When you injure your skin, the body starts work immediately to repair the wound.

The 3 main stages of wound healing are

1. Inflammation,
2. Proliferation, and
3. Remodeling

Inflammatory phase - white blood cells and growth factors flood the wound causing redness, swelling and pain. The main aim is to remove dead tissue and guard against infection. The onset of this phase is almost immediate after injury.

 Proliferative phase – blood vessel network and collagen is laid down to fill up the wound and cause the wound to contract. Epithelialization then occurs to seal the wound up. If this phase is interrupted, there is a high chance for poor wound healing and / or excessive scar formation. This phase occurs 3-5 days following injury.

Remodelling phase – collagen fibres laid down during the previous phase will be rearranged in a neater and compact manner to further enhance wound strength. This phase starts approximately 21 days after injury and may continue past 1-2 years. Though healed, the wound area is always weaker than normal skin. The colour, texture, firmness is also different. Therefore, scar formation is inevitable in a normal wound healing process.

Wound healing is a very complex process and failure to progress through the above stages can lead to chronic wounds.

There are 2 main types of scars, raised(Hypertrophic) and sunken(atrophic) scars.

 Keloids and hypertrophic scars are raised scars due to abnormal excessive wound healing. These scars are bulky, unsightly, itchy and sometimes painful. Keloids and hypertrophic scars are common

1. In people with darker skin,
2. When wounds occur at certain parts like chest, shoulders and earlobes.
3. When traumatic wounds occur i.e burns where healing is prolonged.
4. Surgical wounds i.e post Caesarean Section

Sunken or atrophic scars occur when wound healing is inadequate, leaving depressions in the skin.

The deeper the wound, the higher the chances for abnormal wound healing and scarring.

When surgical wounds are approximated using stitches or glue, they heal quickly via primary intention (healing, in which wound edges are closed actively with a material), producing minimal scars.

However, when extensive wounds with tissue loss are allowed to heal on its own, it is termed healing with second intention. The healing is slower, hence chances for scarring is greater.

Therefore, wound care is very important to ensure it heals as quickly as possible to reduce the incidence of scarring.

The following is known to affect wound healing:

1. Diabetes mellitus
2. Smoking

Picking on the wound

People who have hypertrophic or keloid scars commonly seek treatment because it is aesthetically not pleasing and often painful. As these scars are still actively growing, treatment methods aim to flatten and subdue it. They include:

1. Steroid injections – inhibit further growth within the scar
2. Pressure bandage or scar massage – causes scar tissue breakdown
3. Silicone patch or gel – helps hydrate scar and decrease its volume

Sunken / atrophic scars are managed differently. The aim is to destroy the existing atrophic scar and stimulate the body’s own tissues as much as possible to replace the scar tissue. Treatments include:

1. Subcision – frees deep attachments to elevate sunken scars.
2. Derma rolling/ Micro needling – destroys scars and stimulates scar remodeling
3. Platelet Rich Plasma(Magic PRP) – The abundant growth factors in platelets stimulate new tissue formation.
4. Fractional CO2 laser – destroys scars and stimulate scar remodeling
5. Scar revision – scar is reconstructed to allow better healing. End result is a smaller, less obvious scar.

Scars continue to remodel and mature years after the initial injury. The more mature the scar, the longer it takes to improve the scar.

Here at GEM Clinic, scar management is our expertise. There are various treatments for scars but we feel a combination of these treatments will work synergistically to improve and speed up scar remodelling. Our scar treatment is so effective that we went on to patent the regime with the name RCIT which is short for Regenerative Collagen Induction Therapy. To know more about RCIT, visit your nearest GEM Clinic branch for a free consult.