Scars: How to get rid of them | Bangkok Post: learning

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Scars: How to get rid of them

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Everyone has scars but few know how to get rid of them. Here is some advice from a leading doctor & expert in skincare. 



In photo above one of the victims of the road rage attack by Mu Ham (Kanpithak Pachimsawat) who rammed his car into a group of bus passengers. They said they feel like they are fighting alone for justice.

Click button to listen to Scar Elimination to download

IN THE MIRROR

Leave no scar behind

31/05/2012
Dr Nantapat Supapannachart

Just like a fine piece of silk, our skin starts off being almost flawless, until a burn, injury, surgery or similar trauma scars it. Some scars are small and can be hidden beneath clothes, but many are on the exposed areas of the skin and they can appear pretty unappealing.

"Sure, scarred skin can be perceived as "sexy because it means you made a mistake that led to a mess", as Angelina Jolie calls it. We can treasure those memories and experiences that led to the scars, but we'd still rather have flawless skin, wouldn't we? It's one thing to remember your experiences; it's another to be reminded of those experiences every day by an unattractive scar on your body or even worse, face. 

HOW DO INJURIES TURN INTO SCARS?

Cuts, skin conditions and surgical procedures can all leave scars. Scar formation is a natural part of the healing process. If the damage is only on the top skin layer, they are most often small and barely noticeable. However, [if] the underlying, dermal layer of skin is affected; scarring can be unattractive and obvious. During healing, the fibrous skin protein collagen works from the outside epidural skin layer to the inside, dermal layer. Collagen first works to ensure that when the skin scab sheds or your stitches come out, your skin will stay together. It then works to fill in holes left by the wound

CAN THESE BE REMOVED?

Various factors influence how your skin scars. The depth and size of the wound or incision and the location of the injury are going to impact the scar's characteristics and what can be done. Deep scars are unlikely to completely go away, but there are ways to reduce its size and appearance markedly. Your age, genes, even your gender or ethnicity, will also influence how your skin reacts to the treatments. Some will obtain better results than others.

WHAT ARE THE TYPES OF SCARRING?

Not all scars are the same and each is unique to the injury. But to categorise, you can say there are four main types of scars. Keloid scars are that result of an overly aggressive healing process because of which these scars tend to extend beyond the original injury. Another type of scar is hypertrophic scars, which are raised and red scars that are similar to keloids, but do not breach the boundaries of the injury site. Then there are contracture scars, which are often seen with burn patients. In this the tightening of skin can impair your ability to move and this type of scar may go deeper to affect muscles and nerves. And then of course there are acne scars, which many people experience. If you've had severe acne, those may end up in deep pits scars or those that are angular or wavelike in appearance.

WHAT CAN BE DONE TO DIMINISH SCARS?

Each scar needs to be given special attention and treated uniquely. Mild scarring can be removed using chemical peeling, which is adding a chemical solution to the skin to remove the epidermis, enabling new, regenerated skin to appear, improving the appearance of the condition. For keloid type scars you can begin with using pressure treatment or gel pads with silicone when you sustain an injury. Smaller keloids can be treated using a freezing therapy using liquid nitrogen. Even a Yag laser can be used. Short pulses of the laser beam can smooth, sculpt and normalise the appearance of scars. If the scar remains, injections with steroids can be used. The same injections can be used for hypertrophic scars. If the scars appear depressed, then collagen-related fillers, polymer or fat fillers is injected in small quantities below the surface of the skin to elevate depressed scars.

WHAT ABOUT ACNE SCARS?

For mild acne scarring, again chemical peeling should do the job or needle rollers can be used to stimulate collagen on the surface. If you want real improvement for severe scars, then you have the choice of laser resurfacing. This is primarily used to get rid of nasty wrinkles and scars that appear on the surface of the skin. The laser emits a powerful beam of light that burns affected skin away. A more efficient technology is sublative rejuvenation, which can go deeper than traditional laser heat to your subcutaneous dermal tissue, breaking the sebum cycle that causes active acne to form. It also contracts and restructures collagen, resulting in skin tightening and improved skin quality.

HOW CAN WE PREVENT FUTURE SCARRING?

After an injury, avoid interfering with the healing process. Treat the wound to prevent infection but keep the following in mind. Keep the affected area moist with Vaseline or something similar and cover the cut for about a week. Do not let the injury dry out and scab over. After taking off the bandage, continue to keep the cut moist until new skin begins to form at the site. To prevent the scar from popping out, place pressure on the cut. You can use silicon sheets specially designed to keep the injury area flat. Once the wound has closed over, gently massage the newly formed skin with lotion in a circular motion for 15 to 30 seconds a few times a day as it will help to break down the dense bonds of collagen which will in turn minimise the scarring.

