Removal of postoperative scars. How to make a postoperative scar less noticeable? Removal and treatment. When treatment is urgently needed: what is a ligature fistula of a postoperative scar

Scars and welts can appear on the skin as a result of any damage to the skin. Burns, cuts, surgical operations and even regular acne. Almost every person wants to get rid of such dubious “decoration”, especially if it is located on a visible part of the body or face. Previously, such a procedure was possible only in some cases, but progress in the medical and cosmetology field makes it possible to eliminate almost any scar or scar.

First, let's find out the difference between the names of these skin lesions. A scar is a visible mark remaining on the skin after traumas suffered or surgical interventions. This word is not used in medical terminology and is more common in everyday speech. A scar is the growth of dense connective tissue in areas former damage skin (burns, mechanical damage, ulcers, ulcers or postoperative wounds). This is the term used in medicine to refer to a skin defect that occurs as a result of injury or inflammation of the skin. That is, “scar” and “scar” are practically synonymous. In ordinary speech, scars are often called flat scars, and scars are areas of connective tissue protruding above the surface of the skin.

In our article we will introduce you to the main types of postoperative scars and methods of removing them on the face and body. This knowledge will be useful for you if you want to get rid of such skin defects.

Types of scars

Experts identify the following types of scars:

1. Normotrophic scar. Such a mark on the skin is formed during the normal and uncomplicated process of scarring of the skin after injury. The scar is barely noticeable (in most cases), flat and has a color that is as close as possible to the shade of healthy skin.
2. Atrophic scar. Such a mark on the skin appears after unsuccessful removal of moles and papillomas or develops after acne or pimples. A scar resembles a hole or depression in the skin. Its tissues are flabby due to the fact that their collagen levels are reduced.
3. Hypertrophic scar. Such a mark remains on the skin after various damages her covers. It can be caused by burns, lacerations or bite wounds, incorrect treatment acute injury, permanent trauma to the healing wound area, inflammation or suppuration of the wound, location of the injury in active areas (on the skin of the joints, neck, etc.) or genetic predisposition to the proliferation of connective tissue. This scar always protrudes above the surface of the skin and has a pinkish tint. In some cases, peeling or tears are observed on its surface.
4. Keloid scar. looks like a tumor. The reasons for its appearance are the following factors: a genetic tendency to keloidosis, the scale and location of the injury (ears, pubic or sternum area, etc.). Injuries, surgeries, vaccinations, burns, or tattoos can lead to its formation. Such a scar hangs over the surface of the skin, rises above it and has a bright pink (almost red) or bluish color. Its surface is lumpy and dense to the touch. After 5-6 years, it gradually turns pale, its surface becomes wrinkled, and the central part may sink into the skin.

A separate group can be distinguished postoperative scars. Depending on the healing process and the tendency to overgrowth of connective tissue and keloidosis, such scar changes on the skin on the skin can be normotrophic, atrophic, hypertrophic or keloid.

For what indications and when are scars removed?

There are two types of indications for the removal of postoperative scars:

• medical - the scar is removed in cases where it leads to functional disorders (for example, it interferes with joint flexion, deforms the mouth or eyelid, etc.);
• cosmetic defects - the scar is removed due to the development of complexes in the patient.

The time for scar removal surgery is determined individually for each patient. The following factors are taken into account:

• location of the injury;
• the nature of the blood supply to damaged tissues;
• nature and extent of damage;
• patient's age;
• tissue immunity;
• heredity.

As a rule, in the near future (no later than a month after surgery), scars that are located on the skin of the joints and limit its normal movement are removed. In other cases, operations are carried out after “scar maturation”, i.e. 1-2 years after surgical intervention.

Methods for removing postoperative scars and scars

There are several ways to remove post-operative scars and scars. In each specific clinical case, the method of getting rid of hated marks on the skin is selected individually. The choice depends on the type and size of the scar, the age of the patient and the characteristics of his health. To remove some scar changes, it is more advisable to use a set of measures.

Cryodestruction

Some keloids or hypertrophic scars can be removed by freezing. The doctor wets the applicator in a special coolant (for example, liquid nitrogen) and presses it several times onto the scar formation. The exposure time is determined individually and is several minutes. The area of ​​treated skin becomes covered with icy drizzle. The stages of freezing and thawing are accompanied by very noticeable painful sensations Therefore, this method of scar removal is carried out under anesthesia.

In the first days after surgery, swelling and blisters appear on the skin and scar (consequences of a deep cold burn). After 5-7 days, the bladder opens, serous fluid pours out of it and the healing process begins. The area of ​​cold damage becomes covered with a crust, under which healthy tissue begins to form. The recovery process lasts about 3 weeks. In place of the previous scar, a pinkish scar appears, which after 5-6 months becomes almost invisible. In some cases, to achieve maximum cosmetic effect, 2-3 more of the same procedures are performed.

The success of this technique for removing postoperative scars largely depends on a person’s genetic tendency to form hypertrophic or keloid scars. In the presence of such a hereditary predisposition, recurrence of scar changes is possible.

Microwave therapy

This technique is used as an additional procedure for cryodestruction. It is performed using ultra-frequency electromagnetic waves, which help destabilize water in scar tissue. As a result, subsequent tissue freezing becomes more effective. When using microwave therapy, the scar becomes flatter, turns pale and recurs less often.

Beeches-irradiation

This technique can be used for both removal and prevention of scar formation. It is more suitable for removing young keloid scars. The procedure of close-focus irradiation (x-ray therapy) is performed using special apparatus. The radiation dose and number of procedures are determined individually and depend on the age and area of ​​the scar and the age of the patient. To remove mature keloid scars, they are activated before the procedure using cryodestruction. After achieving a vesicular reaction to low temperatures(after 1-2 sessions of exposure to cold) and all the crusts fall off, irradiation with Buka rays is carried out. After such procedures, keloid scars disappear and rarely recur.

Dermabrasion

This technique, which consists of mechanical removal of the top layer of skin using special rotating brushes or cutters, can be used to remove hypertrophic and some normotrophic scars. During the procedure, which is performed under anesthesia, the doctor grinds the scar (keratinized) tissue down to the upper layer of the dermis.

After the bleeding stops, a bandage is applied and changed periodically. In place of the removed layers of skin, a scab appears, which disappears on its own after 7 days. Over time, the scar becomes less noticeable. In some cases, if the technique is performed incorrectly or is chosen incorrectly, an even larger scar may form in place of the former scar.

Microdermabrasion

Compared to dermabrasion, this procedure is more gentle, but it can only be used to remove superficial scars (atrophic and some normotrophic). To polish the epidermis and exfoliate its cells, aluminum oxide powder, ultrasound or some chemical compounds(acids). Scar removal can be done over several procedures. Their number and intervals between them are determined individually. As a result, a new layer of healthy skin is formed at the site of scar changes.

Laser technologies

These techniques can be used to remove any type of scar changes. To perform them, special equipment and anesthesia are used. Erbium and carbon dioxide lasers are widely used. Their rays heat and vaporize the layers of skin that form the scar and stimulate the production of natural collagen. At the same time, the laser does not damage healthy tissue, provides an antibacterial effect, does not require sutures, and the patient’s rehabilitation is much faster.

The carbon dioxide laser acts at a given depth, and with its help large scars can be removed, while the erbium laser polishes the surface layers of the skin. These techniques can be used on any part of the body, including such delicate areas as the eyelids. Laser technologies are often combined with other procedures: physiotherapy, dermabrasion, microdermabrasion, peeling, mesotherapy, etc. complex impact on the skin provides a more perfect cosmetic result.

