Throughout our lives, we all have experiences that injure our skin, leaving behind unwanted scars. Scars are a type of tissue that the body uses to replace or repair damaged or lost skin. When the layer of connective tissue below the epidermis is damaged, the body responds to close the wound by creating fibrous bands of collagen. These collagen fibres differ from normal skin by being firm, inelastic, and dry with a different texture than the skin around them. Scars can appear anywhere on the body, and their composition can vary. they can look flat, sunken, painful, or coloured. Scars can come in all shapes and sizes, and they can be caused by various factors such as accidents, surgery, acne, and pressure. Over time, most scars will fade, but none will disappear entirely.

The more the skin is damaged and the deeper the injury extends below the surface, the longer it takes the wound to heal, which often leads to a more noticeable or unsightly scar. One of the best plastic surgeons in London, highly qualified in rejuvenation procedures and reconstructive aesthetics (fat transfer surgery), Dr Rozina Ali, shares with us her knowledge about the different types of scars and how fat grafting treatment may be leveraged in scar revision.

Types of scarring

There are various types of scars that can be found in different shapes and sizes. Knowing the type of scar that you have can help you decide which treatment is right for you. If your scar it's raised and extends beyond the original injury, it's most likely a Keloid scar. This type of scar is formed due to the excessive buildup of collagen, laid haphazardly in all directions in an uncontrolled manner. It is more common in darker skin and at certain sites (sternum, deltoid, cheek) or areas across joints.

Do you have a scar that looks like a Keloid scar but doesn't go beyond the area where the injury occurred? In medical terms, this type is called a hypertrophic scar and is usually easier to treat than a Keloid scar. This type of scar forms when excessive amounts of collagen form at the site of injury. They are typically red and raised and may be itchy or painful.

Burns injuries may result in significant hypertrophy and/or scar contracture. This type of scar is often deep and can tighten the skin preventing it from moving properly.

Severe acne scars can leave you with permanent ice pick scarring. These are permanent textural changes and indentations left on the skin resulting from serious, sustained or untreated acne breakouts. A legacy of youth no one wants. Pressure or cold temperatures can leave pale, flattened (atrophic) scars which are unsightly and painful or cold-sensitive.

Not all wounds will form noticeable or troublesome scars, especially if they are only superficial grazes. However, a deeper wound, one that takes longer for your skin to heal, will be more likely to form scar tissue.

Fat transfer for scar revision

Currently, there is no gold standard treatment for scars. However, there is promising therapeutic potential for fat grafting, a treatment pioneered and championed for the past 2 decades by Dr Rozina Ali. The key aims of scar revision are to enhance the appearance of the scar, improve the quality of the tissues and restore functional capacity at the site.

Fat transfer, also known as reconstructive or aesthetic lipofilling or autologous fat transplantation, uses fat gently harvested from the patient’s own tissues and washed and filtered to collect living fat cells and stem cells can be used to elevate depressed scars and rejuvenate the tissues.

Fat cells are harvested in a process similar to liposuction from the donor area using a small needle attached to a syringe. The fat cells are washed and purified and then injected into the scar area using a blunt needle/cannula and syringe. Fat is the richest source of adult mesenchymal stem cells (richer than bone marrow (endothelial stem cells) blood, or skin (epithelial stem cells).

Initially, fat transfer rich in stem cells was used for volume enhancement, but it was noted the overlying skin was improved, and fat transfer has become a gold standard in the treatment of radiotherapy-damaged tissues. In Rozina’s reconstructive practice, this mode of treatment has found therapeutic use in many diseases, most notably its effects on overlaying radiotherapy-damaged tissues. Other conditions include some immune disorders, tissue degeneration (joint resurfacing) and ischaemic conditions (pressure sores, diabetes), as well as intractable gynaecological disorders such as lichen sclerosis.

Is fat grafting an option for me?

Fat transfer is likely a risk-free and very valuable adjuvant in most reconstructive and aesthetic procedures since the procedure uses the patient’s own fat instead of exogenous materials. The major advantages of this procedure are the long-lasting results and the transfer of fat cells with naturally occurring stem cells that can proliferate to become fat-producing or collagen-producing cells such as fibroblasts. Growth factors generated by the stem cells benefit scar tissue and improve skin quality.

Surgical expertise and experience are key factors in the success of any fat harvest, fat preparation and fat transfer procedure. It’s a creative process using living tissue and is very experience and expertise-dependent. Another key determinant of outcome is the status of the recipient site (healthy tissue, surface area and richness of blood supply) thus, efforts to optimise this aspect of the process are ongoing within Rozina’s practice.

If you are interested in knowing more about fat transfer procedures and stem cell usage and benefits, book a consultation with Dr Rozina Ali.

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