what's up everyone we're back Dr
Maxfield I'm Dr Shaw and welcome back to
our Channel Dr Lee where we talk about
all things skin care and dermatology we
are back together here in Charlotte
North Carolina shooting videos related
to skin care and we are so excited to be
back together again it's been way too
long it has it's crazy life is just it's
life but so glad to be back so today
this is actually by popular demand this
is the top comment on another video
where people want to hear about scars So
today we're going to talk about how to
treat scars and how to prevent scars and
specifically we're not going to be
focusing on acne scars because we've
done a video on acne scars in the past
we'll be focusing more on like injury
scars and surgical scars C-section scars
and scars like that so all things scars
here we go here we go
so scars are particularly important to
us not only because as dermatologists we
try to help people with their scars but
because as most surgeons we actually try
to minimize scars after removing some
pretty aggressive extensive skin cancer
so this is like this is a big part of
our battle in a real life is minimizing
scars right so we not only do you treat
scars but we also prevent scars that we
create are like you know we're doing the
surgeries we don't want you to have a
scar afterwards if you do have a scar
afterwards the benefit is that we could
treat that scar so you know we do our
best to minimize that that being said if
you're going into a surgery this is
super important to know anytime needle
breaks skin there is risk of Scar and so
if anyone tells you if like if I told
you me I don't care if it's me or I
don't care who it is if they came up to
you and they told you I'm going to do
surgery on your skin and you're not
going to have a scar then I would run
very far away from that person because
there's so many things to determine how
your scar is going to heal it's not just
how I do the surgery it's not just how
you take care of the wound but it's also
how your body decides it wants to heal
the risk of injury and Scar is always
there any time you cut into the skin
exactly and like things you may learn
about yourself as you go is like maybe
you have a risk of keloids maybe it's on
an area that's a high risk like the
chest and back so there's so much that
goes into it but we're going to talk
about all of the different types of
scars and what you can do for it so what
is the scar what are the types of scars
okay so a scar is basically when your
skin is injured a wound healing process
occurs and then you have a cell called
the fibroblast fibroblast lays down
collagen in a scar-like pattern right so
it's not like your regular collagen
that's underneath your epidermis inside
of your dermis you can feel it it's hard
that's what a scar is it feels hard and
there are multiple ways that it can heal
you can have atrophic scars where the
scars are flat you can have hypertrophic
scars where the Scars come out of the
skin but they stay within the wound and
you can have keloids that are scars that
expand beyond the wound exactly and then
under the microscope we see the same
kind of changes so initially we get this
increase in type 3 collagen then that
remodels to be an increase in type 1
collagen and with these types of these
scars whether it's a normal scar
hypertrophic or keloidal SCAR or you can
just see the difference here in the
collagen it's just a tremendous
difference in how the collagen lays down
organized disorganized thick bubble gum
collagen depending on how it heals
there's a normal progression for wound
healing as well where it starts with the
inflammatory phase then it goes to the
proliferative phase and then it goes
into the remodeling phase during all of
this time you're going to be trying to
help treat it it's also important to
know that you don't know what the final
way that your scar is going to look
until about a year a year is when a scar
reaches maturity and at that year point
you never have a normal skin in that
area it's only about 80 percent as
strong as it used to be and so about a
year is when you need to really decide
like how's my scar look because at that
point you may want to revision all right
so first up how do you prevent the scar
after your skin has been injured in some
capacity yes so the old adage and I
still hear this from time to time is
that you should just let this thing air
out like if it's wet let it dry and I
can say unequival typically that that is
not the way to do it invariably now at
this point I can tell when a person has
let their wound dry out when I see them
in the fall visit it's night and day so
the more moist you keep this area the
more occlusive you put your dressing and
ointment on the better it's going to
heal this is 100 True after looking
thousands of surgical scars and
follow-up and we we get very specific
instructions on how to take care of the
wound afterwards and I can tell you when
people are not following the wound care
instructions because the weight heals
even within two weeks is substantially
different depending on how you take care
of that scar so a hundred percent keep
the wound moist common misconception
okay so you want to keep the moon boy
yeah you want to keep the wound moist we
can agree on that what are you doing to