Surgical operations

To remove cicatricial deformities of the skin, simple, complex and multi-stage surgical interventions can be performed. These methods are more radical, but are rarely used to remove keloid scars (due to their frequent recurrences). The choice of a particular surgical technique is determined clinical case(i.e. type, size and shape of the scar). All of them are carried out under general anesthesia and require rehabilitation of the patient in a hospital setting.

For narrow scars, simple operations are performed to excise them and suturing them with a cosmetic suture. After the healing of such a postoperative wound, a barely noticeable mark remains on the patient’s body.

For scar contractures on the joints (scars that limit the movement of the joint), operations are performed with plastic surgery using local tissues. For this purpose, areas of the skin that are located close to the scar, or a pedicle flap of skin are used (i.e., the flap is not completely cut out, and a feeding pedicle is left on it).

For extensive scars, expansion surgery can be performed. For this purpose, special silicone bags or fabric expanders are used, which are sewn under the skin near the scar. They are gradually being pumped up saline solution, and an increase in their volume leads to stretching of the skin. You can achieve this result in 1-2 months. Once enough new tissue has formed, the expanders are removed, the scar is excised, and the edges of the healthy skin are sutured.

In more complex cases with extensive scars, plastic surgery with free skin grafts is performed. Such interventions can be performed using:

• full-thickness flap - the graft area is excised in the full thickness of the skin;
• split flap - the graft section is split in thickness so that keratinoblasts (cells for self-healing) settle on the donor surface, the flap is excised in the form of a whole piece of skin, a mesh flap, or the branded method according to Reverden.

When performing such plastic surgeries with free skin grafts, various additional devices can be used to ensure faster tissue healing (for example, a radio knife).

Filling with collagen or adipose tissue

This technique is used to remove atrophic scars. It runs under local anesthesia. Several subcutaneous injections are made into the area of ​​the scar, which is buried in the skin, and it is filled with collagen, adipose tissue (taken from other areas of the body) or preparations based on hyaluronic acid. The effect after such scar removal is temporary, since substances introduced under the skin are absorbed over time (collagen - after 4-6 months, adipose tissue– after 6-18 months, hyaluronic acid preparations – after 6-12 months). After this, the procedure can be repeated.

Drug therapy methods

As complementary therapy For the treatment of keloid and hypertrophic scars, various medicines, which are introduced into the changed tissues. The following drugs can be used for this:

• corticosteroids: Triamcinolone acetate, Kenalog-40, Diprospan, etc.;
• immunomodulators: alpha and gamma interferons;
• enzymes: Lidaza, Ronidase, etc.;
• cytostatics: Fluorouracil, Bleomycin

These injection techniques can be supplemented with microcurrent therapy.

The defect caused by surgical damage to the skin is filled with connective tissue (scar) over time. The process is irreversible, but there are ways to improve it appearance annoying flaw in appearance. This means that after surgery it is possible. There are various means and methods to make scars almost blend in color and texture with the surrounding areas of the skin.

Scars after surgery cannot be treated. Where should I put the comma?

The operations you have undergone will remind you of themselves for a long time with scars on your body if you let the healing process take its course. Scars are not attractive to anyone; many people want to get rid of them and return their skin to an attractive appearance. First, you should understand that at the site of the incision, a section of connective tissue devoid of sebaceous and sweat glands, hair follicles. All this time you can use medicinal products to minimize cosmetic damage.

Gradually, one of the main types of scars (normotrophic, atrophic, hypertrophic, keloid) appears in the suture area. Each scar will require an individual approach, but there are general rules treatment. One of the most important things is to prevent chronic inflammation and complications.

What is granuloma?

If surgeons used non-absorbable suture material, a postoperative scar granuloma (the body's reaction to foreign particles in the skin) may occur. Starch or talc used for surgeons' gloves and microorganisms often get into the surgical wound (if asepsis rules are not followed).

The formation of postoperative scar granulomas is prevented by the use of self-absorbable, hypoallergenic types of suture material.

Granuloma impairs the functions of tissues and organs; large accumulations of such formations compress blood vessels and nerves. Fibroblasts form around and scarring occurs. Treatment is usually carried out in a medical facility and involves excision of the connective tissue with granulomas. If the cause of inflammation is suture material, all remaining fragments are removed.

How to speed up the resorption of postoperative scars?

They are in demand in the treatment of scars, preventing the proliferation of connective tissue. Silicone gels and ointments without polyorganosiloxanes promote the natural resorption of scars after surgery. Among the latter, the creams “Contractubex” and “Kelofibraza” have proven themselves well. As consumers rightly note, these drugs are best used for small scars.

Silicone ointments and gels are used in the treatment regimen after removal of postoperative scars and scars, for the prevention of keloids and the resorption of other scars. Polyorganosiloxanes create a thin, almost imperceptible film that protects the cut surface from moisture loss and mechanical stress. In addition, itching and other discomfort.

Gels with silicones are used to resolve postoperative scars for at least 5–10 weeks.

A significant part of pharmaceutical products containing organosiloxanes is produced by European and American companies. Retail prices for waterproof gels and plates remain high. We offer to compare foreign-made scar correction preparations, which were evaluated by experts and consumers in the United States (table).

Rating of products for the correction of scars and scars

Cream "Malavtilin" - an achievement of Russian cosmeceuticals

Many preparations for external use accelerate the regeneration of cells and tissues, promote the resorption and healing of scars. When answering the question of how to remove a postoperative scar, experts often mention physiotherapeutic treatment in combination with the use of ointments. For example, with the information-active drug “Malavtilin”

Cream "Malavtilin" affects the skin, nerve endings, biological active points.

Application effect:

• antiseptic;
• antibacterial;
• antivirus;
• anti-inflammatory;
• anesthetic;
• decongestant;
• deodorant.

Active ingredients in the cream: aloe vera, juniper, jojoba, macadamia oils, hyaluronic acid, malavit, plant extracts (calendula, eleutherococcus, horse chestnut, chamomile). They produce the cream in 50 ml tubes (price 300 rubles).

What are the options for radical treatment of post-operative scars?

Choosing a method for getting rid of a skin defect that has arisen after surgery is not an easy task. Scars are removed with a laser, excision, skin grafting, and chemical peeling are used. Each method of correcting scar deformity has pros and cons. When choosing a particular method, you should trust the recommendations.

Treatment methods for postoperative scars:

• beech therapy - dosed irradiation of the scar with soft x-rays;
• cryodestruction - destruction of scar tissue with local application of low-temperature liquid nitrogen;
• mechanical dermabrasion - removal of the top layer of damaged skin using a special device;
• laser resurfacing - layer-by-layer scar removal, activation recovery processes in the skin;
• surgical method of correction.

The above treatment methods are prescribed with caution for keloid scars after surgery, when the processes in the damage are stabilized.

Video about laser removal of postoperative scar

What are the complications of postoperative scars?

Ligature abscess of a postoperative scar occurs after surgical interventions. Suppuration occurs around the threads, the abscess is opened through a small hole, and a fistula is formed on the surface of the skin. Treatment of a ligature abscess involves the surgeon making a small incision in the skin through which the outflow of pus begins. After this, the doctor takes out the remaining thread with a clamp; if it doesn’t work, he prescribes conservative treatment.

If a patient is undergoing surgery, they need to be aware of common complications. For example, what is seroma of a postoperative scar? This is a collection of lymph caused by rupture lymphatic vessels. Translucent yellowish contents pour out from the capillaries. This complication is most common in overweight patients. Treatment consists of drainage procedures and taking antibacterial drugs.

