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>> Scars are an abnormal response to healing,
either after an injury
or surgery, for example, with an incision.
Scars, however, may heal abnormally
and cause symptoms like itching, pain,
thickening, or tightness.
Therefore, managing these scars correctly
is very important so that we can
improve our outcomes for our patients.
One of the things that we focus on
is how does the skin heal
and how can it be rehabilitated
after this type of injury or incision.
Therefore, the overall outcome is dependent on
interventions that we may do after an injury or a surgery.
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Scars can be managed both surgically, but also medically.
It's important to note that there are many
noninvasive ways that we can treat a scar.
The simplest, perhaps, is massaging the scar
to remove some of the extra swelling that is present.
Also, scars need to have moisturizing agents applied,
as well as sunblock to help prevent pigmentation changes.
However, scars can become thicker, as well as tighter,
and can contract or shorten.
To address this, one of the first things that we recommend
is using silicone sheeting which helps to
soften up the scar a little bit.
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About 10 years ago, we realized that different lasers
could be utilized to help treat scars,
especially the abnormal scars that form
after injury or surgery.
The scars actually target different components
of the scar that are abnormal,
so rather than excise the scar with a scalpel,
we have found that the scars can be rehabilitated.
That is, we can actually address
some of the abnormal properties of the scar.
For example, a pulsed diode laser is used
to decrease the inflammation
by, essentially, cauterizing some of the small blood vessels
that keep a scar inflamed.
Another technology that we've used for the last 10 years
is fractional carbon dioxide laser resurfacing.
This particular laser targets water that collects
within the swollen scars and vaporizes that tissue.
What's vert interesting is that
the scar itself
will remodel
into a more natural
scar
than what the patient may have experienced.
The fractional CO2 laser sets the stage
for the scar to remodel and actually regenerate
some of the abnormal or missing elements of the skin.
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Prior to the introduction of lasers,
we would tell patients they would require
multiple surgeries to address their abnormal scars.
With the advent of laser therapies though,
we are able to modify the skin,
sometimes without the need for any surgery altogether.
This is really an exciting new development
that has occurred just within the last few years.
Lasers will help us to reduce the need for surgery
and sometimes eliminate a procedure altogether.
A good example would be a patient who has a contracture
over a joint or a shortening of the skin.
In the past, we might have to put a skin graft
or even bring other tissue in to resurface that area.
Now, with the use of lasers,
we can decrease the need for that reconstruction,
shorten the procedures, as well as the recover time,
and sometimes even eliminate surgery altogether.
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One of the great things about user lasers now
for reconstruction is that this has
greatly reduced the need for admission to the hospital.
Lasers themselves do hurt quite a bit
and we do need to use general anesthesia
or some type of deep sedation,
but these are very quick procedures,
extremely safe, and are done on an outpatient basis.
Sometimes, however, when we combine
a laser procedure with a surgical reconstruction,
admitting the patient overnight is helpful.
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Recovery after laser treatment depends on
the total area that we treat,
as well as the type of laser that is used.
The pulsed diode laser feels like a rubber band
being snapped on your skin,
which, of course, is not very comfortable,
but if we have to do this over a large area,
we do need to have some sedation for the patient.
However, afterwards, the patient feels like
they've got a minor bruise to that area.
The fractional CO2 laser does hurt quite a bit
as this is an invasive laser
that actually causes vaporization of the tissues.
One usually has a little bit of stinging for about 24 hours,
but in general, patients can get back
to school and work and to social functions
within a couple of days.
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Health insurance does cover most scar revisions,
whether it be through an open surgery
or through laser modification of the scar.
We look at scar revision as a reconstructive procedure.
We are reconstructing form and function of the patient.
There are some aesthetic or cosmetic benefits,
but there are also a number of functional benefits
that the patient will experience.
These benefits include reduction in pain and itching,
but also improved mobility and range of motion
of joints, for example.
So, most insurance companies will cover laser surgeries
and other scar revisions,
but there is a pre-authorization process
that does require documentation
that there is a limitation in form or function.
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Johns Hopkins is really an ideal place to come
for scar revision and treatment for many reasons.
First, we've got a very caring and experienced team
who understand the patients, their needs,
and their goals for treatment.
Secondly, we have access to a wide array
of state-of-the-art laser equipment and technologies
to help us treat these scars.
And third, we have many dedicated professionals
who have expertise in physical therapy,
occupational therapy, and pain management,
all of which are combined to help take care of our patients.
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