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Burn scars can be below the skin level (atrophic) or above (hypertrophic). This type of scar rarely heals unproblematically. Sclerotic contractures often develop from burn scars, which restrict mobility or usually develop into keloids.
The most common forms of burn scars are scar scarring, laser treatment (vascular, ablation, Fraxel laser), cryotherapy, dermabrasion or surgical removal, in combination with silicone patches / silicone films and compression bandages / compression garments.
In many cases, multiple procedures need to be combined, and treatment may require much patience and time. It can take several months to years to succeed, but it is possible! Specialist consultation and assessment of your scar is essential for a good prognosis.
Thermal burns and chemical burns may cause scars, that are fibrous tissues formed on the site of injury. Scars occur naturally as a part of the biological process of healing. When the skin is damaged, it produces protein collagen that forms into thick, discolored cicatrix.
Though not causing pain and not being dangerous, scars are troublesome for many people because of their unattractive appearance. Some scars, e.g, contracture can cause limitation of movements in the affected area.
Classification of Burn Scars
First-degree burns, when only the outer layer of the skin is damaged, normally heal up without scarring or can cause temporary scars that disappear over time.
There are three main types of burn scars:
- Hypertrophic scars. Hypertrophy is thickening of the skin happened due to excessive collagen in the injured area. At the beginning, hypertrophic scars are red and thick, but then they can improve themselves in 2-3 year. Scar therapy can help to make them flatter and paler in shorter time.
- Keloid scars. Keloids start similar to hypertrophic scars but, then, they turn into shiny, rubbery, tumorous lesions. They are thick, rubbery and firm. The colors of keloid scars can vary depending on initial skin color. Although keloids are benign, they can be painful and tighten the skin, preventing you from certain movements. The most common treatment for keloids is surgery.
- Contracture scars. Contracture is tightening of the skin in the burned area. That happens because the skin around damaged area tends to pull together causing the tightness. If the affected area is large, it can lead to movement restriction, especially, when injured area adjacent to the joint. Laser surgery is effective treatment for contracture scars.
Burn Scar Removal: Is it worth?
Mostly, a patient wish is the main reason for scar removal, as they cause harm to the appearance, which is not considered a medical issue, and, normally, insurance plans do not cover this. Although in case of large keloid scars or contracture scars, there is also a medical indication to treat them. In any case, it is worth if you feel your life quality can be improved by scar removal. It is not only a physical condition but also a psychological problem for many people, especially, when the scars are on the face.
Scar Removal in Germany
Presently, the main types of treatment for burn scars are:
- Cosmetic surgery to remove scars
- Laser burn scar treatment
Surgical Burn Scar Removal
Long time cosmetic surgery was the main type of scar revision. In this case plastic surgeon performs precise scar excision and accurately closes the wound to heal. The healing by primary intention, which possible when the wound is clear and no tissue loss is present, cause less scarring than burn and you have a good chance to improve your scars.
However, for keloid scar there is a high probability (up to 45%) of scar recurrence, as keloids tend to grow again. That is why doctors in Germany prefer to combine surgery with other kinds of scar therapy, such as radiotherapy or laser healing.
Burn Scar Removal with Laser
Carbon dioxide lasers (fractional ablative lasers) are widely used for treatment of contracture scars and keloid scars. Ablation is total removal of tissues, similar to vaporization, done by a laser beam. The scar tissue literally disappears. Fractional ablative laser, indeed, consist of numerous tiny beams and which of them drill a micro-tunnel in the target tissue. Causing a new injury to the scar tissue and, thus, reshaping the scar by stimulating natural processes. Using deep ablative laser for remodeling of inner tissues and superficial ablative laser for resurfacing of outer tissues, it is possible to enhance appearance and functionality of the scar tissues significantly.
Healing after laser burn treatment takes from 2 weeks to 1 month. The scar turns red and can swell; the skin becomes dry after the procedure and start peeling in 4-5 day, which is normally. Not much pain is expected.
German cosmetic surgeons use lasers as independent treatment and in combination with surgery or other treatments. Every case is decided individually and the best method of treatment is chosen based on the patient’s situation.
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