Prevention of complications - strict adherence to the rules of asepsis and antisepsis during surgical operations.

Comparison different types treatment of scars leads to the conclusion that a combination of methods is necessary. Modern hardware technologies are developing. However, ointments for scar correction remain in demand. As a result, more and more new products are appearing on the pharmaceutical market - absorbable and restorative creams for external use.

In contact with

Scar is connective tissue, replacing a skin defect resulting from injury, inflammation or surgery. This is the final stage of tissue restoration. Thanks to this ability of tissues to scar, healing of even extensive and deep wounds is possible.

Types of scars

Currently exists clinical classification scars.

• Physiological (normotrophic) scar . After the wound has healed, it is practically invisible and does not rise above the surface of the skin. After some time, it turns red, increases in size, and becomes more sensitive. Several months pass and the scar becomes barely noticeable again. This is the most favorable option for recovery. After a few years it will be difficult to find.
This is how superficial wounds and burns, scratches, abrasions or skin incisions made by an experienced surgeon heal. surgical interventions. Experts try to make tissue incisions along “natural” folds, taking into account the so-called “skin power lines”. This always allows you to obtain good cosmetic results from the treatment.
• Atrophic scar . The scars are flesh-colored or whitish, somewhat retracted into the skin. They arise as a result of minor damage to the skin and subcutaneous fat. Often occur after acne, furunculosis. Sometimes as a result of electrical injury or contact burn (touching a hot object).
• Hypertrophic (pathological) scar . The scars are rough, dense, and rise above the surface of the skin. Peeling, tears and trophic ulcers on scars. There are several reasons for their occurrence:
  • deep burns, lacerations, “bitten” wounds;
  • lack of specialized care during the treatment of acute injury;
  • the presence of inflammation or suppuration in the wound; - constant trauma to the scar;
  • location of the scar in active areas (neck, joint areas, etc.);
  • genetic predisposition to active scarring.
• Keloid scar . This scar looks like a tumor. It hangs like a mushroom and rises above the skin, bright pink or bluish in color, lumpy and dense to the touch. As a rule, its base is larger than the area of ​​the injury. Patients complain of pain, itching, burning, and a feeling of fullness in it. There is currently no clear data on its nature. An important factor is the genetic predisposition to keloidosis and the location of the injury (ears, sternum and pubic area, etc.).

What scars are removed?

There are situations when removing a scar or performing plastic surgery is strictly necessary - these are scars that entail dysfunction of the limb, for example, the impossibility or restriction of movements in full will not allow the affected limb to develop correctly, if the scar deforms the eyelid or mouth of the child and eversion of the eyelid, if it is impossible to fully open the mouth. The second group of indications are cosmetic defects that do not lead to functional impairment, but cannot be eliminated cosmetic defect often negatively affects the psycho-emotional development of the child. Baby is shy problem area, which often limits his communication with peers, and can also become an object of ridicule.

When are scars removed?

Medical indication for mandatory surgical treatment are situations where movements in the joints, where normal skin as a result of the injury it turned into a scar, limited. In these cases, as a rule, the operation is performed as soon as possible after the formation of the scar. In other cases, operate on “immature”, red-purple color, dense consistency, with hypersensitivity scar wrong. Long and problematic healing of postoperative wounds and not always acceptable cosmetic results of treatment are unlikely to satisfy both the patient, his parents, and the plastic surgeon. In most cases, surgery is indicated 1-2 years after the injury, after the scar tissue has fully “matured”. Such scars flesh-colored, with reduced sensitivity. If the scar does not cause a dysfunction of the organ, but is a more or less noticeable cosmetic defect, then the initiative for treatment, as a rule, belongs to the parents. The choice of timing and methods of treatment is made jointly by doctors and parents.

Scar Treatment Methods

When eliminating cicatricial deformities of the skin, various reconstructive operations are usually used; from the simplest to the most complex and multi-stage. For small scars located on aesthetically significant areas of the body (face, neck, décolleté, hands, etc.), it is indicated excision of the scar with plastic surgery of surrounding tissues - that is, after excision of scar tissue, they apply cosmetic stitch- this is a type of surgical suture in which the skin is stitched with thin self-absorbing threads, and these threads are located in the thickness of the skin. The intradermal cosmetic suture should usually be removed after 12-14 days. Often the body reacts negatively to foreign material, causing significant scar growth. The operation is performed under anesthesia. After the operation, dressings are performed using various means, improving healing. The result can be assessed after the scar has healed - several months later. When planning an operation, it is taken into account that keloid scars recur in 50% of cases during such surgical interventions. In the presence of large normotrophic or atrophic scars in the area of ​​aesthetically important areas: face, neck, décolleté, chest, hands, laser resurfacing of scars with carbon dioxide laser "Lancet 2". In this case, dosed laser radiation is used to “smooth” and even out post-traumatic scars. The laser beam penetrates into surface layer skin cells, the upper part of the scar and part of the skin are removed. In place of the removed cells, new ones are formed. At the same time, growth is stimulated healthy cells skin, which partially replace the scar defect. The extent of the operation is determined during consultation and depends on many factors: the nature, extent of the scar, its location, etc. The laser resurfacing procedure does not cause pain. Often, laser resurfacing can cause temporary redness of the skin. Failure to comply with the laser dosage regimen leads to the appearance of areas of skin pigmentation disorder. The primary effect of scar polishing can be assessed in 1-2 weeks, during which time the cells of the surface layer of the skin will be restored. The final recovery is completed no earlier than 3-6 months after the procedure; during this period it is not recommended to expose the skin to direct sun rays, which will avoid the appearance of areas with disturbed pigmentation. The results of laser resurfacing are overwhelmingly good to excellent. Scars become less noticeable, smooth, Small scars are eliminated under local anesthesia, large ones - with the use of general anesthesia. After surgery, various hydrogel and mesh wound coverings are currently used, which, on the one hand, protect the wound from infection, on the other, actively absorb wound discharge if present, in addition, the coverings stimulate wound healing, may contain antibacterial drugs, but Treatment with a solution of potassium permanganate is also possible. The duration of hospitalization is from 1 to 5 days. It is recommended to avoid direct sunlight for 2-3 months. In summer, due to increased solar activity, this method does not apply. Method cryodestruction used for keloid, hypertrophic scars that protrude significantly above the surface of the skin. This technique implies a deep cold burn, followed by wound healing. Nitrogen exposure is carried out within a few minutes, depending on the severity and extent of the scar. In the first 2-4 days after the procedure, significant swelling occurs at the site of exposure, blisters form, on the 5-7th day the blisters open, possibly with the release of a large amount of serous fluid. A scab forms in place of the blisters and healing occurs. The result is assessed 6 months after surgery. If hypertrophic scars are small in size or located in the joint area and slightly limit its movement (scar contractures), apply plastic with local tissues . Tissues located in close proximity to the scar defect are used. This method is the most cosmetically beneficial and not very complicated in technical execution, and is also easier to tolerate for small patients and requires a short hospital stay (several days). Plastic flap on a pedicle is also used. If the scars are extensive, then the optimal way to eliminate the defect is to use the skin surrounding the scar in the form of flaps on a feeding pedicle - a flap of tissue is cut out from the area adjacent to the scar, it is not completely cut out, but a “pedicle” is left that feeds it. The operation is performed under general anesthesia. Inpatient treatment lasts 7-14 days. Often used to eliminate extensive scars expander plastic , especially in the presence of extensive post-traumatic baldness. IN in this case They use so-called expanders, silicone bags implanted under the skin of the scalp, which is then stretched. It turns out a supply of new skin with hair, which replaces the scars. It is possible to restore half of the scalp at a time. This type of plastic surgery is also successfully used to eliminate extensive scars of the face, neck, chest(with deformation of the mammary glands), as well as complex contractures of large joints. At the first stage of the operation, an expander is implanted - a special video camera, instruments and an expander are inserted through a small incision, and the progress of the operation is monitored on a television screen. Then follows the outpatient stage - stretching the expander and the tissues above it, it lasts 1-2 months, fluid is injected into it twice a week. AND The final stage- excision of the scar defect, removal of the expander and closure of the wound with the resulting stretched skin-fat flap. If it is impossible to eliminate the problem using these methods, then use plastic surgery with free skin grafts . If this method is combined with local tissue plastic surgery, it is called combined skin grafting . Grafts can be full-thickness (full-thickness skin) or split-thickness (thin top layer of skin). Good results can be obtained using special devices. For example, using a radio knife, you can make cuts almost bloodlessly and simultaneously cauterize vessels with a diameter of up to 1 mm. In the postoperative period, consultation with rehabilitation specialists is necessary. They provide conservative treatment for children with post-traumatic scars.

