Scar Revision

Keloid Scar Treatment

Tuesday, January 15th, 2013

Dear JE - thank you for your question.

There are definitely ways to help keloid scars. The most common treatment for keloids on the chest, neck, or back, is to use a combination of a laser treatment and injections. The laser that we use is a pulsed dye laser, called the Vbeam Perfecta. It is the best laser for treating keloid scars. The injection that we use is a steriod called kenalog (triamcinolone). Sometimes I will mix the kenalog with another medicine called 5-fluorouricil (5-FU). The treatment does cause a bit of discomfort, but it is not too bad.

It is always a series of treatments. We usually plan on 4 to 8 treatments. We space them about 4-6 weeks apart. Sadly, there is no way to make keloid scars go completely away. But, we can lighten them, make them flatter, and help with the symptoms of pain and itching. We can almost always do a treatment at the consultation appointment if you would like. Also, sometimes insurance will pay for all, or a portion, of the treatment.

Please call our office in Seattle – 206-859-5777 to set up an appointment. Thank you for the inquiry.

Dr R

Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center
www.pacificdermcenter.com

Lasers for Stretch Marks

Friday, December 7th, 2012

Dr Reichel, I am interested in treatment for white stretch marks. I heard that a CO2 laser is the gold standard for treatment. What is the difference between the Fraxel Repair, Fraxel Restore, and the Total FX lasers? Also, I understand that the dermis is made of 70% collagen, what is the other 30% made of?

MW

Dear MW,
Both the Fraxel Repair and the Total FX lasers are ablative fractional CO2 lasers. Fraxel Restore is a non-ablative fractional Erbium laser.
Sadly, once they turn white, stretch marks are very hard to treat (with anything). They are best treated when they are new, and are still red. I have very good luck treating red stretch marks with the Vbeam Perfecta laser (pulsed dye laser). It takes a series of treatments, but can basically make the stretch marks 80% better.
For white stretch marks, what I always recommend, is doing a “test patch”. We choose an area that is a couple of inches in size, and do either one or maybe two fractional CO2 treatments. I use the Lumenis Total FX CO2 laser. For me, I consider this laser to be the gold standard for CO2 lasers. CO2 lasers are more risky when you are treating areas that are off of the face (the face has a lot of sebaceous glands – which makes healing much easier). Since stretch marks are off of the face, you have to turn the energy down. That is why we often need to treat them more than once. The other option is to use the Fraxel Restore laser. I do a series of 4 treatments on the test patch. I would say that about 30% of patients feel that there is enough improvement to treat larger areas. So, as I said, it is hard to treat white stretch marks. I make the test treatments very affordable, and I will bundle the payment into the cost of the whole treatment if a patient decides to go on to treat a larger area. I have had very good luck with treating other types of scars with the Fraxel Restore (surgical, injury, acne).
About the dermis: The dermis is the 2nd layer of skin. It provides pliability and elasticity. The main cell type in the dermis is called a fibroblast. Fibroblasts make the matrix of the dermis. Collagen accounts for 75% of the dermis. Elastin, 5%. The rest is Hyaluronic acid, cells, vessels, nerves and hair follicles.

About the lasers: Fraxel Restore and Fraxel Repair. Fraxel Repair and Total FX are fractional CO2 lasers. Fraxel Restore is a fractional Erbium laser. Both Fraxels are made by Solta (originally made by Reliant). Ablative lasers (CO2) completely destroy the tissue that is treated (the skin literally goes "up in smoke"). However, since they are "fractionated", they only treat a percentage of the area. This is done by laying down columns of laser light, rather than a "sheet" of laser light.
Fraxel Restore causes coagulation, rather than ablation. So, while it also knocks out tiny columns of skin, the top layer is left intact. If you were to look at a biopsy of skin after treatment with the Fraxel Restore, you would see columns of dead tissue surrounded by areas of live tissue. The live tissue begins to regenerate the dead tissue columns - making new collagen, elastin, and new cells. This regeneration process is what causes visible improvement in texture, lines, and pigment.

Treating Acne Scars with Dr. Reichel

Wednesday, December 5th, 2012

I'm currently suffering from acne scars on my cheeks.I've undergone 2 treatments with fraxel laser but am still not satisfied with the result. Can you give me your opinion?

Hi MB,

Thank you for your question.

Treating Acne scars can be difficult, and definitely requires some persistence. I would be so happy to see you to evaluate your cheeks, give you my opinion, and help make a plan for you.

The Fraxel Restore resurfacing laser is a great laser for acne scarring on the face. It does take more than one treatment. I tell most patients that it will be at least a series of 4 treatments.  I have some patients that we have done 8 or more Fraxel treatments for acne scarring. Other options can include chemical peels, or other resurfacing lasers (such as the fractional CO2 laser). I usually reserve chemical peels for patients with mild scarring that are willing to come in every 2-3 months for treatment. The chemical peels that we use here at Pacific Dermatology & Cosmetic Center are superficial to medium depth.

The fractional CO2 laser (Total FX by Lumenis) can be a great option for acne scarring, but there is increased risk if you have a darker skin type. There is also more down-time with the CO2 laser.

For some patients, we will also do filler (such as Restylane) under the scars to help decrease the depth of the scars.

Again – I would be very happy to see you. Please schedule a consultation – 206-859-5777.
Thank you.

Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center
11011 Meridian Avenue N Ste 102
Seattle, WA 98133
ph 206.859.5777

Scars? We can help you......

Thursday, August 2nd, 2012

Good News For Future Scars

Scars are often thought of as battle wounds—reminders of a time and place when the body was put to the test and survived with a story. Anyone who has had a C-section can attest to this. After all, a scar—the fibrous tissue that replaces normal skin after injury—is your body's way of repairing itself and is a natural part of the healing process.

For instance, while a healthy baby is a good trade out for a C-section scar, some scars, especially those from cosmetic surgery, are not typically ones women want to show off. This explains why so much research continues to be done to improve the look of post-surgery scars. New strategies are constantly being developed and tested and now, scientists at New York University have found a new treatment to reduce or in some cases, stop scars from forming on the skin. Researchers found that applying agents that block certain receptors in healing skin can greatly reduce the scar, producing skin that feels more like the original, unscarred skin. Research is still in the beginning stages, but it could mean that post-operative scar care could be greatly improved.

At this time, there are some good options already available for scars. Nonablative lasers can stimulate the production of collagen from within the body to improve texture and tone on the surface of the skin. "In the past, the go-to in-office treatment for treating scars was cortisone injections and silicone-based sheeting, but today the trend is to use laser devices," says Seattle dermatologist Jennifer Reichel. "They are more predictable, offer better results in many (but not all) patients, and are especially effective at treating raised, red scars. Plus, they can safely be used on facial scars." I generally recommend the Fraxel DUAL or the Vbeam Perfecta, both are excellent options and offer a gold-standard of treatment.  Injectable fillers can also be used with success to treat deep facial scars, especially those caused by acne.

Most doctors agree that it is also important to continue to treat your scars at home in conjunction with any in-office scar treatment. There are also over-the-counter options like Mederma. The good news is, much time and research is going into scar treatment, so hopefully one day, they really will be a thing of the past.

The physicians at Pacific Dermatology & Cosmetic Center would like to consult with you concerning your scars, whether they are acne-related, pregnancy related, or from auto accident.  Call our office to schedule your consultation with Dr. Jennifer Reichel or Dr. Laurie Jacobson.

Non-surgical treatments for treating scars

Monday, July 2nd, 2012

Dear Dr. Reichel

I am looking for Scar revision of 8 inch scar from chest surgery 15 years ago. What none surgical treatment can improve the look of this scar?