No two scars are ever the same, notes Mr Jorge Leon-Villapalos, Consultant in plastic, reconstructive, aesthetic and burns surgery, and Clinical Lead of the London Scar Clinic. And, certainly, no two patients are ever the same. That’s why he believes in treating everyone in his care as individuals. It’s not just a person’s scars that are the focus of his attention, he says. It’s the person as a whole.
“We don’t treat scars, we treat patients with scars”
Scarring can happen as the result of trauma (such as self-harm or accidents), surgical intervention, burns, skin infections (chickenpox, for example) and scarring diseases, plus inflammatory conditions such as acne vulgaris. Scars themselves are fibrous tissue that may be hyper or hypo-pigmented, raised, depressed, or feel tight, itchy and painful.
A multi-disciplinary approach to treatment
Yet whatever a scar’s cause or appearance, patients do have to face an uncomfortable truth: medicine is not yet at the stage where scars can be eliminated. They can, however, be ameliorated; and this is best done with the help and support of an entire team of professionals.
A single patient should therefore be referred to a variety of specialists from numerous medical fields, including dermatology, laser treatment, cosmetic, plastic and reconstructive surgery, physiotherapy, scar management and hair transplantation.
This multi-disciplinary approach is vital in modern scar treatment, explains Dr Emma Craythorne, Consultant Dermatologist and Dermatological Surgeon at the London Scar Clinic. It’s necessary precisely because each patient has such individual needs.
In fact, she maintains that the days of a scar being treated by just one healthcare professional should be consigned to the past. “It’s such an old-fashioned way of thinking,” says Dr Craythorne. “And it’s ineffective. The fact is that whatever has caused the scar, a multi-disciplinary team can achieve much better results for a patient. For example, a case of skin cancer would be reviewed by healthcare professionals including a dermatologist, plastic surgeon, oncologist, radiologist and pathologist.”
The benefits of a personalised plan
After opinions have been given from each specialism, a personalised treatment plan is created for the patient. Drawing up such a plan requires a thorough knowledge of the patient’s history and an awareness of their concerns.
“It’s very important to listen carefully to the patient,” says Mr Leon-Villapalos. “We have to find out what their worries are, and how far they want to go in terms of complexity of treatments. This involves an honest discussion about what can be done to help minimise the impact of their scar.”
Treatments range in complexity from massage, moisturising and sun protection, to cosmetic camouflage, micropigmentation, laser treatments, micro-needling, dermal fillers, fat injections and more invasive treatments such as subcision (cutting fibrotic strands between a scar and underlying tissue, to reduce indentation) and ultimately surgery.
Physical scars can have a psychological impact
Physical scars can also cause long-lasting mental scars that may lead to anxiety and depression issues. Dr Craythorne believes that today’s ‘selfie’ culture has to take its share of the blame for this, because it has made many of us feel increasingly self-conscious about our looks.
“We live in an image-conscious society, which can be problematic for some people’s mental health,” she says, pointing out that even a tiny physical imperfection can have major consequences for a person’s psychological wellbeing. “For instance, scars which may seem small to others such, as a chicken pox scar, may subjectively be a greater problem for the person carrying it and can have a devastating impact on their quality of life. They may find social interaction difficult, and may avoid school, university or work.”
Psychological support for patients
Mr Leon-Villapalos agrees. He recalls treating people who have even been too ashamed to show their scars to close family members. “Some patients have concealed them for years and some have undressed in the dark to avoid revealing scars to their partners,” he says.
Others believe that scars — and particularly facial scars — can impact their careers. “They may avoid doing workplace presentations or meeting clients,” says Mr Leon-Villapalos. “In some cases, people feel that they have been passed over for promotion because of their scars.” Many patients are so troubled by their scars, they never leave their house.
This is why psychological support can also be of value during the treatment process. “Yes, it’s important to treat a scar with such interventions as laser therapy or surgery,” says Dr Craythorne. “But it can also be important to treat the person’s response to that scar. A lot of our work is done in conjunction with psychologists, because this is often a way of helping people deal with the emotional effects their physical scars can leave. It can be a key part of a patient’s multi-disciplinary holistic treatment.”
Ultimately, it’s no longer credible for patients to be offered limited treatment, stresses Mr Leon-Villapalos. “Most scars — other than simple ones — require more than one treatment from more than one professional,” he notes. “With the right mix of holistic treatments from a range of experts, we can aim to return patients to their normal life with the best outcome possible.”