Website - medical portal online consultations with pediatric and adult doctors of all specialties. You can ask a question on the topic "treatment of scars after surgery" and get a free online doctor’s consultation.

Questions and answers on: treatment of scars after surgery

2010-01-20 19:07:30

Maria asks:

Hello!
In the abdominal area, 10 years ago, there is a hypertrophic scar after surgery. After a year of using Contractubex, the scar did not change in size, but was significantly smoothed out. If, for the best result of laser resurfacing, we continue the course of treatment with ointments, then which one will be more effective: Dermatix or Zeraderm?

Answers Kovalenko Yulia Alexandrovna:

Hello Maria!
I’m glad that you got the effect of contratubex with such a long-lasting scar, congratulations! As for the continuation of treatment and what ointments to use, this is only to the specialist who will directly carry out the procedure for you. Perhaps the effect will be better if you use certain ointments after laser resurfacing.

2016-04-03 18:53:08

Ksenia asks:

Hello. Help me please. I am 34 years old, I suffer from episyndrome, which arose as a result of an operation to remove meningioma of the right frontotemporal region (03.2014), a scar was formed, which is the cause of attacks (as the doctors explained). 9 months after the operation, attacks began, I took Finlepsin retard 200 mg . 2 days a week for 7 months. Attacks 1 time per month, without loss of consciousness, for 1-2 minutes. Convulsions on the right side of the face, twitching of the tongue, difficulty breathing. Due to the side effect, I quietly reduced the dose of the drug to 100 mg. 2 days a week.
plus I added the nootropic drug Cognum (calcium hopanthenate) 250 mg. 3 working days for 1 month. For 4 months. there were no attacks, then there were again 1 day per month. The same, I continue to take Finlepsin retard 100 mg 2 times a day. On the last EEG there were general cerebral changes with phenomena of rhythmic disorganization, with elements of paroxysmal activity in the middle temporal and central region on the right. I often experience trembling all over my body, slight twitching of the tongue, numbness of the tongue, palpitations, fear, this happens after taking the drug. Maybe finlepsin provokes seizures? Perhaps I need to change my treatment? Cancel anticonvulsant no one is taking it, maybe there is an alternative? Is it possible to use homeopathy in my case for treatment? I checked my thyroid gland 3 months ago, hormones are normal, blood sugar is also normal. Doctor, please tell me what to do? I'm already completely exhausted in my search. Thank you very much.

Answers Starish Natalya Petrovna:

Hello! Based on the above information, it is impossible to answer your question unambiguously. It is necessary to understand what kind of scar, what kind of scar, i.e. see an MRI image of the brain. Next, check his nutrition - do a blood vessel scan of the head and neck, check his condition cervical region spine - do a CT scan. EEG alone is not enough to make one decision or another and adjust your treatment.

2015-02-19 11:22:04

Nataly asks:

Good afternoon. I had a laparoscopic cholecystectomy more than 10 years ago, and a year after the operation, during full examination a scar was discovered after healing of the duodenum and gastritis of the stomach. All these years nothing bothered me. For more than 3 months, pain appeared in the right hypochondrium, not associated with eating. I donated blood and had a gastroduodenoscopy and ultrasound. Helicobacter pylori, Amoxicillin-ratiopharm 1000 mg, Klerimed 500 mg and Omep 20mg were detected simultaneously. Diagnosis -chronic gastritis. The doctor answered my questions that it doesn’t matter to me what type of gastritis I have, the acidity was not checked and I need a diet. She warned only about possible diarrhea and does not see the need to monitor the progress of treatment. Question: do you need to know your acidity, follow a diet, and is this examination sufficient to establish the cause of pain in the right hypochondrium that continues? What to do?

Answers Vasquez Estuardo Eduardovich:

Good afternoon, Nataly! I answer your questions: Finding out about your acidity is not necessary, because... for us doctors, by the nature of the complaints, it often becomes known; Do I need to follow a diet? - probably the doctor considered it necessary for some reason. We usually attach special importance to diet. Is this examination sufficient to establish the cause of pain in the right hypochondrium that continues? - we consider them sufficient, but complaints, despite treatment, may remain for a long time and will have a tendency to worsen; What to do? - If complaints continue, we advise you to seek a second opinion from a gastroenterologist - only in terms of consultation.

2015-01-19 10:11:10

Marina asks:

Hello! I ask for help. I am 39 years old. In June 2014, I had surgery to remove the uterus, cervix, left ovary, and tubes. Diagnosis: fibroids 18 weeks, large cyst on the ovary. The postoperative period was normal, discharged as planned. After discharge, she continued to be monitored by the attending physician regarding purulent discharge. Treatment: douching with chamomile, tampons with levomekol. Followed up every 2 weeks. The discharge did not stop. I was treated like this for 1.5 months. Then I had to move to Russia. The discharge acquired an unpleasant odor and I consulted a local doctor. 5 months have passed since the operation. I was sent to the department with a diagnosis of purulent colpitis. They took all possible tests. But the tests are all normal. There is a large number of leukocytes in the smear. They thought that there was an infiltrate after the operation, they sent for an ultrasound, but they did not confirm it. Treatment was prescribed: douching with chamomile, trichopolum, tampons at night with dimexide + Vishnevsky ointment. After 2 weeks of treatment, I came to the appointment with the same problems + in the evening the temperature rises to 37.3. The doctor said that there were threads sticking out of my inner seam, but he couldn’t remove them because the seam was starting to bleed. By back wall the scar is thin and painful. Continued treatment for another two weeks + tetracycline antibiotics. He said that I had nothing to do in the department. They don't do that. I did all the treatment. Nothing changed! The discharge was purulent, a specific smell appeared again, and in the evening there was a fever. I'm desperate. 8 months after surgery. Inseam painful. Maybe you can recommend something. Blood sugar level is 4.8. SOE, POE are normal.

Answers Sitenok Alena Ivanovna:

Hello, Marina. How can I help in such a situation without seeing you?.. Judging by the description, the situation is not simple. Ideally, contact the doctor who performed the operation. If this is not possible, go to any gynecological hospital!

