Q: I have several old scars on my legs that really bother me. I had laser done on my scars over a year ago in a plastic surgeon’s office but I don’t see any improvement. How can I get rid of my scars?
A: When discussing possible scar treatments, one concept that needs to be eliminated from any patient’s vocabulary is the phrase, ‘getting rid of scars.’ A scar represents permanent damage to the skin layer that once had normal tissue (with good color and suppleness) replaced by abnormal tissue. (depigmented, less pliable) Therefore, the realistic goal is scar reduction not scar elimination. This is why the term ‘scar revision’ is fairly accurate, the scar may be improved but it is not completely eliminated.
While scars on the face represent the best opportunity for maximal scar reduction, scars below the neck are not so forgiving. This is because trunk and extremity skin is thicker (thicker dermis creates more scar) and the healing wounds are exposed to more shear and frictional stresses which work to stretch out the scar. Therefore, non-face scars never (and I emphasize never) can look as good as facial scar work no matter how it is done or by whom.
Leg scars represent the least successful area for scar revision on the body in my Indianapolis plastic surgery experience. They are particularly refractory to any significant improvement for the reasons stated above, particularly below the knee. The thickness and tightness of the skin in this area makes scar revision work difficult.
Lasers are often touted and perceived as having some magical properties for scar improvement. While lasers do have a role in scar treatments, it is not a dominant one. They are best used as a finishing treatment for some minor skin resurfacing or retexturing. They are not like an eraser tool on Photoshop.
Dr. Barry Eppley