keep the wound moist okay so there's a
lot of things that people will tell you
to do they'll tell you to wash the skin
with hydrogen peroxide wash it with
alcohol you don't want to do any of
those things actually all of those delay
wound healing what you want to do is
just wash with soap and water that's the
only thing you want to do is washing
your wounds next what do you put on it
so there's Neosporin there's Bacitracin
at the stores you don't want to use any
of that stuff either not only are they
super high risk for contact allergy but
they're not really going to benefit the
wound healing process and in any
capacity right so no Neosporin no
Bacitracin no triple antibiotic ointment
all you simply need to do for most
wounds is put something like vaseline on
it and let me take a moment just to dunk
on vitamin E again so Dr shot put out
another video within the last few months
about vitamin E because it went viral
and this this is what we talked about
before like vitamin E is not helpful for
wound healing especially in this pure
concentrated form if you're going to use
a skin oil which I actually don't think
you should I think you just use Vaseline
like Dr Shaw said if you're going to use
a skin oil you'd want one with high in
linoleic acid like sunflower oil
safflower oil even jacoba argon coconut
those all might help but again I think
they're inferior to just Vaseline right
and they've actually studied a lot of
what happens during wound healing when
you put Vaseline in a wound and you
basically get this like leapfrog effect
of your skin cells where they start to
actually heal so like any even though
you're under an occlusive dressing you
would think oh how is it going to heal
itself if it has something on top of it
no it's actually helping it heal like a
hundred percent we can guarantee that's
the best thing that you can do for your
wound The Only Exception is if your
dermatologist or whoever removes
something from your skin tells you to
put another antibiotic ornament on
something like Mupirocin follow those
instructions of course we don't want to
give any advice that your doctor didn't
give you but in general for most wounds
simply pure white petrolatum exactly and
I think that's really a good point
because yeah I also personalize my wound
care instructions per patient per
surgical site per location per size of
the flap and reconstruction so don't
think that everything we're saying is
like 100 hard fast rule applies to
everyone universally nothing does um so
we're caveating this if your doctor told
you otherwise I would listen to them
because they know your skin all right so
now you're in the wound healing process
you're maybe two three months down the
road you're starting to form a scar what
do you want to put on that okay so you
go to the scar Isle of CVS and you see
scar treatments and they're going to be
two major players in the spot you either
have the choice of putting onion extract
on your skin or you have silicone so
which one are we going with if you have
to pick one you'd go with silicone right
okay so Mederma contains an onion
extract in it and Mederma was almost the
dog Pond what you were supposed to put
on scars and there was a good paper that
came out on the benefits of this onion
extract that's in Mederma to help with
scars and then later on they did the
meta-analysis that analyzed Mederma and
found that it probably does not have
benefit and the benefits that people are
probably seeing are just because they're
keeping the wound moist rather than the
actual onion extract doing something for
the skin now I'm going to tell you this
because I love playing Devil's Advocate
we do know with onion extract it's been
studied in a couple different capacities
so you you will find studies showing
onion extract can be helpful so we know
the onion extract from in vitro studies
can inhibit like fibroblast activity so
it kind of can temper the remodeling and
the scar growth in theory a lot of the
clinical studies with onion extract have
actually been combined with other
hydrating and moisturizing ingredients
and I think that's where some products
might be better than others some of them
do actually combine the Sun and extract
with other ingredients that would mimic
maybe some of those smaller clinical
studies than just like a pure onion
extract itself now this is a moment I've
been waiting for this is where I dunk on
Dr Shaw there was a study there was a
study a head-to-head study showing that
onion extract was comparable to uh
silicone and Scar gel in terms of
benefits when did it come out let's
let's check I have everything bookmarked
at all times I bet you I could find a
study that shows that turmeric is
superior to both this came out in
2017. who published at Mederma
no disclosures private study what
Journal was this published
fair enough I'm not against Mederma uh
so overall though there are more studies
um for silicone in the benefit of so you
really can't do both you only can do one
because they're going to cover the skin
most of the time I what I do like and so
I still prefer silicone despite this
this relevant study which I appreciate
him staying on top of the research that
being said I actually like the silicone
like bandages that they have because
there's something that actually just
stick on the wound and they're reusable