2015-01-13 10:38:23

Natalia asks:

Hello, Doctor. I ask you for help. I am 3 months post-surgery to remove several hemorrhoids and an anal fissure by excision. After the operation there was a drop of blood only after examination by the surgeon. 2 weeks ago, during an examination, the surgeon said that everything was healing well, there were no wounds, the scar was soft. but every day after stool my pain and cramps get worse. Because of this, I walk around the house a little, sitting half sideways. I rest from pain only at night, in my sleep. and in the morning everything is new. I continue treatment with methyluracil suppositories, but baths do not bring relief. I previously used Anomex and Sediproct suppositories. the doctor says that such pain may be due to endometriosis or osteochondrosis of the sacrum. I ask you to help me with advice, what should I do? except constant pain and spasms don’t bother me. How can I alleviate my suffering?

Answers Tkachenko Fedot Gennadievich:

Hello, Natalia. To correctly answer your question, an in-person examination is required to assess the condition of the anal canal wounds. Therefore, I would like to recommend that you contact another qualified proctologist - get a “second opinion”.

2014-12-24 20:55:02

Tatiana asks:

After surgery on the kidney, there was suppuration of the postoperative scar - they opened it up. Then the fistulas, which were twice purulent, were opened. Excision and drainage were performed. 3 cultures showed Pseudomonas aeruginosa sensitive to gentamicin, all were injected with cefatoxime. The improvement was temporary. The abipym was punctured and complete healing of the wound does not occur; the fistulas open in subcutaneous tissue. Treatment lasts 7 months. Please advise further treatment, which drugs and antiseptics are best to use for the wound.

2014-10-26 11:17:59

Olga, 38 years old, asks:

Hello, I am 38 years old. In October 2013, I had hysterectomy with appendages. Necrosis of both ovaries, external endometriosis of both ovaries, wedge-shaped defect of the uterus (scar failure) (as a result of unsuccessful treatment of an in-hospital infection during a caesis section in 2010). Immediately after surgery for 9 months. I used Livial, it had no effect, I suffered from insomnia, I was exhausted from frequent hot flashes, the vaginal mucosa was dry and painful, it was impossible to have a sexual life, the family broke up. In July 2014 (after 9 months of using Livial) I began to apply the estramone 50 patch, total composition. things got better, but I read that you need to add gestagen. Which HRT is optimal for me and WHAT DOSE OF ESTROGEN DO I NEED TO RECEIVE ACCORDING TO AGE. Is Angeliq suitable for me (drospirenone is most similar to natural progesterone), but is the estrogen dose low for my age, and can I even have it? There is also Femoston, Klimonorm, the same patches and gestagen in the table, please advise which is better, because I can’t stand it without HRT, but now from personal bitter experience I am convinced that Livial after extirpation of the uterus and appendages is relatively at a young age It doesn’t help at all, at least it didn’t help me. Yes, and my hair also dries out very much, how can I deal with this, I’m afraid of losing my long hair, is it a question of hormones? Thank you in advance for your attention and I look forward to your response

Answers Medical consultant of the website portal:

Hello! Substitute hormone therapy regarding post-castration syndrome - this is serious treatment, which cannot be prescribed “on the Internet” and cannot be selected by a woman independently. You need to find a competent gynecologist or gynecologist-endocrinologist so that the doctor can assess the condition of your body and select the optimal drug. Take care of your health!

2014-08-27 11:09:16

Natalia asks:

Hello!! I really hope to get an answer.. Here is my mother’s story: She is 73 years old. In November 2012, he was diagnosed with cancer of the left mammary gland T4N2M1G4, mts in s/c l/u 2 kg, infiltrative ductal carcinoma. Immunohistochemistry: EP-(15%), PrR-(-), c-erbB2-(+). The left breast is very deformed (retracted), there is a large wound on it, about 8 cm in diameter, from which oozing yellow liquid, and a dense tumor in its structure (almost under the armpit), which did not move, as if attached to the bone. Immediately, due to the impossibility of performing an operation, treatment was prescribed: 1. A cycle of 6 chemotherapy according to the FEC regimen (fluorouracil, epirubicin, cyclophosphamide), every 20 days, from December 18, 2012 to April 10, 2013. The results were immediate: after the first drip, the tumor began to decrease, but after the 4th, weakness and pallor were noted, and on the 5th and 6th, except for general severe weakness and swelling there were problems with the veins during and after the administration of the medicine. Veins are burned. The effect of the chemotherapy is good: after the 5th drip, the tumor “gathered” by 60% and began to be mobile, the possibility of surgery became possible. After finishing the chemotherapy, the surgeon sent me for radiation before the operation to make the tumor even smaller. During this examination, he changed the diagnosis to T4N2MxG2 grade IIIB-III class.gr.
irradiation
2. In May-June, radio irradiation of the tumor area was carried out (the armpits and lymph nodes were not irradiated) with a single dose of 2 Gy, a total dose of 60 Gy, with a depth of 70%, on a Varian device with a Linear accelerator - the first 10 irradiations, then for technical reasons the treatment was completed - another 20 sessions - on a regular old gamma machine. the tumor decreased even more. After irradiation, CT analysis: a decrease in the tumor process by 45%, a decrease in the volume of pathological tumor contrast by 65%, the absence of axillary nodes, the absence of the appearance of new lesions. No mts was found in the bones.
In August 2013, an operation was performed - radical mastectomy according to Madden. Also deleted 4 axillary lymph node, in which there were metastases. The operation was difficult and long. The surgeon said that he scraped the infiltrate from the bone millimeter by millimeter.
Epicrisis: Diagnosis: T4 pN2 Mo G2 stage IIIB-III class.gr
Histology: infiltrative ductal carcinoma G2, in 4 lymph nodes of the mts process.
Immunohistochemistry dated 08.2013: Er-(+ 15%), Pr-(-), HER-2\new- (-) negative reaction.
After the operation, AROMAZIN was prescribed. 3 months after the operation, severe lymphostasis began on the side of the operated arm. To monitor the course of the disease, an analysis of the breast tumor marker CA-15-3 was carried out. At a norm of 25 units. : before surgery - 36.7, immediately after surgery - 26.2, 5 months after surgery - 52.6. REA, CEA tests are normal.
RECIDENT
On December 30, 2013, a control CT scan with contrast was performed. Result: Condition after left-sided mastectomy according to Madden. In the left axillary region along the vascular bundle there is an infiltrative inductive process up to 70x30 mm in diameter, along the anterior edge of which, along the midclavicular line, nodular formations of 10 and 13 mm are visible, which intensively accumulate contrast (implantation mts). Similar nodular hyperdense (hypervascular) formations are visualized in the soft tissues of the anterior and left lateral surface of the chest wall along the anterior and middle axillary line at the level of the middle segments of the 3rd, 4th, and 5th left ribs. In m.serratus ant.sin nodular hypervascular formations are visualized (cranicoudally): 7, 9, 10 mm. Conclusion: Ca mammae sin. Condition after radiation therapy and surgical treatment. Infiltration of the left axillary region. Relapse in the muscles of the chest wall on the left.
Surgery is not recommended because There are many metastases, they are small, and they cannot all be removed. During a manual examination by the surgeon, a small, pea-sized tumor was visible and clearly palpable. 01.2014 – relapse was cytologically confirmed.
The first course of chemotherapy was immediately administered (one session) (paclitaxel 230 mg, dexamethasone 20 mg, diphenhydramine, sodium chlorine, sturgeon; controloc 40 mg, eluoxan mg 380). By this time, the tumor had grown and became like two immobile ribs of a bean, inseparable from the bone. The chemotherapy was not easy to bear; there was no visible positive effect on tumor reduction. The tumor even grew a little. We decided to abandon chemistry in favor of superficial irradiation of the metastatic area with a linear accelerator (i.e., electrons) so that, with a favorable result obtained from irradiation, this recurrent tumor could be excised. But due to family circumstances, the start of radiation was delayed. Then, due to low lymphocytes, the start of irradiation was delayed again... From 02/17/2014 to 02/27/2014, a course of irradiation to the relapse site in the left axillary zone + chest wall SVD 18 Gy on a Varian linear accelerator, for technical reasons, irradiation of this zone was completed on 03/20/2014 to 03/31/2014. SVD-14 Gy achieving partial regression...
On March 30, 2014, a repeat immunohistochemical study of the material taken during the operation was performed. Result: Er (++3) -61.5%, Pr(+) - 0.72%, HerB2 (+), Ki-67-12%. Next, the patient took Tamoxifen 20 daily from 04/01/2014 to 06/25/2014 .
A BIOPSY was performed immediately! histologically confirmed mts in the skin of the chest, - infiltrative carcinoma of the second stage of differentiation Er(++), PR(+), HerB2(+).
After the biopsy it started a sharp increase MTS.!!!
07.2014 – CT scan with contrast was performed. Result: recurrence of SA in subcutaneous scars. Axillary lymphadenopathy. Mts in the soft tissue of the chest wall, mts formation in the right adrenal gland 46x21.. Formation of the left vastus dorsi muscle -21x15, lesion S3 of the right lung, lesion S10 of the left lung, subclavian infiltrate.
07.2014 – bone scintigraphy was performed. There are no skeletal pathologies.
07.2014 due to the strongest pain syndrome and lymphostasis that developed after surgery, an ultrasound scan of the upper limb was performed. Conclusion: Acute phlebothrombosis left subclavian vein, secondary lymphostasis of the left arm. Treatment was prescribed with Clexane 0.4 - two months + Detralex 2 tablets - 2 months.
From 16.07 the patient will take pain relief with Fentanyl Sandoz -50 patches, tramadol, morphine (tablets).
LOCUS MORBI: left supraclavicular area l/u 0.5x0.5 cm, scar after skin biopsy in the left subclavian region, healing by secondary intention, medial part of the scar after left mastectomy infiltrate 2x3 cm, below the subclavian scar two skin mts 0.5x0, 5 cm, above the s/o scar three mts 0.5x0.5 cm and one 0.8x1 cm, above the distal part of the s/o scar a zone of hypermia 10x8 cm in the apical part infiltrate 2x2 cm.
Diagnosis: Left mammary gland T4N2M0, grade 3B, local relapse, skin metastases, mts to the lungs, grade 2 gr, pain syndrome.
08/07/2014 – treatment with Faslodex 500 was started. dosage regimen (1+14, then every 28 days).
08/20/2014 – second dose of Faslodex.
The general condition of the patient now: Heart is normal, minor age-related changes... no acute diseases. Observed general weakness. The patient lies almost all the time due to severe constant pain in her arm. Decreased appetite, lost a lot of weight.
Question: While taking the drugs Aromasin and Tamoxifen, which are both aimed at blocking the production of estrogen, the patient experienced clearly negative dynamics, relapse, and growth of Mts. Does it make sense to transfer the patient to Faslodex, which is a drug with the same effect (blocking estrogen production). ?
What can be done in this situation? What treatment might be optimal???? Really looking forward to your reply!!!

