We were very excited to collaborate with Plastic Surgery Hub on a Facebook Live info session on scar repair. In case you missed it, here are all the questions we received and answers from our Clinician Manager Ann-Marie.
Q: When you ask anyone for the best scar cream or gel, everyone has a different opinion. What is your expert opinion and are any better than others? Are there any ingredients I should be looking for?
It is so true. There are so many products on the market and for the consumer, it is really hard to understand what’s going to work for you.
We look at key ingredients and use a combination of products. The first thing I’d like to mention is antioxidants. So when we think of a scar, we think of taking out the inflammation in the scar first. We can do that with antioxidants and anti-inflammatories.
There are three key ingredients; Vitamin A, Vitamin B, and Vitamin C, and they are your antioxidant vitamins.
A tyrosinase, or pigment, inhibitor is really important as well. It will prevent hyperpigmentation in the skin that can occur from scarring as well.
Then we also use a combination of silicone products, such as strataderm or stratamed for scars, which we’ll talk about later as well. These products kind of act as a band-aid over the skin.
We also recommend a collagen product, and we’ll dig down into that one when we talk about collagen in some of your further questions.
Q: I’ve heard LED is good to have before surgery to help with the scarring. Should I have it before and after? Are there any other non-surgical treatments you recommend?
LED lights are a great source of healing post-procedure, so it’s something we recommend our patients do afterward, specifically a red light that helps with healing. Also known as Phototherapy, it’s something we also use in clinics in combination with a lot of our lasers.
In terms of other non-surgical treatments, this is something we really specialise in at Rejuvenation Clinics of Australia. We have fractional lasers, also known as CO2 or Fraxel. We also have our newest laser, which is our Pico laser. That’s a newer technology in the industry and that’s where we’re driving our best results at the present time.
The Pico laser stimulates collagen, and at the end of the day, scar tissue is made of a collagen protein network, so we want to stimulate collagen in the dermal layer of our skin [the deeper layer] to either help flatten the scar or create a different structural integrity to the skin.
We often recommend Pico treatments to our patients [for scar repair]. Generally one treatment per month, between six and ten treatments total, depending on the scar, the history of the scar, and where it’s located.
The other benefit to our Pico laser is, in comparison to our CO2 and Fraxel lasers, there is less downtime, it’s not as painful, you’re back at work the next day, with mild redness, and quicker results than some of the older modalities. It can be used on many types of scarring, including surgical scars from tummy tucks or caesarians, as well as accidental scars from skin trauma.
Q: How do things like Pico work on older scars? 3 years old, history of keloids?
We have so many different types of scars, so keloid scars are usually raised, it can be quite red still, it can be a little bit shiny. For keloid scars, our general protocol is for you to come into the clinic and see one of our doctors, such as Dr Cussell [our Clinical Director]. He would do an assessment on the keloid scar first and he might do a cortisone injection.
The cortisone helps flatten and take down the inflammation in the keloid. Sometimes keloids can still be a little bit cranky, they can be a bit red and very vascular, so step one is generally a cortisone injection.
From there onwards, we start treating it with things like the Pico laser. Even in older scars, it’s completely fine to start using the laser treatment. We can also incorporate the LED treatment that we were talking about, but cortisone followed by laser is a really good stepping stone.
Q: Is dermabrasion good for helping to reduce scars? I’ve heard of people having fractional laser, but does it really work?
Yes, dermabrasion can help reduce scars, and yes, fractional lasers like the C02 and Fraxel that I was talking about before are fractionated, and they do work really well. We do still recommend a Pico laser, the reason being that fractional lasers drive heat and a photothermal response in the skin whereas our Pico lasers use a photoacoustic and cause a vibration in the skin.
The healing time is also different. The fractionated lasers have more downtime, more redness than our photoacoustic Pico laser, so that’s why we steer more toward our Pico laser rather than our fractionated lasers. Both are going to give you a result, but it depends on downtime, pain threshold and how quickly you want a response.
Q: I’ve got an old scar from my c-section about 10 years ago. What would you suggest is going to help with it, or is it too late? I kept thinking it was going to get better, but it’s still quite raised and red.
