How deeply indented atrophic scars are treated at Wangsimni Dermatology [Laser, Subcision, Regenerative Injection]

Treatment methods by type of atrophic scar

Hello, this is Laon Dermatology in Wangsimni.

Even after a wound has healed, scars left on the skin can remain a major concern. When the skin suffers external impact, it goes through a regeneration process to protect itself. During this process, if collagen is formed in excess or in insufficient amounts, a scar with a different texture from the surrounding skin can remain! Once tissue has been altered, it is difficult to recover naturally over time, so an accurate diagnosis of the condition should come first. Today, as the first step toward restoring smooth skin, let’s take a detailed look at the types of atrophic scars and how to care for them accordingly :)

Treatment methods by type of atrophic scar

Why do atrophic scars form?

The process by which atrophic scars form involves surprisingly complex physical responses. When deep inflammation develops in the skin or strong stimulation is applied, the damage reaches the dermis. At this point, our body rapidly produces collagen to fill in the lost area. However, if the regenerated collagen is not arranged in an orderly way and clumps together, or if regenerative ability is lacking and a sunken space forms instead, a scar develops!

Fibrotic bands that grow abnormally beneath the skin can also pull the surface of the skin downward. These structural changes create differences in height across the skin’s surface and are a major reason the skin texture looks rough from a distance! Therefore, simply smoothing the surface alone is not enough to expect meaningful improvement; the tangled tissue inside must first be gently released.

<Atrophic scars>

• Texture and height differences compared with the surrounding skin

• Natural regeneration alone has limitations in recovery

• Pigmentation is often left behind as well

Why do atrophic scars form?

Three types of atrophic scars

The sunken scars commonly observed are broadly divided into three types. The first is the ice pick scar, which has a narrow opening like a sharp tool has pierced the skin, but it goes deeply inward. It often appears subtly on the cheeks or around the nose, and because it is deep, it requires detailed care~ In contrast, a boxcar scar has clear vertical edges, almost as if it were sharply carved down, and its base is relatively flat. This type often remains after old chickenpox marks or after severe inflammatory breakouts!

Finally, a rolling scar refers to a sunken condition in which the boundaries are not distinct and the skin forms a gentle wave-like depression. This occurs because fibrotic tissue beneath the skin pulls the skin downward strongly! Since the shape and depth of scars vary, rather than applying the same device to every scar, it is more efficient to choose the appropriate tool by considering the physical characteristics of each type. Simply identifying which type your own scar belongs to can make the direction of care much clearer :)

Three types of atrophic scars

Scar treatment using lasers

So how should these scars be managed? The most representative method is to use lasers to stimulate skin regeneration. When laser energy is delivered to the targeted scar area, microscopic thermal damage occurs, and our body begins to secrete regenerative substances from the surrounding healthy tissue to heal it. This takes advantage of the principle by which hardened scar tissue becomes more flexible and new collagen fills in, gradually flattening the sunken area!

Recently, a variety of devices have been used to minimize damage to the skin’s surface while strongly promoting regeneration in the deeper tissue. If the scar edges are too sharp, the process may also include gently resurfacing them with an ablative laser to reduce the difference in height! When combined with a physical method that cuts the fibrotic bands beneath the scar, laser energy can be delivered more deeply and bring about more satisfying changes. Because this method uses the skin’s own regenerative ability, gradual improvement can be felt over time!

<Scar treatment effects expected from lasers>

• Gentle flattening of scar edges

• Improvement in skin texture and overall density

Scar treatment using lasers

Scar care using regenerative injections

If the depressed area is deep and wide, regenerative injection care that directly injects regenerative ingredients can be very helpful. When particulate ingredients such as Juvelook or PN formulations extracted from salmon are injected into the dermis, those ingredients directly stimulate fibroblasts! The stimulated cells begin to activate and start producing their own collagen and elastic fibers. Rather than filling the area with artificial substances, this is a process that encourages the body’s own tissue to fill in on its own, which has the advantage of less foreign-body sensation and very natural-looking results.

The injected ingredients are slowly metabolized within the skin, making the dermal layer denser and more compact. As the thinned skin barrier becomes thicker and more volume appears, the base of the sunken scar is lifted upward! In particular, when laser treatment and regenerative injections are used together, a synergistic effect appears and you can experience the skin environment itself becoming healthier~ As the skin’s basic resilience improves, it becomes stronger against external刺激 and the overall skin texture can become smoother, delivering a two-in-one result :)

<Scar care using regenerative injections>

• Restoration of volume in depressed scars

• Strengthening of the skin barrier

• Improvement in skin elasticity and density

Scar care using regenerative injections

The importance of combination care

In conclusion, for highly satisfying scar care, a comprehensive strategy tailored to each person’s type is essential. In most cases, one person’s face shows a mixture of ice pick, boxcar, and rolling scars! For the deep and sharply indented ice pick areas, precise high-output lasers should be used to induce deep regeneration; for boxcar areas, ablative lasers should be used; and for rolling scars, subcision and regenerative injections should be appropriately combined. Rather than insisting on only one method, balanced improvement is possible only when customized care suitable for each concern area is provided :)

It is important to consider not only reducing the depth of the scar, but also the color harmony with the surrounding skin and the consistency of the texture. Scar treatment does not end in a short period of time, so you should allow enough time for the skin to regenerate, with patience. Please consult with a board-certified dermatologist and create a care plan that is truly right for you. I hope the information summarized today will be a helpful guide in easing your scar concerns :)

The importance of combination care

Treatment methods by type of atrophic scar