Answers Bondaruk Olga Sergeevna:

Good day, Natalia! Honestly, there are a lot of questions about treatment... and it cannot be ruled out that in addition to relapse, there are also post-radiation complications. You can probably try chemotherapy, for example, methotrexate-based regimens - CMF, you can try oral fluoropyrimidines... it’s difficult to give advice in this case without seeing the CT scan and the patient

2014-07-10 05:27:16

Svetlana asks:

Hello, please tell me, 1) if there is an enlargement of the left and left ventricles and there is an aneurysm (written in the anterior septal wall of the apex) after extensive heart attack, and there is a photo of the aneurysm, how can we understand that it is all over the scar, it turns out that there is no dense scar at all? such a conclusion a year after the heart attack, and two months later they wrote an apical aneurysm. It turns out that it increased over the course of the year. Could this be? or as cardiologist consultants wrote to me on the Internet, that these sizes are not very informative and depend on the equipment and the technician and the doctor who performed the ultrasound, this is true and do sizes play a big role, I read that they do (but you can read everything that whatever, but how in practice) 2) with such data, what is recommended, CABG with aneurysm surgery? There may not be an alternative - intravascular methods of treatment? Is age 67 a contraindication for surgery? and is there a positive prognosis without surgery? I read that EF may decrease, but how long does it take for this to happen, maybe it remains stable for many years, do such cases happen? I read that complications after an aneurysm operation are not small, 3) for a year they took both Zilt and Cardiomagnyl, after a year some doctors say to stop Zilt, others Cardiomagnyl, but I think maybe both are needed, because there is a complication of an aneurysm (but there is a history of duodenal ulcer) please answer my questions

Answers Bugaev Mikhail Valentinovich:

Hello. 1) everything is theoretically possible, and the aneurysm can grow larger (due to tissue dissection, say), and the experience of the diagnostician plays a role. Of course, the size of the aneurysm plays a big role - the larger it is, the greater the volume of the heart muscle that is disabled from work, the higher the risk of a blood clot forming in it, the higher the risk of its rupture. 2) there is only one tactic - CABG with aneurysmectomy. Intravascular treatment is indicated only for small aneurysms, when the issue of its removal is not fundamental. 67 years is not the age for such operations. Without surgery, the prognosis is much worse. EF decreases for everyone, but for everyone differently; many factors influence this. Yes, all operations have their own risk of mortality and complications, but the risk of disease is much higher. It is necessary to operate in good center with extensive experience to reduce these risks. It would be nice to first study and compare the results of the centers’ work over several years, but in practice this is very, very difficult to do. 3) both clopidogrel and aspirin are drugs for the prevention of myocardial infarction. They do not affect the risk of aneurysm thrombosis.

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ABOUT One of the most popular myths about scars after plastic surgery is that until the scar matures, you cannot touch it, and only after 6 months you can start doing something with it.

There are others: that the seams need to be wiped with vodka, that in the first months after plastic surgery the patient should strain less, otherwise the scar will become rough, that almost any scar will turn white over time and become hardly noticeable...

Tells Radetskaya Larisa Iosifovna, dermatologist-cosmetologist, candidate of medical sciences, laser therapist and head of the training center for laser technologies, specialist in scar correction and treatment.

When should I start dealing with post-surgical scars?

N You can start working with the scar 2-4 weeks after surgery, when the stitches are removed and the scabs have come off.

Signs of pathological scar growth may appear as early as 3-4 weeks. What you should pay attention to? The appearance of additional sensations in the scar (itching, pain), increased brightness, hyperemia, stagnation bluish color indicate that the scar is beginning to actively grow, although normally it should gradually fade. And then it is necessary to include therapeutic procedures that help curb the growth of the scar. The sooner you start this fight, the easier, faster and cheaper it is. will undergo treatment. And the better the end result will be.

This does not mean that 2 weeks have passed - and rather it is necessary to intervene in the scarring process. But if the patient was told to wait for the final result within six months, then he will come to the cosmetologist in six months. And the scar, in the presence of the above symptoms, can grow significantly during this time.

