Scar Revision

Scar Revision in Los Angeles

Our office is a regional referral center for scars of all types. Most people assume that scars are merely a cosmetic concern, while some may even dismiss the importance of scar revision as being just a ‘vanity’ issue.  All of this is misguided, as scars often have a combination of functional, medical, cosmetic, and even emotional issues. Scars can be quite problematic, and our office is equipped with the latest and most-advanced laser, RF, sublative, ablative, non-ablative, surgical, chemical-peel based, and mechanical scar treatments available. In fact, we are among the leading scar treatment center in the United States.
 
Skin type is a major concern when treating scars; partly because skin type can affect the types of scars you develop as well as the types of treatments that can be safely used on a scar. Our office sees many patients with olive skin or dark skin, allowing us to formulate tailored programs that can address your specific scar based on your specific skin type.
  
Although surgery is an important element in scar revision, it does not represent the only treatment type.  Surgical scars are often improved by post-operative laser, RF, and topical treatments. This combination approach can dramatically modulate scar formation and can help you achieve your cosmetic goals with your scars. 


Keloid Scars:

Keloid scars are often described by their appearance rather than their behavior.  New studies into keloids have shifted our understanding of keloid disease as it relates to scar dynamics and the mechanisms of cellular repair and wound healing. Keloids are typically large masses of scar tissue that arise above the plane of the skin.  They occur commonly as a result of skin trauma, burns, piercings, surgery, and acne.  The location of a keloid is not limited to the face, but rather, can occur on any part of the body. Some areas like the palms and soles of the hands and feet are not commonly associated with keloid formation, whereas the ears, face, shoulders, and chest are more often related to abnormal keloid growth. 
 
As one of the leading scar treatment plastic surgeons in the country, Dr. Raffy Karamanoukian has developed specific scar protocols to help treat keloids on the face and body. Regardless of your ethnicity, skin type, and severity of keloid formation, Dr. Karamanoukian has specific treatments using lasers, RF, cryotherapy, IIT, and topical therapy to help smoothe out your keloid scars, reduce the visibilty of your scars, improve the cosmetic appearance of your scar tissue, improve pain and discomfort from keloids, and prevent recurrence. 
 
Piercing keloids and keloids cartilage piercing keloids are often encountered in our Santa Monica plastic surgery clinic. Keloids that penetrate the ear cartilage can be problematic because the keloids are often invasive and grow into the structural cartilage of the ear, making excision more difficult.  Cartilage keloids can, however, be treated with a combination of conservative excision followed by laser and IIT. Topical application of Plato's Scar Serum can help your keloid before and after surgery. Keloids on the belly button from an infected belly button piercing do not invade cartilage and are often treatable with a combination of laser, injections, and minor excision. 


Scar Discoloration (PIH):

The treatment of dark discoloration around a scar is often difficult as there are deeply embedded pigment granules within a scar that has either been chronically inflamed or that has taken a long time to heal. 

 
At times, an injury to the dermis and epidermis may stimulate the production of melanin by the melanocyte pigment cell.  This abnormal deposition of melanin granules can cause a characteristic brown discoloration on the skin once the skin injury is healed.  This may occur after a burn, a cut, a scrape or even after an acne breakout. 
 
Pigmentation that occurs after an injury to the skin is commonly known as postinflammatory hyperpigmentation.  Treatment of postinflammatory hyperpigmentation is often difficult and may take months to see a noticeable or visible improvement.  Our plastic surgeon Dr. Raffy Karamanoukian is one of the leading scientists and clinicians in the field of abnormal skin pigmentation and melasma.  Both conditions are caused by abnormal deposition of melanin and both can be treated with initially conservative measures such as topical creams, laser therapy, chemical peels, and daily exfoliation. 
 
An initial stage in the process is topical therapy using Melarase topical cream including Melarase AM, Melarase PM, and Melapads.  If you are concerned about abnormal pigmentation and dark scars, a consultation with Dr. Karamanoukian in his Los Angeles plastic surgery office may be warranted.  Dr. Karamanoukian will examine your scars and skin discoloration and determine the clinical depths of the pigmentation, whether it is epidermal or dermal in origin.


Forehead Scars:

Some of the most prominent scars on the face involve the forehead and hairline.  The forehead is a broad area above the eyebrows and because of its overall surface area and position on the head, it is prone to be injured during car accidents, traumas, and other injuries.  The forehead is also exposed to high amounts of sun and is vulnerable to develop a skin cancer and other sun induced skin changes.  Forehead scars can often be covered by hair growth in women with bangs, but men find it increasingly difficult to cover the forehead scars with their natural hair.  There are many people who have forehead scars or who anticipate forehead scar with a future surgery, and request scar removal treatment for the area.  Forehead scar removal involves a complex series of treatments that are designed to improve the quality of the scar, release underlying depression and atrophy, or soften thickened and hypertrophic scars.  The patients who have forehead scars may benefit from these combination procedures offered at the office of Dr. Raffy Karamanoukian.

 
Most forehead scars involve one of three problems, including skin discoloration, depression of a scar, and thickening of the scar.  These combination procedures result in an abnormal looking scar that does not blend in with the surrounding tissue.  Skin discoloration associated with a forehead scar can occur with hypo or hyperpigmentation.  Hypopigmentation of a forehead scar involves whitening and loss of color of the skin associated with a loss of pigment cells.  On the other hand, hyperpigmented forehead scars are often darkly discolored with brownish coloration.  Hyperpigmentation of a forehead scar is relatively easy to treat with a combination of a melapeel and topical application of Melarase AM and Melarase PM for several months.  This will effectively treat the hyperpigmentation and lighten the skin tone around the scar.  Hypopigmented scars, on the other hand, are more difficult to treat and are caused by a significant loss in melanocytes in the skin.  Treating hypopigmented scars is often difficult as there is no absolute way to increase the pigment cells within the skin.  In these cases, hypopigmented forehead scars can benefit from either fractional skin resurfacing or surgical excision.
 
Depressed forehead scars involve an atrophic response to injury in which the scar has widened or stretched out, causing a gradual loss in the dermis and height of the scar.  Depressed forehead scars can become very evident in certain types of light and may lead to a significant depression and contour problem.  Depressed surgical scars on the forehead can be treated with a combination of subcision followed by scar release.  Subcision involves a small procedure with the scar tissue tethering the scar down its release, thereby popping up the depressed scar.  Subcision is an amazing procedure that can dramatically improve the quality of the scar and cause a scar to be less noticeable compared to the surrounding skin.
 
Hypertrophic or thickened scars on the forehead can also be improved using a combination of pressure management, IIT, cortisone injections, and vascular laser.  These scars can be modified in order to make them more appealing and more cosmetically natural compared to the surrounding skin on the forehead.  If you have a thickened forehead scar and believe that you may have a hypertrophic or keloid response to scar formation, the best option would to schedule a consultation with Dr. Raffy Karamanoukian in our Los Angeles plastic surgery office, and ask for recommendations regarding scar improvement.

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