[HEALTH]Scars run deep, but surgery can go far deeper

In a perfect world, nobody would have any scars and everybody would have a smooth face. But it’s not a perfect world, of course: Accidents can happen at any time, or pimples can leave scars on noses, cheeks or foreheads. People with even slight scarring on their faces can feel ugly and suffer from low self-esteem.
Human skin consists of an outer layer (the epidermis), an inner layer (the dermis) and fat tissue (the subcutaneous). Any damage to the outer layer is easily healed, but wounds that puncture the dermis will leave scar tissue. The location of the wound is also important: A scar is more likely to form on legs or arms, which are constantly in movement. The face, in contrast, has more hair follicles and damaged parts are more easily filled and healed.
Plastic surgeons usually deal with scars, burns and bigger injuries, while dermatologists usually deal with damage from skin diseases, pimples or chicken pox.
Given that pimples can leave small craters on the face, most dermatologists treat the scars with laser surgery. Laser therapy entails peeling away the damaged skin and it is relatively more time-effective than other forms of treatment.
If the damaged area is too wide and deep to be treated with a laser, what are known as “cross chemical reconstruction” methods are used to inject chemicals into the depressed part to help the skin fill up. The chemicals go into the inner skin and stimulate texture cells, increasing the synthesis of collagen and elastin. The inner skin then thickens and the sunken part of the skin begins to elevate, fleshing out and reconstructing the damaged part.
“The advantage of this treatment is that it makes the affected area look more natural,” said Chung Ki-yang, a dermatologist at Yonsei University Medical Center.
Surgery often leads to hypertrophic scars, which once healed are thick and raised and often darker than the surrounding skin. Laser therapy is used to alleviate the scarring and recolor it to better match the surrounding skin.
In the case of lacerations, if the scar is long, surgery is performed to break down the scar. The long scar is broken down in the same direction as wrinkles. This is called “Z-plastic surgery,” and makes large scars look small by creating optical illusions.
To treat depressed scars, the scar tissue is removed surgically and the different skin layers of affected parts are sutured. Sometimes fat is inserted into the inner skin to fill the depressed area.
What about scars on small children and babies? “When babies and young children suffer injuries and are scarred, the scar tissue is likely to remain because the scars tend to spread out as their skin expands,” said Bae Tae-hui, a plastic surgeon at Chung-Ang University Medical Center.
Babies and young children should wait until after they stop growing to have cosmetic surgery to remove scars. If they must have surgery to remove scars, they should undergo general anesthesia to avoid the fright associated with surgery.
Facial lacerations should be sutured as soon as possible. All injuries must be washed with hypertonic solutions to prevent infection. Dust and other foreign elements must be cleaned off of abrasions; if not, the skin could be left disfigured.
No matter how well the damaged part is stitched, there will still be some scarring. The shape of the scars is determined by how the affected part is torn and how the injuries are positioned in relation to winkles. After the surgery, silicon gel, scar cream and massage should be applied to the damaged parts to minimize scarring.

by Limb Jae-un