Some operations cannot be done without strong tissue tension: in the T-shaped joint after anchor mastopexy, in the sutures after abdominoplasty or in the “tick” going into the intergluteal fold during body lifting. It is this tension that can cause increased growth of scar tissue: the connective tissue grows, trying to quickly close the wound defect and restore the integrity of the body. This is the law of pathophysiology: before the functional tissue has time to grow, the connective tissue will grow.

Such areas can acquire not only a red, but also a stagnant-bluish tint, since the vessels grow very actively, and the outflow of blood is difficult. Prolonged congestive hyperemia in a large percentage of cases will lead to the appearance of hyperpigmentation.

What if a certain area of ​​the suture does not heal for a long time? ?

Long-lasting inflammation means that the primary adhesion of the wound edges has not occurred. The scar in this area will no longer be perfectly thin. And if you do not help the tissues in such a situation, the scar will either spread and become wide, or rise above the level of the skin.

It is necessary to treat the wound, stimulate tissue regeneration in the problem area, and then begin to work with the scar itself.

Hygiene of sutures (scars)

The seams can be wiped with chlorhexidine or miramistin, but not with vodka. Vodka burns and dries out the delicate young epithelium; its use is completely unjustified. After the surgeon has given permission to shower, wash the sutures with a regular body wash, preferably a pH-neutral one. Scars need to be washed every day. In the scalp - daily or every other day.

These words are confirmed by a very experienced dressing nurse, who has been working with eminent doctors for 40 years. plastic surgeons caring for scars of patients after plastic surgery:

“For disinfection, chlorhexidine is sufficient, which does not have such an aggressive effect as vodka. In medicine, vodka is not used as a means of treatment, disinfection or care for postoperative sutures.”

Is it possible to determine in advance how healing and scarring will proceed?

It's very difficult. It is necessary to carefully monitor the scar in order to begin treatment measures on time. Ideally, the body should have an absolutely balanced ratio of collagen (the protein that makes up scar tissue) and the enzyme collagenase (which absorbs excess collagen formed during scarring). Then the scar is formed normotrophic, elastic, soft, does not pull or sag. But, alas, this does not always happen.

In reality, this ratio may be different for people, and it determines what kind of scar it will be: normotrophic, hypotrophic or hypertrophic.

There are people whose collagenase is very active, or whose collagen production is reduced, and they may develop hypotrophic (retracted) scars. In such patients, fillers based on hyaluronic acid can be absorbed quickly, in a couple of months, although they should “stand” for 6-8 months. If an insufficient amount of collagenase is produced, collagen dominates and grows, and a hypertrophic scar is formed.

Healing and scarring depends on many reasons: from the activity of enzymes in the human body, from congenital or acquired lack of vitamins, microelements, hormonal profile, immunity, stress.

If a person has already had some kind of intervention, you can guess how the healing will proceed by carefully examining the existing scars. But, firstly, a lot depends on the tension of the tissues during this operation, and secondly, in different areas of the face and body, the skin can heal differently.

The influence of physical activity on scar formation

There is an opinion that for several months after plastic surgery it is advisable to minimize any physical exercise(including sex) to avoid blood flow to the stitches. The rush of blood, the myth goes, can lead to scar growth. Is it so?

Postoperative swelling causes tension in the tissues and stretches the edges of the scar. Filled with extra intercellular fluid tissues compress blood vessels and create hypoxia ( oxygen starvation) and ischemia (decreased blood circulation) of tissues, microcirculation worsens. The next stage will be the growth of scar tissue, and then the body will “sprout” additional vessels in it to compensate for the lack of oxygen and prevent necrosis. Therefore, the faster the tissue can be relieved of swelling, tension and tension that it creates, the more delicately the scar will form.

Adequate physical activity (after the end of early postoperative period) improves tissue trophism and accelerates the movement of all fluids - lymph, venous outflow, arterial inflow, and therefore accelerates recovery and healing. Of course, we are not talking about doing acrobatic stunts, riding a horse or doing strength exercises on the operated area a week after installing the implants. Typically, it is necessary to limit activity for up to a month, and then you can include light/moderate workload in your life. But lying in bed and waiting for the swelling to go away on its own is not advisable. Vascular bundles lie in the muscle layers, and muscle movement helps move fluids into in the right direction, to the collectors that discharge liquids.

Of course, first of all you need to listen to the recommendations of the operating surgeon.. I speak as a specialist who is consulted only with bad scars. The patient may not even think about the fact that scarring can be pathological, and considers his symptoms to be a variant of the norm. This material is a warning and a call to carefully monitor scars in order to prevent a situation where the consequences of “beautification” boldly cross out the effect of “beautification.” And to fix it, it will take a lot of painstaking work over several months.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Working with scar

Patients don't know modern capabilities corrections and agree to live with wide, hyperpigmented or bluish scars, enjoying the good shape of the chest or abdomen after surgery. But it is POSSIBLE to improve the condition of almost any scar! We can make the scar flat, improve its color and smooth out the boundary between the scarred surface and healthy surrounding skin.

If healing proceeds without any problems, the scar does not require help or additional intervention. But if itching, pain, or discomfort appears in the scar, this is a reason to consult a cosmetologist with experience in working with such pathology. A thorough examination and palpation, clarification of the characteristics of healing and the characteristics of the patient’s body allow us to build the correct algorithm for working with pathological tissue.

Treatment is selected individually, depending on the specific clinical situation. Some people need to coagulate venous and/or arterial vessels, others need to soften deep scar formations, sometimes directly influence proliferation (cell division and multiplication) in the scar. It is often necessary to relieve tension in surrounding tissues with botulinum toxin, and in atrophic processes, on the contrary, to replenish the required volume of missing tissues. The set of measures almost always includes one or another laser procedure. The more technological capabilities a doctor has in his hands, the more sophisticated the correction will be.

*Patients often call hypertrophic (bulging) or wide, “blurry” scars keloids. It's a delusion. A keloid is uncontrollably growing scar tissue, and one of the main diagnostic criteria is its growth beyond the boundaries of the damage. The fight against keloids is a separate topic.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

AND Sometimes patients with pathological scars are prescribed only physiotherapeutic procedures: for example, a course of medicinal electrophoresis.

Physiotherapeutic methods perfectly help tissues in different periods healing: first of all, when there is an urgent need to reduce acute tense tissue swelling. Magnetic therapy, microcurrent therapy and other classical methods are suitable for this. Remarkable results can be obtained using a low-intensity laser. In addition to drainage, each method has other specific effects: improving arterial microcirculation, increasing oxygenation, increasing mitochondrial cell activity and tissue energy potential.

But as a physiotherapist who defended his dissertation in physiotherapy, I know very well how much the technologies of classical physiotherapy differ in terms of effectiveness and dynamics from the modern capabilities of aesthetic medicine. In no way do I belittle the effectiveness of physiotherapeutic technologies!

Treatment of a patient after anchor reduction mammoplasty. Hypertrophied pulling scars, hyperpigmentation. In the photo: before (application 7 months after surgery) and the result 2 months after 1 BBL+Halo procedure without preliminary preparation and post-laser therapeutic procedures(the patient lives in another city and no longer comes for procedures).

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

N It is necessary to relieve the tension of scar tissue and coagulate the vessels feeding the scar. At the same time, the phrase “removing blood vessels” sounds short, but in reality more than one procedure will be required. The vessels tend to sprout again and again, and their growth will have to be restrained.

A set of measures is required: both to relieve tension and to coagulate the vessels. By coagulating blood vessels, we deprive scar tissue of nutrition. Large veins can grow from small vessels, which are sometimes impossible to coagulate without getting burned: scar tissue is much denser than healthy skin, and heat dissipation in it is worse. And this is one of the reasons to start working with the scar on early: Bye pathological vessels They have not yet become large, and it is much easier to remove them.