so you can just apply them and cover
your scar as long as your scar is not
too big so I actually like even when I
was healing my own scarf from my most
surgery that had my chest that's what I
used as a silicone bandages because
they're just easy to apply easy to wash
easy to reapply so that's what I
personally prefer that wouldn't get on
my shirt the gel so that's what I would
recommend for most people silicone has
the most data but turns out I need an
extract has some data I think it's I
think it's second fiddle would you go
they were there like if you had to pick
for eight topical for a maturing scar I
think silicone and then just purely by
data does anything else come above onion
extract for you if you're just like no
probably not I would also throw in like
a retinoid into the mix here because
rhinoids can help remodel scars and they
can also help with the hyperpigmentation
that occurs a lot of times with scars so
I would throw that in the mix
potentially but uh but uh but it will
actually give you you've moved onion
extract up higher for me because it was
Mega low for me I know it was actually
so so you moved it up a little bit for
me I still I still yeah good job all
right so the actual the whole thrust of
that I actually wanted him to still deny
it why do you say the whole thrust of
things oh yeah it's not a phrase
I don't read old book I read really old
books I don't know the thrust of it like
nobody speaks like that no no I'm always
willing to concede as more information
comes out I said in the very beginning
of the channel we want to be challenged
we want to be debunked so please debunk
us because we're always open to more
information so that's personally thank
you for bringing in new information that
being said I'm still going with silica I
am too okay so all right that's that's
the topicals now we have some of the
procedural options and these can be
these are where you really get like the
most bang for your buck these are the
most effective right and this is coming
in later on in the wound healing process
so in a more mature scar you're going to
see benefits with these but what we're
looking at here is we have a lot of
different options you know one of the
good options that we have that
dermatologists can perform is
microneedling so basically a device that
pokes tiny little holes in the skin this
is a video of us doing this on the face
just for resurfacing and then there's
another option called radio frequency
microneedling that basically does the
same thing as micro needling but also
introduces some heat to contract the
wound so you have radio frequency
microneedling you have regular
microneedling you can do chemical peels
on scars and then you can even do laser
resurfacing on scars exactly and so with
the lasers we are so many different
types of lasers we can start it's
different components of a scar you'll
see studies of vascular lasers for early
stretch marks that really just gets rid
of that reddish Hue to it and then
you'll see things like fractionated CO2
laser where you're poking multiple
multiple multiple holes similar to
microneedling just a bit more aggressive
to kind of try to remodel that scar with
the laser trying to figure out how you
should treat this scar you should really
try to go with somebody that has a lot
of options and the reason why is because
he said say you have some a little bit
of redness to the scar but the scar is
also pretty thick you may want to treat
it with something that treats the
redness the vascular lasers and then
follow that with the treatment that
actually treats the collagen like
something like a CO2 laser so it's
oftentimes combining therapies that
you're going to get the best results but
if you go to a place that only has micro
needling they're only going to offer you
microneedling so go somewhere that has
more modalities to treat these more
advanced scars I think there's actually
value of seeing a dermatologist who like
understands the over-the-counter space
too is because I think it's important to
have an encompassing understanding of
everything out there even if you don't
do it it's important to know what else
is available for the patient and offer
it up one of the advantages of how we
train and why our training is so long is
that we learn learn about what other
people do and what other people can
offer so like if you come to me with
heart issues like I know like I send
this to my Cardiology colleague because
they know so much more about how to
interpret EKGs than I do even though
like I know a little bit about EKGs and
so along the process we learn about
what's in our scope of practice what's
not in our scope of practice and where
we should send somebody right so there
are certain phases of your life for your
reach where you come to me for a
cosmetic procedure and I'm going to say
like you got to see my my plastic
surgery colleague because I can't help
you with what I have in my tool ship
exactly but we've seen it done before so
I mean like been a part of a thousand
deliveries it's that first-hand
experience and I guess it sounds like
scientific anecdote where we've seen the
whole scope of what you could experience
and so we can have more individualized
and personalize that information for you
so going back to lasers a CO2 laser is
one of the best options that you can
