – scars & stretch marks cannot be 100% removed, no matter where you go or what method you use, as they are a natural process of the body. These treatments are intended to improve the appearance of the scar, not eliminate it completely.
Scars can be a source of discomfort and self consciousness, and are one of the most difficult cosmetic conditions to treat. Each person has their own unique marks, and so a thorough consultation is required in order to determine the best way to improve the appearance of scars and stretch marks.
Successfully treating a scar’s appearance requires a plan, and most of the time this plan consists of more than one treatment being carried out. For instance, treatment of acne scars may require both, a laser as well as a dermal filler for a particularly deep acne scar. Stretch marks often need multiple treatment sessions performed in order to create a noticeable difference. In addition, part of the treatment plan also requires maintenance at home from your end, which your physician will be able to provide you with more information about.
Dermatologists have the specialized training required to be able to determine the best treatment methods for you based on your particular scarring, your lifestyle, and your health (eg: medication, diabetes, whether or not you get cold sores). Dermatologists also have the training and experience to tell you when to treat a new scar as well, since scars can take up to one year in order to develop fully. Your age and how long you’ve had the scar also affect what treatment options are best for you in order to reduce your scar’s appearance. For instance, large hypertrophic scars can be mistaken for keloids, and vice versa. These two both require completely different methods of treatment, and since time is important with scar reduction, consulting a board certified dermatologist such as Dr. Behroozan ensures that you can start the correct treatment early.
Many patients think that treating scars often requires surgery, especially since surgical scar removal methods are frequently offered from plastic surgeons. These surgical techniques have the potential to make scarring even worse, and can require downtime. These methods are only one option out of many for treating scars, and most treatment options are non surgical.
In addition to scars, a physician will also be able to assist you with other concerns you may have besides your scars. For instance, lasers and microneedling are also able to treat other cosmetic concerns such as fine lines and wrinkles while simultaneously being able to treat scars as well. Skin cancer can also be mistaken for a scar. There have been times when people believe they have a simple scar even though they don’t remember injuring their skin at all. Like scarring, treating skin cancer early is the key to having successful recovery and results. Whenever you see something of concern on your skin, get it checked as soon as possible.
No matter the treatment you receive, it is important that these procedures are performed safely. Improperly performed treatments, especially lasers, can result in burns and even worse scarring, and these occurrences of botched treatments are unfortunately prevalent. The skill of the person performing the treatment is more important than the treatment itself, as this directly affects the results. Without expert, specialized knowledge of the skin, the treatment you receive may not give you the results you are looking for. In a dermatologist’s hands, side effects are usually minor and disappear within a couple days at most. A board certified physician, such as Dr. Behroozan, ensures that your safety is always the number one priority.
Home remedies such as almond oil, cocoa butter, oilive oil, and Vitamin E are commonly touted as self treatment methods; however, these products do not have research that proves their effectiveness.
The biggest downside to these OTC and home treatment methods is that they are all expensive. They require repeated use over a long period of time, and this can require multiple purchases. Because the results take many weeks or months in order to determine their effectiveness, you won’t know if these products are working until you’ve already purchased multiple sessions and invested a lot of time into these to no avail.
Receiving verified, proven information from a board certified professional ensures that you obtain the best results possible, especially when compared to sketchy information from the internet that doesn’t have sufficient research or evidence to back it up. Even OTC treatments such as silicone gels are not universal for everyone. Receiving information from a dermatologist limits the amount of trial and error you will need to conduct on your own, which will save you both, time and money in the long run (time is especially important when it comes to scar healing). Dr. Behroozan also offers products such as medical grade sunscreen at both of his locations in order to ensure that you have everything you need for a complete scar reduction regimen.
Sun exposure should be limited as much as possible before a treatment. No tanning should be done at least 2 weeks prior, and sunscreen with SPF30 or higher should be used every day. Let your doctor know about any medications you are taking or conditions you have as well before your treatment.
Smoking not only slows down the healing process, but also increases the risk of larger scars. Frequent consumption of alcohol and high amounts of caffeine while the wound is healing dehydrates the body and skin, and should both be avoided in the interim.
Because these treatment methods require breaking up the old scar and the body must develop new collagen in its place, results will continue to improve over 3-6 months usually. This does vary, however, depending on the treatments used and your body’s own natural healing process. Multiple treatments may be required as well, which can affect the timeframe. Your doctor will be able to provide you with a better timeframe of when you can expect to see results after your treatment regimen has been completed in full.
Taking care of a new wound as soon as you receive it is one of the best things you can do to mitigate the appearance of a scar. Some things to keep in mind are:
Hydration – Proper hydration is especially important while a scar is healing. Scars should be kept well moisturized and well hydrated. It is a misconception that scars should be aired out to dry. This not only causes scabbing which takes even longer to heal, but can potentially cause even MORE scarring.
Nutrition – Having a balanced diet with adequate protein intake is important. Protein makes up the building blocks of healing skin, and facilitates the healing process. Additionally, excess body fat in those who are overweight can impede the skin’s ability to close the wound seamlessly. A healthy body weight ensures that the body is able to perform the healing process more efficiently.
Sun exposure – UV radiation from the sun is bad for the skin, and in the case of scarring, can make them appear darker and allow more discoloration. Sunscreen with at least SPF30 or above helps limit the discoloration and protects against the radiation from the sun.
Cleanliness – any bandages or wrappings that are used in the area need to be kept clean. The wound should be properly washed and maintained in order to wash out any germs and debris. Hydrogen peroxide should be avoided, as this damages the skin even further. Instead, fresh wounds should be cleaned using soap and water. Stitches are recommended for deeper scars, as this helps the skin heal more smoothly and minimizes the appearance of the scar.
There are many common home remedies that are said to help with reducing the appearance of scarring and stretch marks, such as aloe vera, honey, olive oil, and cocoa butter just to name a few. Some of these remedies do help soften and exfoliate the skin, and don’t do any further harm. However, no studies have proven these treatments to be effective in reducing the appearance of scars. The treatments offered by a medical professional have research and evidence to prove their effectiveness in reducing the visibility of scarring & stretch marks.