This is also a type of scar that we treat on a regular basis. If it’s still raised and red, it might be a keloid, and it’s still quite cranky. First of all, you would need to come in for a review, we would need to check if it’s a keloid scar. If it is, same protocol; have an assessment, see if it’s something we can inject with a cortisone to help take down the aggressiveness and help it to flatten slightly, and then we’ll probably come back in with a Pico laser.
You can treat older scars. It just depends on the condition of the scar and the type of scar.
Q: What about for stretch marks? Can you use laser?
Some people classify stretch marks as scar tissue. It is a different type of fibrous tissue. Generally, if it’s an older stretch mark, they usually have that silvery white colour which is a little bit harder to treat, but with a Pico laser, once again, it’s stimulating that collagen underneath to improve the texture, the volume and the structural integrity of the skin to help make it visually even in regards to tone.
So we do treat stretch marks, but once again we would have an assessment to see if the stretch mark is that little pink, reddish undertone or if it’s more of that silvery white. And then we would tailor the treatment plan or the settings to that client.
If it’s still a little bit pink, we would then incorporate a vascular laser to treat the redness first before treating to promote more collagen in the area.
Q: Have you heard of the Stratpharma range of products? Stratamed, Strataderm, Stratamark… What’s your opinion on these silicone based products?
We actually use these products in treatment, we use them post procedure. The way I describe it to my patients is that it’s kind of like a protective band-aid over the skin. It prevents bacteria from entering the area, it helps calm the area, and it does support the healing process as well, so absolutely, we know those products. We do get our patients to take those products home post-Pico Scar Repair or other laser treatments that we have, including RF Needling.
We do recommend them to our patients in combination with those other key ingredients we spoke about before, which are the anti-inflammatories, the antioxidants, your pigment inhibitor serum and your collagen peptide serum. So, we use them in combination with others, but yes, they are fantastic products to use.
Q: Can you give us some hints to help scars after a cosmetic surgery procedure, such as a tummy tuck, to heal better or faster? Or to prevent them from becoming a scar?
This is an interesting one. First of all, I would always follow your doctor’s instructions. Sometimes when you look at a scar, you think it’s healed, but internally there’s still that healing process happening. So, always listen to your doctor’s post-care instructions, minimise movement in the area, and depending on your doctor’s instructions, you can use products.
Please always ensure you minimise UVA and UVB exposure. That’s probably my biggest tip, making sure that you apply sunscreen. I always recommend my patients use a physical sunscreen as opposed to a chemical, so a zinc based sunscreen, the reason being UVA and UVB denatures collagen over time, but [sunscreen] will also prevent vascularity and prevent the scar from becoming a little bit agitated or cranky. Make sure you have as little sun exposure as possible, and make sure you wear sunscreen.
Q: How long after surgery do you have to wait before you have laser treatments?
It really depends on the type of surgery. We do incorporate LED quite quickly post surgery, two to four weeks after, to start that healing process through a light source first. Then, after the doctor’s clearance and depending on the type of surgery, we would probably start incorporating laser between three to six months post-procedure, but once again, it depends on the scar.
I had a patient with a facial scar who I started treating 8 weeks after the stitches came out. So, I did give the skin a little bit of buffer time, but I was able to start treatment at 8 weeks. Again, it really depends on the type of scar, where it’s located, but come in first for an assessment as soon as you have the scar and then we can create that treatment plan for you and give you an accurate time line, which is really important as well.
It can take a while [to treat a scar]. You don’t want to cause trauma to the area if it’s still healing in some aspect, however, we can do it sooner rather than later, depending on the situation.
Q: Do you think there’s a benefit to doing it sooner rather than later?
Absolutely. There is a benefit of sooner rather than later because your cells are recreating that collagen and that renewal process is in action mode in regards to repairing and nurturing that particular area, so doing the treatment early is good because we can further help stimulate and help speed up that healing.
Q: How long do scars take to fade?
