Dr Anastasakis explains how to treat scars with a minimum invasive technique at the IFFPSS World Congress, 2012, Rome.

1. Konstantinos Anastassakis MD, PhD
Head & Neck Surgeon
Athens, Greece

2. What is a scar?
Scar is the visible
final state of the
natural skin healing
process.
Besides scratches,
every wound results
in some degree of
scarring.

3. Causes of scars
wound scars (trauma)
surgical scars
acne scars (inflammation)
burn scars (contracture)
There are several different kinds of scarring, each
caused by differing amounts of collagen over
expression.

4. Facts about scars
And this is for the…developed world only
No data on the rest 5.7billion humans

5. Numbers on scars
500.000.000cm=5.000.000m =5000km of scars/year

6. Everybody has a scar,
unless he lives in a bubble…

7. Good things about scars
Great conversation starters, help people
be creative in storytelling.

8. Good things about scars

9. BADBAD things about scars
For physicians, scars are a source of frustration
Patients regard scars as stigma!
Substantial physical, psychological, emotional & financial costs.

10. • Burn them
• Melt them
How do we treat scars until now
• Grind them
Actually
destructively
with ablative
procedures

11. Replace scar with another scar, hopefully
shorter or thinner

12. We must
stop being destructive…
and start to be constructive!

13. (NO ablative procedure can meet these
requirements! )
How we SHOULD treat scars?
Both are physiological requirements to be
fulfilled

14. A rational &
RECONSTRUCTIVE approach!
Micro-needling

15. Micro-needling devices

16. Usual, traumatic needles injure skin!
Just like a scalpel!
Even though
tiny, it is still
there!

17. A Non-Traumatic micro-needle
(Ø = 0,25 mm) compared with a 27G injection needle
(Ø = 0,4 mm)
Non-traumatic micro needles and penetrate the dermis
without cutting it, they just part skin cells!
Micro-needling: How it works?

19. How it works:
Injury stimulus on dermis
Alarming signal for stem cell attraction
Release of NATURAL growth factors
Vertical scar perforation
“Nothing to repair”
Filling of the old scar bed

20. How it works:

21. How it works:

22. How it works:

24. Typical Micro-Needling
applications
 Acne scars
 Facelift scars, Parotidectomy, Thyroidectomy, Oncologic
Surgery
 Surgical abdominal scars (appendectomy, Cesarean
section, abdominoplasty etc)
 Thoracic scars
 Breast augmentation, breast reduction, breast
reconstruction scars
 Orthopedic scars (Knee, femoral, upper arm, vertebral)
 Hair transplantation scars (Strip procedure scars, scalp
reduction or scalp extension scars)
 Burn contractures
 Striae

25. Scars to treat with P.C.I.T.
 Atrophic-Depressed
 Hypertrophic-
Elevated
 Contracture
 Acne scars

26. Microneedles and atrophic scars
“Too Little” is complemented (collagen addition).
Microneedles stimulate skin stem cells and cause skin cells to
proliferate new fibroblasts migrate into the scar-bed and fill it
with new collagen layers.

27. Microneedles and hypertrophic scars
“Too Much” is
decomposed (Scar
degradation)
•Different cells are
stimulated to degrade old
collagen strands.
Most probably
microneedling stimulates
enzymes (proteinases) to
degrade scar tissue
Still ELUSIVE

28. Example of stained skin
cross-section from a
biopsy
Collagen fibers stained
purple are
increased up to
1000%
and to a depth of
0.5 to 0.6 mm

29. X 20 times magnification
New Collagen is stained purple.

30. Preparation & Procedure

31. Procedure
gentle pressure, roll the
roller over each area in
each direction, vertically,
horizontally and in both
diagonals
until you get an even
pattern of petaechie

32. Procedure

33. Immediately after session 24hrs after session

34. Acne scars

35. 2 treatments P.C.I.T.,
12 weeks apart

36. 2 treatments,
12 weeks apart

37. Ice pick scars
on the forehead
37

38. Scar improvement 4 weeks after 1st
treatment

39. 4 sessions of Microneedling
Source: Jaihsree Jarad, Bombay/India

40. Source: Jaihsree Jarad, Bombay/India
4 sessions of Microneedling

41. Acne scars after 2 sessions

42. Good clinical improvement after 4 treatments
Courtesy by Prof. P. Niwat

43. Good clinical improvement after 4 treatments
Courtesy by Prof. P. Niwat

44. Courtesy by Prof. P. Niwat
Great improvement of moderate atrophic acne scars
after 4 treatments

45. Burn scars

46. Burn scar - 1 treatment
Source: Med. Hochschule Hannover

47. 3 months post-op
Source: Med. Hochschule Hannover

48. Improvement after
1 treatment,
3 months post-op.
Burn scars on forearm
Source: Med. Hochschule Hannover

49. 3 months post-op
Facial burn scars
Source: Med. Hochschule Hannover

50. 1 treatment, 7 months post-op

51. 1 treatment,
7 months post-op

52. A 3 years old post-burn hypertrophic, hyper pigmented scar on the
posterior surface of the left calf.
Before and 8 months after 1 procedure of micro-needle session.

53. 1 treatment,
4 months post-op

54. Other types of scars

55. 3 treatments,
6 months after
last session

56. 3 treatments,
6 months after
last session

57. Stretch marks, 2 treatments

58. Micro-Needling Advantages
 NO post-op pain.
 NO side-effects.
 Minimal social down time.
 Any area of skin can treated (around the
eyes, neck, dorsum of hands)
 Even areas previously LASER-(mal)treated.
 No damage on skin.
 No use of xenobiotics (Collagen Fillers etc.)

59. Microneedling
is Re-CONSTRUCTIVE
NOT ablative

60. Contraindications
 Never use on infected skin
 Avoid using on keloids and moles

61. dr.anastassakis@gmail.com
Konstantinos Anastassakis MD, PhD
Head & Neck Surgeon
Athens, Greece