Scars form as part of the natural healing process when the skin is cut (as in surgery) or injured. There are four main kinds of scars. Atrophic scars are indentations or depressions that form in the skin, like acne scars. They can vary in size, shape and depth. Hypertrophic scars are thick, red, raised scars that form within the boundaries of a break in the skin. Keloid scars are similar to hypertrophic scars. They are red or dark-colored, thick and raised and may also be itchy. But unlike hypertrophic scars, keloid scars are more aggressive in growth. The scars continue to grow in size and may extend well beyond the border of the skin injury. Contracture scars form after a loss of a large area of skin (like from a burn). As the scar forms, it pulls on the edges of the wound, causing the overlying area to tighten. A contracture scar that forms over a joint can interfere with the mobility of the affected limb. Contracture scars can also form deep into the tissues and affect the underlying muscles and nerves.

Many scars eventually heal on their own. Others fade with time, but remain noticeable. Generally, the more tension and motion in the area of an injury, the greater the chance of a slow-healing and visible scar. Younger people with healthy skin tend to develop larger, thicker scars than older people.

Reducing the Visibility of Scars

There are several options for reducing the visibility of scars. Some scars can be camouflaged with make-up. Injections of steroids or cortisone can shrink some scars and reduce the excess growth of scar tissue. Soft tissue fillers can be injected under the skin to fill in the depressions caused by some pitted or depressed scars. Dermabrasion can reduce the appearance of some scars by "sanding" away the top layers of skin. Chemical peels can remove shallow or superficial scars with chemicals that cause the top layers to "peel" away. A laser can also be used to resurface the skin and smooth the appearance of some types of scars.

In some cases, surgery may be used. In a punch graft, a tiny circular cutting tool is used to remove a circle of skin around the scar. Then, a section of undamaged skin of the same size is used to fill in the area. The new skin may be held in place with surgical tape or stitches. Punch grafts are best for deep or pitted scars, like those caused by severe acne. Surgical scar revision is a process in which the scar is surgically removed. Doctors then close the area using a variety of techniques that make the new scar less visible or obvious.

FRAXEL® for the Skin

Another possible treatment for some scars is Fractional Photothermolysis, or FRAXEL®. The FRAXEL laser energy reaches into the epidermis (top layer) and the dermis (the layer underneath). It resurfaces the epidermis and promotes the growth of new, plumper collagen in the dermis. But unlike other lasers, which broadcast a single ray or pulse of laser light, FRAXEL produces thousands of very narrow columns of laser energy, called microthermal zones, or MTZs. Using the analogy of pixels, FRAXEL laser beams hit 20 to 25 percent of the "pixels" in the target area of skin. The areas in between are untouched. The controlled pinpoint areas of damage enables the skin to heal at a much faster rate than if the entire surface area had been treated.

Since only a small surface area is treated in a session, several treatments are needed. On average, most patients have three to five sessions spaced two to four weeks apart.

FRAXEL treatment can produce mild pain or a stinging sensation. Patients are typically given a topical anesthetic prior to the start of the procedure. Doctors can also use other techniques to minimize discomfort during a treatment session. Afterwards, patients may feel like they have a mild sunburn. However, cosmetics can be applied soon after the treatment is over. Mild pain and some swelling may persist for two to three days. The skin can have a pink coloring for five to seven days. As with a sunburn, the skin may turn a bronze color and then flake.

Uses of FRAXEL for Scars

FRAXEL is currently approved for treatment of acne scars, age spots, melasma and wrinkles around the eyes. Research also suggests it can improve the appearance of existing scars by 51 to 75 percent.

Cosmetic Dermatologist, Cameron Rokhsar, M.D. recently completed a study to look at the ability of FRAXEL to reduce the appearance of fresh scars. The pilot study involved a group of patients who had a benign or cancerous skin lesion removed. Treatment was started when the sutures were removed or within two weeks after suture removal. FRAXEL was used on one-half of the scar. The other half was left to heal on its own. After a series of five treatments (about three months later), the FRAXEL-treated side showed a 50 to 70 percent improvement in appearance compared to the non-treated side.

Rokhsar says FRAXEL therapy is a cosmetic treatment and not typically covered by health insurance. The average cost is $500 to $800/treatment.

For information on the FRAXEL® system or referral to a physician, visit the company's website at http://www.reliant-tech.com.

For general information on scar formation or treatments:

American Academy of Dermatology

American Society for Dermatologic Surgery

American Society of Plastic Surgeons