Facial Scars

Dr. Niamtu employs the latest technology to assist with the cosmetic treatment of facial scars. These include scars from trauma such as automobile accidents, cuts and lacerations as well as scars from surgical procedures performed on the face.

The advent of ultrapulse CO2 laser resurfacing has enabled a simple treatment for many scars. Most scars can be improved or totally eliminated with the Ultrapulse laser. This procedure takes only several minutes and is usually performed with local anesthesia. The scarred area is treated with the laser which causes a flattening of the scar borders and the formation of collagen in the skin. The result is a flatter and better blended scar. Some scars can be totally treated with a single laser session while most require a follow up laser procedure. Generally patients wait 90 days between treatments.

This patient above is shown with an unfavorable scar from brow surgery (top picture).  The middle picture shows the scar immediately after CO2 laser treatment and the bottom picture shows the patient one month later.

Many surgeons suggest waiting a full year before revising a scar. The contemporary literature as well as research performed by Dr. Niamtu show that better results are obtained by lasering scars early. By lasering scars as early as eight weeks, better results are obtained. In addition, the patient does not need to go a full year with an unsightly scar.

The examples in the gallery show treatment of traumatic scars. Each was treated by single or multiple sessions of CO2 ultrapulse laser resurfacing .

Lumenis Deep FX is a new type of “Fraxel” or fractional laser resurfacing that shows great promise for facial scars including burn and acne scars.

How does the laser treat the scar?

The CO2 laser can precisely remove scar tissue in layers as thin as a human hair.  By removing the diseased scar tissue the scar is reduced and shrinks.  In addition, the laser is also used to blend the junction of the scar and normal tissue.  Minor scars may respond to a single laser treatment while bigger scar may require multiple CO2 laser treatments.  These procedures are generally performed with local anesthesia and only take several minutes.  The healing is from 1-2 weeks and the treated area may remain pink for a while but can be covered with make up.

The above patient received this scar from an automobile accident.  Dr. Niamtu treated the scar with a single treatment of CO2 laser (middle picture).  The picture on the right shows the scar 10 years later.

The above patiet was treated with two sessions of CO2 laser for this traumatic scar.

The above patient was treated with two sessions of CO2 laser for this traumatic scar.

This 8 year old patient had 2 laser treatments to a traumatic scar


Silicone Injection for Scars

Patients often present to my office with scars from previous accidents or surgery and seek cosmetic improvement.  Most scars can be improved by laser treatments and generally lighter skin is easier to treat than darker skin.  Some scars are treated with subcision which involves separating the scar bands under the skin and some scars need surgical excision and resuturing.

One problem that is encountered is depressions in the neck or face.  These depressed scars can vary from a small acne scar or be severe in the case of previous tissue loss from previous wounds or surgery.  Numerous treatments exist for depressed scars including treating with fillers, fat, implants and surgery.  Although fillers are useful, most of them are temporary and wear in less than a year.  Fat is an option, but usually requires multiple treatments and is sometimes not “thick” enough to lift the heavy scar tissue.

Silicone injection is a permanent treatment, that has been safely used for 50 years to treat depressed scars or fill voids.  Silicone injection has a bad reputation in some circles and is due to the abuse of the product by inexperienced injectors.  Unscrupulous doctors use hardware store silicone instead of an FDA approved medical grade product.  In addition, instead of microdroplet or “rice grain” injection technique, large volumes or “puddles” of silicone are injected.  Getting Home Depot silicone from an unlicensed person in a hotel room seems crazy, but many people have been harmed in this manner.

Medical grade silicone injected by an expert injector with proper technique is a natural feeling and looking solution to various scar problems and has been safely performed for half a century.  Silicone is considered a permanent treatment as the injected droplets become surrounded by the body’s own collagen and the result actually grows slightly over about a month.  Due to this, multiple small treatments are performed until the final result is reached.  Since silicone is not reversible, injection s should always be conservative by experienced surgeons.


The patient above was treated with silicone injection to scars on right cheek and CO2 laser resurfacing.


Surgical Treatment of Scars

Luck

Although many scars can be treated with laser only, some scars need surgical revision as well as laser smoothing.  The images to the left show a hypertrophic scar of the bridge of the nose (A).  Concave areas tend to scar worse.  This scar was treated with a “Z-Plasty” technique where the thickened portion of the scar was incised and the flaps were transposed to remove tension from the wound (B, C).  Several laser treatments were then performed over the next several months.  The final result is shown in picture D.

Kahsay This  patient to the rightwas treated by Dr. Niamtu with similar scar revision techniques

The image below shows a patient with severe cystic acne scarring.  The deep scars at the corner of the mouth are too deep to simply laser, so they are excised and resutured to make them shallower.  The suture line can then be treated with the CO2 laser.  The picture on the right hand side shows the result after surgical scar excision and CO2 laser resurfacing.

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The above patient sustained a dog bite and was treated with plastic incision closure by Dr. Niamtu


A letter from a happy patient