It is almost impossible to find a person who does not have at least one scar on his skin. The healing of skin wounds, which inevitably occur throughout a person's life, is accompanied by tissue scarring. Small, thin and flat scars in inconspicuous places practically do not bother a person, but there is a special kind of scars that significantly affect the appearance and can become a serious problem.
Especially for readers of estet-portal.com, plastic surgeon Grishay Sergey Evgenievich spoke about effective and proven methods of treating keloid scars. Read the expert opinion of a specialist right now.
Sergey Evgenievich, tell our readers what keloid scars are and how they differ from other types of scar tissue?
If all layers of the skin are damaged, in an adult it heals with scarring. Scars can be normotrophic, hypotrophic, hypertrophic and keloid.
Keloid scars are often confused even by doctors with hypertrophic scars, and in order to make this diagnosis, there are & nbsp; clear criteria.
The keloid scar grows and always goes beyond the boundaries of the place where the injury was inflicted, that is, the area of the scar is larger than the area of the lesion. Keloid scars can grow to gigantic sizes, there have been cases when a keloid scar has grown constantly, and from a small dot it can turn into a soccer ball. A keloid scar can form after any skin injury: as an iatrogenic, & nbsp; and household.
In your opinion, what actions of the surgeon during the operation can provoke the formation of keloid scars?
No one specifically creates a keloid scar, it is formed if there is a predisposition of the body to its formation, and this can never be foreseen. It happens that it never occurred before, and then it took and spontaneously formed, with exactly the same injuries. Therefore, I always tell my patients that if we are treating keloid scars, then it is necessary to observe & nbsp; for at least six months, because during this period there is a scar formation as such. If a keloid scar wants to form, then we will see a trend towards its development.
How effective is the surgical treatment of keloid scars?
This problem is quite complex, and today there is no algorithm for the treatment of a keloid scar. Excision of such a scar gives a recurrence in about 90% of cases, that is, excision itself is ineffective for the treatment of keloid scars. Often, specialists use several combinations. I try to excise the skin with a scalpel, but the deep layers are already with a laser. It is believed that the laser has a better effect in terms of tissue trauma, and the wound heals better. If we are engaged in surgical treatment of keloid scars, it is necessary to remove the tension on the skin as much as possible, it should be on other layers, depending on the area on which the scar has formed.
Tell us about the innovations in aesthetic medicine that most effectively help in the treatment of keloid scars?
Currently, injections of glucocorticosteroid hormones, in particular betamethasone or diprospan, are used. Diprospan injections can also be used as a mono-method of treatment. I often use it if the keloid scar has not yet grown to a large size. In my practice, there have been clinical cases when 3-4 injections of diprospan with an interval of 3-4 weeks resulted in complete resorption of the keloid scar, and where the bump was, a flat area became. Yes, it is not perfect yet, it differs in color, but the scar is no longer dense, and you can use different types of laser resurfacing to correct the color. Silicone sheets or gels are also used to treat keloid scars. Currently, only plates have an evidence base in the treatment of keloid scars, but they are expensive. Gel is more economical, it is not enough to cover the scar area with a thin film. The application of the gel prevents moisture from evaporating, relieves tension from the skin, and I really see its effective effect on my patients.
In some cases, if classical methods do not help, we resort to the treatment of keloid scars with the help of radiation therapy: both remote and implantation, when radioactive materials are injected directly into the scar. Another interesting way to treat keloid scars – it is a compression therapy that is particularly effective in treating earlobe scarring. This method involves the use of two magnets that press the lobe on both sides. For compression in other places, compression underwear or squeezing with something else may be used, depending on the location of the scar.
Do these treatments for keloid scars help to completely get rid of the scar?
If a person has any scar, it is impossible to completely get rid of it by any method that exists today. The phenomenon of why wounds heal without scarring in young children is being intensively studied. Apparently, there is some ratio of stem cells or special proteins, growth factors, which in children have a special effect on wound healing.
Unfortunately, if an adult has a formed scar, then it will never be possible to remove it from this place.
It can be made less noticeable, thinner if the scar is hypertrophic or keloid – you can make it flat, inconspicuous, hide it in a crease, do laser resurfacing or dermabrasion, but unfortunately it is impossible to completely get rid of the scar. Treatment of any scars – it's quite a difficult problem and it often takes months or even years to get over it.
Tell me about a case from your practice related to this problem that you remember the most?
In my practice there were interesting cases. My last patient, a 30 year old male who had post-acne on the sternum. He turned to the district surgeon with a request to remove the "points" after acne, but the appearance after that became ten times worse. Approximately a year later, the patient came to me for help, and we decided that we would be treated with diprospan injections. A month later, the patient returned satisfied, said that those scars that were dense, like cartilage, became much softer, and the red scars became paler. We continued the treatment, and 4 sessions of diprospan injections made the convex, ugly keloid scars completely flat.
There were even cases of spontaneous remission, when the keloid scar grew, and then, without any treatment, it became smaller and almost completely disappeared. There were girls after earlobe piercings, whose keloid scar was the size of a walnut. In this case, we had to first excise the scar tissue, after which we made injections of diprospan, and for 2 months the patient did not contact us. At the 3rd month, the keloid scar recurred, we made another injection of diprospan, and the growth stopped. Now we do not see a relapse, absolutely everything is fine. I select the method of treatment of keloid scars individually for each patient, taking into account all the characteristics of his body.
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