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Taculing, Bacolod City, Negros Occidental
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November 27, 2020

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Age: 21 years old

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Special Features

A Scar is Born

By: Risa Caldoza, MD, FPAMS, FPAPSHPI article_14

Our face has vital functions – breathing, sight, speech, and eating. The fifth? Appearance. The face is a channel of identity, the primary means we recognize and interact with each other. No wonder that a change in the appearance of one’s face is a big deal.

Facial scarring is perhaps the worst form of skin scarring one can have. It can be caused by severe cuts such as a car accident or a fist fight, second- and third-degree burns (first-degree burns generally heal without scarring), chemical burns such as acids, and acne. It can also be intended, such as facial scarification in most African cultures, but that is a different article altogether.

Parisian artist Helene Guggenheim, who practices kintsugi (Japanese art of celebrating fractured pottery by bringing it back together with gold) on scarred people, said that a scar is “a witness of our reconstruction and the sign of our ability to adapt, to reinvent ourselves, and even to mutate. And, in this respect, we are gods.” Although scars point to imperfect chaotic healing, it is an awe-inspiring process of the body’s resiliency of dealing with wounds fast.

Sadly, Asians, Blacks, and Hispanics are more prone to scarring compared to Caucasians. We have thicker, more seborrhoeic (oily) skin that predisposes us to keloids and hypertrophic scars. Young people (10-30 years old) are also more prone to scarring since their skin has more elastic fibers that give more tension, and their rate of collagen production is greater. In general, the longer it takes for a wound to heal, the more prominent the scar. As many as six of 10 patients who undergo surgical procedures develop hypertrophic scars, while up to nine of 10 burn patients will carry scars for life.

Especially with acquired disfigurement, where the trauma is thought to be random, the mind issues are unique, ranging from challenges in social functioning, hostility, to anxiety. Two of 10 people with visible scars or facial deformities suffer from depression and four of 10 go through post-traumatic stress disorder. There are also resilient patients, who usually have a very good family support system, bouncing stronger from their facial scars.

The greatest hurdle for most is coping with the social response to their facial appearance. In social interactions, people stand a foot further away from those with facial scars. People were also less likely to offer help to those with scars on their faces. What they offer consistently though is any one of two things: stare or avoid interaction.

Observers rate people with facial scars as less attractive than those without scars. Case in point: bad guys have scars. Consider Freddie Krueger, Darth Vader, Al Pacino in Scarface, and Scar of The Lion King…need I say more? When shown photos of people with facial disfigurement, they were judged to be less outgoing, competitive, and assertive than the same people when shown in images without facial disfigurement.

And the list goes on – in employment, people with facial scars are rated less favorably after an interview, especially for jobs with high degree of customer contact.

Heal beautifully

We have been consciously covering and addressing scars then and now.  Ancient Greeks treated scars around the eyes by – are you ready for this? – applying a little crocodile dung as eye shadow. As early as 1500 BC, Egyptians were using sandpaper to smoothen scars. The Romans of old would put fake moles made of leather to pockmarks and scars. Now, we use our long hair as shields, don huge sunglasses, and rely on the power of makeup, giving might to the $20 billion cosmetics industry.

But thanks to breakthroughs in medical science, attaining better skin may just be within our reach. In 1955, silicone was first used medically as a shunt for children with hydrocephalus. In 1947, Dr. James Brown injected silicone in burn victims to fill scars and wrinkles. The 70s saw the introduction of liquid silicone for scars. In 1983, silicone gel sheeting was first used for hypertrophic burn scars. Today, there is a plethora of silicone-based scar therapy – from sheet, gel, ointment, spray, stick, patch, to strips.

Using topical self-drying gels are popular because they are easier to apply. They hydrate the skin, allowing it to breathe, protect against nasty bacteria, help churn out collagen, and stop itching and discomfort. If used regularly for several months twice a day, it can make raised scars (not older than two years and except third-degree burns) lighter, flatter, and softer. It should not be used on open and depressed scars caused by acne or chickenpox. Remember that managing your scar demands commitment – at least six months of your time.

Some doctors will recommend pressure therapy, where a patient wears a pressure dressing, which may be an elastic bandage or stocking. Steroid injections on the scar itself may help shrink it by half. Dermabrasion, which softens the upper layers of the skin, may make scars look better. Laser therapy or pulse-dye light can give patients remarkable results. When all other treatment fails, scar revision therapy may be an option. And then, there is always gold leaf.


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Keywords: acne , burns, collagen, patients, skin, scar revision therapy, pulse-dye light, laser therapy, dermabrasion, steroid injections, pressure therapy, silicone, facial scars, post-traumatic stress disorder, depression, hypertrophic scars, keloids, facial scarring, scar, scars   
  
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