Dr Nantapat Supannachart is an American Board-certified dermatologist and laser surgeon. Call 080-500-0123 or visit www.apexprofoundbeauty.com

(Source: Bangkok Post, IN THE MIRROR, Leave no scar behind, 31/05/2012, Dr Nantapat Supapannachart, link

Scar Vocabulary

scar - areas of the skin that change shape and color after an injury: "areas of fibrous tissue (fibrosis) that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound (e.g. after accident, disease, or surgery) results in some degree of scarring. An exception to this is animals with regeneration, which do not form scars and the tissue will grow back exactly as before" (See Wikipedia)

leave scars -
when some injury results in scars on your body 
scar formation -
when a scar gradually forms and appears over a wound on the body

victims - people who are hurt from the actions or crimes of other people
rage - being very very angry
road rage - when a person driving a car becomes very angry (and does something stupid like shoot someone or ram into someone)
ram - hit something with a car or other moving thing

injury - physical damage done to a part of the body such as a wound or cut
trauma - a serious injury การบาดเจ็บรุนแรง

wound - an injury in which your skin or flesh is damaged, usually large บาดแผล บาดเจ็บ
cut - a small wound

scab -
when a skin or wound is getting better the hard dry layer of blood that forms on the outside (See Wikipedia)
shed - fall off (exampled: snakes shed their skin at a certain time of year)
skin scab sheds

healing - the process of a wound or cut getting better and developing skin or a scar to cover up the wound (See Wikipedia)

process - a series of actions that you take in order to achieve a result แนวทางปฏิบัติ, กระบวน, วิธีการ
healing process

natural - found in nature (not made in a factory by humans) ตามธรรมชาติ
natural part of the healing process

aggressive - done with great energy and intensity; forceful (See glossary) ก้าวร้าว ซึ่งมีความมั่นใจสูง
aggressive healing process

bandage - plaster, a piece of plastic and cloth to cover a wound or cut ปลาสเตอร์,  ผ้ายางปิดแผล
taking off the bandage

layer - a thin sheet of a substance; a level of material, such as a type of rock or gas, which is different from the material above or below it ชั้น
layers of the skin - the skin has three layers: epidermis, dermis and hypodermis (See Wikipedia)
skin layer

epidermis - the outer layer of skin without blood vessels that protects the body from germs and grows out, is shed and replaced (See Wikipedia)
dermis - the second inner layer of skin with blood vessels, hairs follicles and oil glands, that cushions the body from stress (See Wikipedia)

collagen - a type of cell and tissue found in skin and muscle that makes it strong (See Wikipedia)
fibrous skin protein collagen

type-1 collagen  
- "the most abundant collagen of the human body. It is present in scar tissue, the end product when tissue heals by repair. It is found in [muscle] tendons, skin, artery walls, cornea,...[muscles]... , ...cartilage, and .... bones and teeth", most of the collagen in the body is this type of collagen (See Wikipedia)

collagen-related fillers -

fibrous skin protein collagen works from the outside epidural skin layer

stiches -  
suture, surgical suture; the closing of wounds by doctors by sewing the skin together, to help the wound heal well (See Wikipedia)
stitches come out
- when sutures are taken out after the wound has healed
surgery
- medical treatment in which a doctor cuts open someone's body การทำศัลยกรรม การผ่าตัด

keloid  scars -
 a big raised scar with overgrowth growing beyond the boundaries of the original wound (See Wikipedia)
hypertrophic scars - a big raised scar without overgrowth growing beyond the boundaries of the original wound (See Wikipedia)



silk - ผ้าไหม
fine - not rough; high quality; having great detail (example: the fine weave of the cloth took a lot of work)
fine piece of silk - a piece of silk with a very detailed small weave (not rough); of a very high quality

flaw -
something wrong, not right, not perfect (example: the flaw in the middle of the diamond) ข้อบกพร่อง, ข้อด้อย, ข้อตำหนิ, จุดบกพร่อง
flawless -
without flaws, perfect

exposed
- not protected from something ได้รับ ได้สัมผัส (แดด หรือสารพิษ เป็นต้น) openly affected by and not protected from ได้รับ ในที่นี้หมายถึง สูดควันบุหรี่
exposed areas of the skin - skin that is not covered or protected from something (such as the sun's rays or from touching the ground)

unappealing - does not look nice 
appear pretty unappealing


Just like a fine piece of silk, our skin starts off being almost flawless, until a burn, injury, surgery or similar trauma scars it. Some scars are small and can be hidden beneath clothes, but many are on the exposed areas of the skin and they can appear pretty unappealing.

perceived as - people see it as ... ; people understand it to be ...

