Specific attention areas in scar management : management of atrophic scars

Abstract

Atrophic scars represent some of the most difficult and insidious pathologies confronting the reconstructive surgeon. Deriving from the ancient Greek “a-trophos” (wasted), the term presents a vivid representation of the clinical picture and an area of scar management particularly worthy of specific attention. The atrophic scars typically develop as a result of an intracutaneous inflammatory process. Rather than exuberant inflammation, the process results in reduced matrix regeneration and focally reduced collagen production. Focal contraction of the scar tissue will result in uneven soft tissue defects. Clinically, these result in contour defects on the surface of the skin [1]. Several pathologies may result in atrophic scars [2], This chapter is intended for the experienced laser practitioner tackling three clinical conditions presenting to the reconstructive specialties, often as a last resort after exhaustive traditional management: acne, striae albae, and burns. It explores common principles, followed by state-of-the-art management and evaluation of the senior author’s experience.