have for lasers basically pokes tiny
little holes in the skin by targeting
water produces a little bit of heat but
helps to resurface and blend that scar
over time you're probably never going to
get to a hundred percent but the idea is
that you're going to get incremental
Improvement I had a Dermatology friend
described this to me Dr bonusali said
that I tell people that every time we
treat it it's like you add one more
Instagram filter to the scar so they
don't go away right away it's shades of
improvement that you look for with these
treatments now keloids keloids are their
own their own special thing they're a
little bit different so we have to give
a little bit of nuance for that a keloid
because it extends beyond the wound
margin there's a lot of cell signaling
it was just completely hyperactive these
may not respond to any of the things we
listed before in fact you take a really
special consideration even if you go so
far as to cut out the keloid scar and
then redo the whole surgery there's a
really good chance it coming back and
can come back bigger so sometimes with
keloids you do like more conservative
approach and that you might inject it
with a steroid where you use that side
effect of atrophy to your advantage or
you might inject it with other uh other
agents there's a lot of different
injections you can use to try to stop
that excessive cell growth or if you're
using it on an area that's amenable to
it you can actually use pressure too so
if it's on the earlobe you can do your
injections and you can also actually
apply constant pressure to you try to
help minimize it and just also key loads
on the earlobes tend to respond better
than other places so one really good
treatment for your keloids is actually
radiation so here to talk about
radiation is a new guest Dr alduba
right right he decided to somehow match
us today
so Dr aldoba is a born-certified mode
surgeon he's also my business partner at
our practice and the reason I'm bringing
him on right now is because he is a good
friend of mine but also because he is an
expert at treating keloids with
radiation so when we first got our
radiation machine
so first of all thank you for
introducing me I appreciate you having
me here I had a different shade of blue
and then I wanted to match you so can't
go wrong matching Dr Shaw so yeah
so I got the radiation machine to treat
skin cancer non-melanoma skin cancer
squamous cell carcinoma basal cell
carcinoma but an additional benefit to
radiation treatment is that after you
remove the keloid you can radiate three
times three days in a row to inhibit the
fibroblasts those are the scar producing
cells you don't actually directly
inhibit the fibroblasts you inhibit the
mast cells from releasing mediators that
actually then stimulate the fibroblasts
to cause your keloid scar so Dr Shaw
here's a quick quiz okay if I remove a
keloid sure and I don't do anything sure
what is the chance that that kilo is
going to recur like 50 50 71 okay I told
you all statistics are made out
if I remove it and I and I do three
doses of radiation this is superficial
radiation so it's not affecting any
other site three doses three days in a
row what do you think the recurrence
rate will twenty percent three percent
three to four percent so that's so it's
been excellent I've done it on a lot of
patients and so far knock on wood no
recurrences radiation a great treatment
option I've actually seen good results
with that at our office so you know we
radiate the people afterwards they come
in three times they do great that
process you have to come in more often
but it's a good way to not have to worry
about it coming back which it's Mega
high risk exactly and the radiation
machine we use is the census SRT 100
right so it's superficial so when people
hear radiation they think I don't want
to be radiated but the way that these
census machines are are designed is so
that it really only affects the top
layer of the skin where you're trying to
treat those keloids if it's just a
liquid radiation that's how it's 20 it's
just a little bit thank you you're
welcome thank you for having me guys and
then tying this all together so there's
kind of a time frame you can follow
within the first two weeks after an
injury or operation you're really
looking to keep it moist so using that
Vaseline to lock in all those growth
factors the hydration and the moisture
that's extremely important until let's
say the sutures come out then uh when
the scar is kind of entering that
remodeling phase but it's still early
and maturing that's really one when you
want to use probably that silicone scar
gel Plus for my design and extract right
that's when that's happening but after
that scar has matured settled in and
robust if it's still there it's just not
where you want it that's when all those
other treatment modalities come in up to
two weeks Vaseline two weeks to let's
say six months you're doing your
Silicone and then for six months onwards
you're looking at more robust treatments
that you see at your dermatologist yeah
perfect thank you all so much for tuning
in please like comment and subscribe and
let us know if you like us being back
together you want to do more of the long
distance videos
all right we'll see in the next
appreciate you always
thank you