mistake -
do something wrong สิ่งที่ผิด
made a mistake

mess -
สภาพสกปรกและไม่เรียบร้อย, สภาพรกรุงรัง
made a mistake that led to a mess

treasure (noun) - a collection of very valuable things ของมีค่า, เพชรพลอย, ของสูงค่า
treasure (verb) - treat something as very valuable, appreciate it a lot

memory - things that you remember from your past ความจำ
treasure those memories - remember things and place great value on them

experiences
- things and events that happened to you in your life

attractive
-
nice to look at
unattractive -
not nice to look at 
unattractive scar -
a scar that is not nice to look at

"Sure, scarred skin can be perceived as "sexy because it means you made a mistake that led to a mess", as Angelina Jolie calls it. We can treasure those memories and experiences that led to the scars, but we'd still rather have flawless skin, wouldn't we? It's one thing to remember your experiences; it's another to be reminded of those experiences every day by an unattractive scar on your body or even worse, face. 

notice (verb) - see something (and know that it exist or happened) สังเกตเห็น, พบ, เจอ
noticeable (adjective) - something that you can see (and be aware of its existence) 

barely - almost not happening แทบไม่เคยเกิดขึ้น
barely noticeable - difficult to see it (difficult to know that it exists)

underlying - underneath, supporting, forming a foundation or basis for something
obvious - clear; easy to see, recognise or understand ชัดเจน

epidural skin layer - epidermis
dermal layer of skin - dermis

ensure - to make certain that something happens or is done รับรอง ให้ความมั่นใจ ให้การยืนยัน 

Cuts, skin conditions and surgical procedures can all leave scars. Scar formation is a natural part of the healing process. If the damage is only on the top skin layer, they are most often small and barely noticeable. However, the underlying, dermal layer of skin is affected; scarring can be unattractive and obvious. During healing, the fibrous skin protein collagen works from the outside epidural skin layer to the inside, dermal layer. Collagen first works to ensure that when the skin scab sheds or your stitches come out, your skin will stay together. It then works to fill in holes left by the wound

factors - one of the things that effects a situation or event ปัจจัย
influence - the power to have an effect on people or things; affect what people do or think อิทธิพล to affect or change how someone or something develops, behaves or thinks มีอิทธิพลต่อ, ชักจูง อำนาจบังคับ

depth - the distance down either from the top of something to the bottom, or to a distance below the top surface of something ความลึก
incision - a cut into something with a knife or surgeon's scalpel

impact -  the effect some event has, the changes it causes, the good or harm that an event does ผลกระทบ

markedly - changed in a big way that can be noticed
reduce its size markedly

gender
- the fact of being either male or female เพศ (See Wikipedia)
ethnicity - whether a person is from Thailand, Italy, the US, UK; or whether they are Asian or Caucasian (Farang), etc ..
.
results - what is produced in the end by an activity or task
obtain better results

Various factors influence how your skin scars. The depth and size of the wound or incision and the location of the injury are going to impact the scar's characteristics and what can be done. Deep scars are unlikely to completely go away, but there are ways to reduce its size and appearance markedly. Your age, genes even your gender or ethnicity, will also influence how your skin reacts to the treatments. Some will obtain better results than others

unique - very special, unusual or good ที่มีลักษณะพิเศษ เป็นเอกลักษณ์
categorise - to put people or things into groups with the same features จัดกลุ่ม, จัดประเภท

tend to - to be likely to behave in a particular way or have a particular characteristic มักจะ
extend - to include something more ยืดออกไป ขยายออกไป
extend beyond

these scars tend to extend beyond the original injury

site - a place where something happened ที่เกิดเหตุ  สถานที่  สถานที่เกิดเหตุ
injury site

breach - to break through something ฝ่าฝืน ละเมิด
breach the boundaries

breach the boundaries
of the injury site

contracture scars - burn scar contracture, the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the injured area" (See Wikipedia)

impair - prevented from working
tightening of skin can impair your ability to move

acne - the red spots that teenagers often get all over their face from sebum blocking their pores, pimples (See Wikipedia)
sebum - an oily-waxy substance on the skin coming from the sebaceous glands under the skin (See Wikipedia)
acne scars

severe
- very serious and worrying ที่รุนแรง ที่น่าเป็นห่วง
severe acne

deep pit scars


angular
or wavelike in appearance

Not all scars are the same and each is unique to the injury. But to categorise, you can say there are four main types of scars. Keloid scars are that result of an overly aggressive healing process because of which these scars tend to extend beyond the original injury. Another type of scar is hypertrophic scars, which are raised and red scars that are similar to keloids, but do not breach the boundaries of the injury site. Then there are contracture scars, which are often seen with burn patients. In this the tightening of skin can impair your ability to move and this type of scar may go deeper to affect muscles and nerves. And then of course there are acne scars, which many people experience. If you've had severe acne, those may end up in deep pits scars or those that are angular or wavelike in appearance.