In terms of treatment, if you start sooner, I usually say that it’s a cumulative result, so I’m not going to be able to provide a wow factor result just from one treatment, depending on the scar. We generally recommend to our patients six to ten treatments, depending on the type of scar, the depth of the scar and where the scar is located.
I normally take a photo halfway through and have a reassessment, so I would say that it will take at least three treatments before you start to see some changes, and then it’s a cumulative result from there on.
Q: Do any home remedies help with different scars?
I was doing a little bit of research on home remedies that are spoken about in the industry, and I guess the best home remedy, if you are going to do something about a scar, my top one would be aloe vera. As we know, aloe vera is extremely calming and it will take out any inflammation in the area, or the scar. However, I truly hand-on-heart believe that an at-home remedy will not treat the scar alone. You need to be using those products we’ve been speaking about, your antioxidant serums, pigment inhibitors and stratamed, and you need to use some form of laser.
Once again, products are more epidermal (or surface layer), we need to travel down into the dermal (deeper) layer of the skin to start stimulating that collagen or that protein network to improve the structural integrity of the skin. So, I truly believe that home remedies can be used, but with other things, you’re going to get a better result.
Q: Are there any food and diet recommendations to help with healing? I don’t smoke anymore which I know helps, but any certain foods help?
I think my passion is really looking at things happening internally and externally, and how we can support that in combination to treatments. So, in regards to food and diet, this is such a big aspect. My biggest tips in regards to food and diet is first of all, ensuring that you’re having as many anti-inflammatories as possible, so you can do that through antioxidant supplements or through food. Things like an ingredient known as curcumin is a really great anti-inflammatory, so it’s great for scars but I also recommend it to my patients who have vascularity or rosacea to help calm things down internally.
Probiotics are important because we know how gut health is extremely linked to our other organs and our skin. Lots of water will help with the healing process as well, and a healthy active lifestyle I think is really, really important.
Our lifestyle factors, whether it’s alcohol consumption, whether it’s smoking, have such a big effect on how our body processes wound healing and healing in general. I think that having a healthy diet and lifestyle, in corporation with our treatments, will bring the best outcomes for our patients.
Q: How painful are these procedures?
Everyone’s pain threshold is slightly different. With the Pico, we do offer our patients sometimes a topical numbing cream to make them feel more comfortable, we also have cold air going over the area during treatment, so it’s not something our patients should be concerned about. We’re here to help you and get you the best result and provide a therapeutic setting.
The best possible way that I can describe the feeling of a Pico laser for scar repair is like a vibration or a little tapping sensation. Similar to pins and needles. It’s not a thermal laser like our Fraxel or C02.
Q: I recently burnt my arm on a sandwich press. It has left a flat, shiny scar on the inside of my wrist. Can the Pico laser help reduce the redness?
Yes it certainly can, we can treat both the vascular (redness) of the scar and the repair/ healing of the scar tissue. I would also highly suggest starting on your active product ingredients we have spoken about, such as the Rejuvaus ABC Serum, Collagen Rebuild and Stratamed.
Q: Would you treat a face-lift scar the same as you would a tummy tuck?
We would more than likely use the same technology, a Pico Laser using a specialised handpiece, however the amount of treatments and the technical recommendation of time between treatments will be different. We would also, prior to treatment, assess the scar, whether this is a keloid scar which we would initially treat with cortisone injections administered by one of our Doctors.
Q: Can you recommend anything for dark circles under eyes (treatments)? Besides normal water, sleep and healthy diet?
Our PRP Plus treatment assists in lightening, brightening, hydrating and strengthening the fine delicate skin around the eye area. To minimise the appearance of dark circles, we extract your Platelet Rich Plasma (PRP) from a sample of your own blood and combine it with a combination of a [natural hydrating ingredient], amino acids, antioxidants and vitamins and minerals which is then injected into the skin using a specific injection/needling gun. We recommend three treatments, once per month for the best results.
I would also recommend ensuring you are using an eye cream that contains Vitamin K, such as the Rejuvaus Eye Serum, which inhibits red/blue discolouration and helps clear discolouration.