Wound and Scar Healing

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We all have the scars to prove that life happens, sometimes it’s marked by illness, accident or even just a bad bout of teenage acne. Dr Portia Gumede discusses how skin aesthetic treatments can help patients with darker skin types to improve the appearance of scars.

Treating scars are as important for a patient’s self-confidence as it is for their mental wellbeing. As an aesthetic doctor, I see many patients who feel self-conscious, anxious and even at times depressed about scars on their body, whether they’re visible to others or not. Scars serve as a physical reminder of life events, whether big or small, good or bad. But despite the reason, many patients would like to remove them in order to feel more self-confident.

Scarring as we know, is the skin’s way to heal and protect itself. However, not all skin types heal in the same way. Our genetics do play a role in how our skin reacts to injury. Studies have found that darker skin types (IV, V) are in many cases more prone to excessive scarring in comparison to skin types II or III on the Fitzpatrick scale.

Of course, the ideal would be to avoid scarring altogether, but we know all too well that this isn’t possible. So, when life does happen, how can we help patients with darker skin types to safely improve the appearance of their scars?

Let’s first understand the process of scarring

Our skin is quite good at taking care of itself – so good in fact, that when the skin is injured it immediately starts the repairing process. If the wound is so deep that the dermis is affected, it can’t replace the specialised tissue, thus the skin is repaired using collagen and elastin to repair the wound. This results in the formation of scar tissue. Furthermore, even after the wound is healed, the surrounding skin cells will direct collagen to the area, which can cause it to look irregular. This is when keloid, hypertrophic and atrophic scarreng occurs.

Taking care of a wound during healing can have a massive impact on the appearance of the scar

Operations often leave nasty scars, so it’s important to follow your doctor’s care and instructions to ensure that your scar heals as it should afterwards. Fortunately, not all scars are a result of an operation or an injury that requires medical care. More often than not, the skin is injured without ever necessitating a doctor, and its these wounds that still require special attention to ensure that the skin heals without leaving a bad scar.

If the injury does not suffice a trip to the hospital, start off by cleaning the area with mild antiseptic soap and water. Once the bleeding has stopped and the wound is clean, apply a barrier cream to keep the area from drying out. You can also protect it from further injury by using a bandage if necessary. Change the bandage and clean the area daily.

Once it’s healed, topical creams that contain vitamin E and retinol can improve the appearance of scars. Always apply sunscreen to the area when going outside, as it can be especially sensitive to sun exposure (this will also help reduce hyperpigmentation). If scarring is due to the patient’s struggle with acne, we first attend to treating this skin condition to prevent future scarring.

Improving the appearance of old scars depend on the type of scarring that has occurred

Hyaluronic fillers

Hyaluronic fillers can be used to treat atrophic scars. These are small but deep holes in the surface of the skin. When a blemish starts to heal, collagen forms, and in this instance, starts pulling the skin inwards which causes a depression. We can use dermal fillers to fill up the space by injecting it underneath the skin. Though this is not a permanent solution, it does provide patients with a smoother appearance for up to six months, where after they will need a touch-up.

Chemical peels

Skin resurfacing in the form of mild chemical peels are successful in improving the appearance of mild scarring caused by acne, cuts or illnesses (such as chicken pox) that cause lesions. Chemical resurfacing can be used on both atrophic and hypertrophic scars to rejuvenate the skin by encouraging the production of healthy skin cells for a smoother skin surface. Chemical peels also address hyperpigmentation that regularly accompanies scarring. A series of treatments are required to improve the appearance of scars.

Microneedling

Recently we’ve found that microneedling is also effective in treating atrophic and hypertrophic scarring in darker skin tones – however, I do recommend that you choose a doctor that’s experienced in using this treatment on darker skin. Microneedling both breaks up the fibrous scar tissue and encourages the production of healthy skin cells to smooth out the skin and improve the appearance of scars.

Laser

Laser resurfacing is another treatment that can address scarring. Just check with your doctor or aesthetician that the laser treatment they provide is proven safe to use on darker skin types, as older laser technology does not always accommodate darker skin. The heat generated by the laser stimulates healthy cell production, which can considerably improve the appearance of scars and post-inflammatory pigmentation.

Treating keloid scarring is the trickiest. I take it on a case-by-case basis. If a patient does have keloid scars, I would advise them to make an appointment with an aesthetic doctor or dermatologist to decide on the best course of treatment which may include steroid injections, applying silicone gel sheeting, freezing it off or surgery.

Written by Dr Portia Gumede.
MBChB, Diploma AAAM, Board
Certified AAAM. Owner at Dr P Aesthetics www.drpaesthetics.com

A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice. 

Issue 30 – June 2019 (Winter)

This article was written by Dr Portia Gumede and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine June 2019 Edition (Issue 30). 

A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skin care, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).

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