Scars on the face
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Scars on the face are permanent structural changes in the skin resulting from damage—mechanical, inflammatory, surgical, or traumatic. They are the outcome of a healing process in which normal skin tissue is replaced by fibrous tissue rich in type I collagen. Unlike healthy skin, a scar has a different collagen fiber architecture, reduced elasticity, altered pigmentation, and often changed vascularization. Due to the facial location—a highly significant aesthetic and psychosocial area—even small scars can significantly impact a patient's self-esteem and quality of life. The nature of a scar depends on the injury's depth, individual genetic predispositions, age, skin phototype, and the course of the inflammatory process.
Facial scars – types
The classification of scars is primarily based on their morphology and the dynamics of connective tissue remodeling. On the face, the most commonly observed are:
1. Atrophic Scars
These result from the loss of the proper skin tissue and insufficient collagen synthesis. They are characteristic of:
- acne vulgaris,
- chickenpox,
- inflammatory follicular injuries.
Subtypes include:
- ice-pick (narrow, deep),
- boxcar (with defined edges),
- rolling (undulated, with subdermal adhesions).
2. Hypertrophic Scars
- protrude above the skin level,
- confined to the area of the original injury,
- associated with excessive fibroblast proliferation and collagen production.
They occur more frequently in younger individuals and during an intense inflammatory state.
3. Keloids
- extend beyond the boundaries of the original wound,
- have a tendency to grow,
- may cause itching, pain, and a feeling of tension.
Their formation is linked to dysregulated growth factors (including TGF-β) and abnormal fibroblast apoptosis.
4. Traumatic and Postoperative Scars
Dependent on:
- surgical technique,
- skin tension (Langer's lines),
- healing process,
- any potential infectious complications.
They can take on a linear, atrophic, or hypertrophic form.
Facial scars – treatment
The therapeutic approach depends on the type of scar, its age, and the patient's skin phototype. Treatment should be stepwise and based on mechanisms of collagen remodeling and stimulation of regenerative processes.
1. Topical Treatment
Mainly used in the early phase:
- Silicone preparations (gels, sheets) – reduce transepidermal water loss and normalize collagen remodeling,
- ointments with heparin, allantoin, onion extract,
- topical retinoids (for acne scars),
- sun protection (SPF 50+) to prevent post-inflammatory hyperpigmentation.
2. Injection Treatment
- Corticosteroids (e.g., triamcinolone) – reduction of hypertrophic scars and keloids,
- 5-fluorouracil injections (in selected cases),
- platelet-rich plasma (PRP) – stimulation of angiogenesis and regeneration.
3. Procedural Therapies
Aimed at:
- inducing controlled micro-injury,
- remodeling of collagen fibers,
- improving skin texture and tone.
It should be emphasized that complete removal of a scar is not possible – the goal of therapy is to flatten, soften, and improve the integration with the surrounding skin.
Facial Scars – Treatments
Contemporary aesthetic medicine and dermatology have methods with documented clinical efficacy in the remodeling of facial scars.
1. Fractional Laser Therapy
- ablative lasers (e.g., CO₂),
- non-ablative fractional lasers.
Mechanism of action:
- creation of microcolumns of thermal damage,
- stimulation of neocollagenesis,
- reduced recovery time by preserving "islands of healthy skin."
2. Microneedle Radiofrequency
- simultaneous microneedling and heating of the dermis,
- controlled thermal coagulation,
- remodeling of type I and III collagen.
3. Medical Microneedling
- collagen induction through controlled micro-injuries,
- improvement in skin elasticity and texture,
- possibility of combining with autologous therapies.
4. Regenerative Therapies
In the treatment of facial scars, the following are used, among others:
- platelet-rich plasma,
- fibroblast-stimulating preparations,
- autologous therapies supporting the reconstruction of the extracellular matrix.
5. Procedures Available in Clinical Practice
For the treatment of facial scars, the following are used, among others:
- CO₂ fractional laser,
- microneedle radiofrequency,
- medical microneedling,
- platelet-rich plasma therapies,
- medical peels with controlled depth.
The choice of method should be preceded by an assessment of:
- the type of scar,
- skin thickness,
- Fitzpatrick phototype,
- tendency to keloids,
- patient expectations.
Therapy often has a combined nature and requires a series of procedures at 4–8 week intervals.