given special attention

chemical peels -
"chemicals which destroy the epidermis in a controlled manner, leading to exfoliation and the alleviation of certain skin conditions, including superficial acne scars. Various chemicals can be used depending upon the depth of the peel, and caution should be used, particularly for dark-skinned individuals and those individuals susceptible to keloid formation or with active infections" (See Wikipedia)

remove
- to take something away เอาออกจาก
remove the epidermis

treatment
- the process of providing medical care การรักษา
pressure - pushing on something; a force causing change
pressure treatment

gel pads with silicone

sustain
- to experience, injury, damage, loss, etc. ประสบกับ (ความสูญเสีย การเจ็บป่วย)
sustain an injury

therapy
- a treatment which helps someone feel better, grow stronger, etc., especially after an illness การบำบัดโรค
freezing therapy

Yag laser
- one  type of laser used in skin treatment (dermatology)

beam - to send out a beam of light, or an electrical or radio signal, etc ลำแสง คลื่น a line of radiation or particles flowing in one direction ลำแสง
laser beam

pulse -
one amount of something (such as light or laser) for a short period of time; one among many regular pulses 
short pulses of the laser beam

smooth - not rough, without bumps
sculpt -
change shape  

normalize -
make normal again
normalise the appearance of scars
 
steroids -
a drug or pharmaceutical used in some skin treatments (See Wikipedia)
injections with steroids

depress -
lower, move to a lower level; push down
depressed -
at a lower level

elevate -  move to a higher level
elevated - at a higher level

scars appear depressed
elevate depressed scars

below the
surface of the skin

Each scar needs to be given special attention and treated uniquely. Mild scarring can be removed using chemical peeling, which is adding a chemical solution to the skin to remove the epidermis, enabling new, regenerated skin to appear, improving the appearance of the condition. For keloid type scars you can begin with using pressure treatment or gel pads with silicone when you sustain an injury. Smaller keloids can be treated using a freezing therapy using liquid nitrogen. Even a Yag laser can be used. Short pulses of the laser beam can smooth, sculpt and normalise the appearance of scars. If the scar remains, injections with steroids can be used. The same injections can be used for hypertrophic scars. If the scars appear depressed, then collagen-related fillers, polymer or fat fillers is injected in small quantities below the surface of the skin to elevate depressed scars.

mild - just a little bit; not severe
mild acne scarring

stimulate - encourage activity, growth, and development กระตุ้น (See glossary)
stimulate collagen on the surface

improvement - when something gets better or when you make it better การปรับปรุง, การทำให้ดีขึ้น
real improvement for severe scars

laser resurfacing

wrinkles -
folds in the skin; when skin is not smooth (See Wikipedia)

nasty
- bad or very unpleasant อันตราย, น่าวิตก
get rid of nasty wrinkles

efficient - produces a lot from few resources; doing a task with no waste of time, money or energy
efficient technology

rejuvenation
- the process of making someone look or feel young and energetic again
sublative rejuvenation

traditional
- things that have been used for a long time
traditional laser heat

subcutaneous - under the skin

tissue - the substance that animal and plant cells are made of เนื้อเยื้อ
subcutaneous dermal tissue

cycle
- a series of events repeated over and over again (in the same order)
active - working, operating, doing its job

the sebum cycle that causes active acne to form

contracts
- grows smaller, shrinks
contracts and restructures collagen, resulting in skin tightening and improved skin quality.

For mild acne scarring, again chemical peeling should do the job or needle rollers can be used to stimulate collagen on the surface. If you want real improvement for severe scars, then you have the choice of laser resurfacing. This is primarily used to get rid of nasty wrinkles and scars that appear on the surface of the skin. The laser emits a powerful beam of light that burns affected skin away. A more efficient technology is sublative rejuvenation, which can go deeper than traditional laser heat to your subcutaneous dermal tissue, breaking the sebum cycle that causes active acne to form. It also contracts and restructures collagen, resulting in skin tightening and improved skin quality.

moist - containing water; slightly wet เปียกชื้น

scar popping out
place pressure on the cut

dense
- very thick
bonds - close connections joining two or more things or people ความผูกพัน
dense bonds of collagen

minimise - to reduce something harmful or unpleasant to the smallest amount or degree ลดให้เหลือน้อยที่สุด ลดจำนวนลง
minimise the scarring.

certified
- inspected officially and verified that the company follows the rules ผ่านการรับรองคุณภาพ

After an injury, avoid interfering with the healing process. Treat the wound to prevent infection but keep the following in mind. Keep the affected area moist with Vaseline or something similar and cover the cut for about a week. Do not let the injury dry out and scab over. After taking off the bandage, continue to keep the cut moist until new skin begins to form at the site. To prevent the scar from popping out, place pressure on the cut. You can use silicon sheets specially designed to keep the injury area flat. Once the wound has closed over, gently massage the newly formed skin with lotion in a circular motion for 15 to 30 seconds a few times a day as it will help to break down the dense bonds of collagen which will in turn minimise the scarring.

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