NOV-DEC 2016

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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60 NOVEMBER/DECEMBER 2016 | Surgical Aesthetics "There is a difference between a hypertrophic scar and a keloid," says Babak Dadvand, MD, of Beverly Hills, Cali- fornia-based Dr. Dadvand Plastic Surgery. "People tend to refer to all raised scars as keloids, when in fact most of them are hypertrophic scars. The key difference is that although both types are raised, hypertrophic scars maintain the same shape as the original incision, whereas keloids can have a completely different shape and size than the original incision. For example, keloids of the earlobe after piercing can look like little golf balls." Whether your patient is struggling with extensive traumatic scarring, a poorly healed hypertrophic surgi cal scar, or keloid scarring, there are a variety of surgical and nonsurgical treat- ment options available. "The one thing I tell patients regarding scar treatment is to be patient," says Dr. Dadvand. "Time is on your side. Most scars tend to improve with time, and even when adding dif- ferent scar therapies to Mother Nature, it's important to let both the therapy and time do their thing." The type of scar, its location and its appearance will help guide treatment. Skin type and patient ethnicity also play key roles in determining the best tools to alleviate unsightly scars. Patients of Asian, Hispanic and Middle Eastern descent may be more prone to hyperpigmentation. African Americans may be at higher risk of keloids due to genetic predisposition. Surgical Scar Revision In many cases, you can help patients shed unappealing surgical scars and painful reminders of traumatic injuries with a single surgical procedure. In these cases, no-tension, meticulous closure is essential to healing, says Edwin F. Williams III, MD, FACS, president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and managing partner of Williams Center Plastic Surgery Special- ists in Latham, New York. In an effort to avoid tension that can cause additional hypertrophy or atrophy with widening of the scar, he cuts out the existing scar and uses a layered suturing technique to close the wound. Following surgery, it takes a year for the scar to fully mature. If the scar occurs on the scalp or in the eyebrows, it can be especially noticeable due to the loss of hair growth in the area of scar tissue. For these cases, John Kahen, MD, founder of Beverly Hills Hair Restoration in Beverly Hills, California, uses follicular unit extraction (FUE), to extract hair follicles from the scalp and then transplant them into the scarred areas to conceal the scar tissue. Nonsurgical Scar Treatments Laser treatments and intralesional injections are the most widely used nonsurgical techniques to improve the appear- ance of scarring. Ibrahim Khansa, MD, et al, published "Ev- idence-Based Scar Management," a comprehensive review of keloid, traumatic and surgical scar revision techniques in Plastic and Reconstructive Surgery (September 2016 Supple- ment). They reviewed more than 40 studies to provide evidence-based guidelines. In split-scar studies, pulsed dye lasers (PDL) and CO 2 lasers were the most effective devices for established hy- pertrophic scars. The PDL reduces pruritus and erythema; CO 2 improves scar pliability. If only one laser is used, PDL— which targets the microvasculature of the scar—was found to be the most effective overall, but its shallow penetration (1mm) limits its ability to reach the depth needed to release scar tissue. The authors note that combing PDL with CO 2 , PHOTOS COURTESY OF BABAK DADVAND, MD Dr. Babak Dadvand performed surgical resection of this patient's keloid scarring. He injected kenalog prior to closure. One month after surgery, she began using a silicone and methylprednisolone scar cream and received a second kenalog injection to halt new tissue growth. AFTER BEFORE SURGICAL AESTHETICS SCAR REVISION

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