But the vessels begin to grow pathologically due to tension, so it is impossible to single out each topic separately - here is a red scar, it needs to be coagulated, but here is a convex one, inject it. The algorithm is different in each case. For example: first botulinum toxin, enzymes, hormones (or another option). Then laser correction of blood vessels. Then, possibly, laser scar correction.

By the way, the phrase “laser resurfacing” is unprofessional, since it can mean anything. Which type of laser treatment will be needed depends on the condition of the scar and the area in which it is located.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Myth: “The longer you wear strips, up to 6 months, the tripe is better protected from stretching."

Strips are completely useless in the later stages. For different zones, the period of their use is different, and the surgeon, upon examination at the right time, will remove and cancel the strips, since the final adhesion and fusion of the edges of the wound has occurred. The tissues are stitched, and a thin strip of patch on the upper layer of the epithelium does not affect the formation of the scar. If internal tension persists, which stretches the skin, strips cannot help.

Working with scars after blepharoplasty: before and after 2 procedures using a classic fractional erbium laser.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Working with scars after removal of biopolymer gel: before and after 2 procedures with a fractional erbium laser:

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

How much does it cost?

E If the patient has limited funds, it is better to come for a consultation and discuss options taking into account financial capabilities. Medicine is not mathematics. It is impossible to say: “I will do everything in one procedure.” Sometimes it is better to excise a complex scar and then begin to work with a new scar, carrying out supportive and preventive measures at the right time.

The cost of treatment depends on the complexity of the work, the number of stages, the quality and area of ​​scarred surfaces, the need to use various medications and botulinum toxin, as well as the level of professionalism of the doctor.

For example, with an anchored breast lift, the total length of the stitches can be 50 cm, or maybe 100 cm. Botulinum toxin needs to be injected both into the scar itself and around the scar - sometimes a whole bottle is needed, which is 500 units. Sometimes more.

Vascular coagulation with BBL broadband pulsed light is done with a small adapter, and the cost of the procedure is determined by the number of flashes.

If it is necessary to include platelet-derived growth factors PRP in therapy, the cost of the procedure depends on the number of tubes used, when the price of one tube for PRP is now 12,000 rubles.

Thus, one procedure for working with scars can cost either 6,000 rubles or 60,000 rubles.

Often patients come immediately for “laser resurfacing” of the scar. But before you start laser treatment, preparation is usually required: bring the scar to a calm state, make sure that it no longer grows, and minimize all risks.

Laser treatment is carried out at intervals of 1-2 months, sometimes less frequently. How many procedures will be needed, and most importantly, which treatment options will be optimal in a particular case, it is impossible to answer without an examination. It all depends on the condition of the scar, timing of treatment, localization. Two or three procedures - in the most ideal situation, when everything is quite good and you want to make the scar almost invisible. If the picture is not so flawless, 4 or 5 procedures or more may be needed. Both laser and non-laser technologies are used.

I sometimes prescribe gels and patches for scar treatment between procedures. They create compression, moisturize the scar and thereby help to restrain its growth.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Silicone gels and patches for scar treatment

If the gel or patch is intended to treat hypertrophy or keloid, then it should be used only according to indications: on an already hypertrophied or keloid scar. The task of these agents is to resolve pathologically growing tissue. If such preparations (and these are medicinal covering materials containing active substances) apply to normal scars that are still forming without excess collagen, they can really have a negative impact, and the scar will “spread.”

But if the product is indicated for the treatment of any forming scars, then its composition is different. Special patches are great for protection and moisturization fresh scars and are useful in the postoperative period.

Working with scars after a facelift. From the moment of the first request (first photo) to the first laser correction(last photo) I had to work for 8 months. The sooner it is detected pathological development scar, the faster its laser correction is possible:

First visit 8 months after surgery: hypertrophy (convex scar), there is a keloid-like area, congestive hyperemia due to long-term vascular growth, tissue tension, discomfort in the scar.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Scar treatment process therapeutic methods: coagulation of vessels was carried out with broadband pulsed light, reduction of tissue tension with botulinum toxin, inhibition of growth and reduction of the density and amount of pathological collagen with hormonal and enzyme preparations within 8 months.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

First laser correction: fractional Er:YAG without coagulation, in some areas with coagulation to reduce wrinkles and skin contraction.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

2.5 months after the 1st laser correction

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Scars after leg lengthening using the Ilizarov apparatus.

1st procedure: Er:Yag fractional laser, 2nd (after 3 months): – Halo. Photos before and 1.5 months after the second procedure:

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Scars on the scalp

M Can hair grow at the site of the scar on the scalp after a facelift? In place of the scar itself, there is, of course, no scar tissue: there are no hair follicles or other functional cells. But you can reduce the width and volume of the scar, increase the amount of healthy skin around it, using laser and cellular technologies, and thus the hairless area will decrease. Subsequently, hair can be transplanted into healthy skin next to the scar, which will significantly improve the situation aesthetically.

Covering scars with tattoos

E If you plan to improve the condition of the scar, you do not need to get a tattoo on it. Laser exposure works to damage the skin, but a tattoo will not allow you to use, for example, a broadband laser that is absorbed by paint pigments. And if in the future you want to get rid of the drawing, a lot of additional difficulties will arise.

Hypotrophic scars (pits)

P When working with hypotrophic scars, the specialist’s task is to smooth out the sharp transition from the bottom of the fossa to healthy skin, as well as stimulate the growth of healthy dermal tissue in the atrophy zone. Is it possible to fill a hole with filler? Yes, this is a disguise that needs to be repeated periodically. But it is possible to achieve complete replenishment of the defect and smoothing of the skin at the site of former atrophy.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

One scar was completely corrected and leveled with the surface of healthy skin after 1 laser procedure, and the neighboring one will require another procedure.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

A scar on the face after removal of a congenital pigmented nevus with hair growth in childhood. 2 laser correction procedures were performed.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Working with hypopigmented (white) scars

B A white scar is scar tissue that lacks the melanin found in healthy skin. White scars can also be very noticeable. For example, hypopigmented scars around the areola after breast surgery.

How to improve the condition of such a scar? We need to reduce the amount of scar tissue and try to replace it with healthy tissue. You can make a couple of classic factional ones laser procedures, and then, to completely level the microrelief and smooth out the boundaries, use the HALO technology. With the help of cold ablation, we remove part of the scar, and during healing, a different collagen will grow - not the same one that healed the scar. In place of scar cells, we stimulate the appearance of healthy cells and tissues in which melanocytes will appear, producing our natural skin pigment. And then the difference in color between scar and healthy tissue will gradually smooth out.

Is it possible to make scars completely invisible?

It is possible, but not all. Once again, I would like to emphasize that any outwardly similar scars can behave completely differently. Let me also remind you that in this article we are not talking about keloid scars.

Sometimes, if the scar is very large, rough, deformed, and its correction requires a lot of time and effort, it is better to excise it (but before doing this, extinguish the pathological growth and make sure that risks are minimized). Here we need mutual understanding and interaction between the cosmetologist and the surgeon. Next, we even out the color of the scar, help the hyperemia fade, and then reduce its width, height, and volume.

Time is our helper, but time can also be our enemy. We work not only on the scar itself, but also on healthy tissue. Scar tissue will thin out, healthy tissue will grow. The transition between them will become less noticeable, perhaps completely invisible to a prying eye.