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Scar Treatment

Scar Treatment Los Angeles


Almost everyone has scars on their body.  Scars are a natural response to the healing process, but can become disfiguring and unsightly if they are not managed properly.  Scars can occur on any given area of the body and can show up as contour irregularities, depressed scars, thickened scars, hyperpigmented scars, lightened scars, fibrotic scars, ice pick scars, and assymetric scars.  These can all occur as a result of trauma, accidents, surgery, acne, or chronic inflammation.  It is the role of a plastic surgeon to identify the key elements of a scar and to recommend critical strategies to improve the aesthetic look, feel, and properties of the scar.


Dr. Karamanoukian is a plastic surgeon practicing in Los Angeles.  He has two offices in the Los Angeles area and treats patients for cosmetic surgery as well as reconstructive surgery.  He was featured on the popular television medical series, The Doctors, for his innovative strategies to treat scars on the body.  He is available for consultation to discuss your particular scar needs. Schedule a consultation with Dr. Karamanoukian by calling (310) 998-5533.


Laser Scar Revision in Los Angeles


Dr. Karamanoukian has developed extensive experience in the management of scars with laser.  Lasers work by a process known as selective photothermolysis, wherein a specific chromophore on the skin can be selectively stimulated or ablated.  By examining the pathologic features of your scar during your consultation, Dr. Karamanoukian can utilize distinct laser wavelengths to improve the quality and size of your scar.  The process can be used in combination with other scar revision techniques such as TAC injection, scar revision, scar modification, subcision of scars, and chemical / topical treatment. Dr. Karamanoukian is available for laser scar removal by calling (310) 998-5533.


Non-surgical Scar Revision 


Not all methods of scar revision are surgical.  An alternative treatment for difficult hypertrophic, thickened, or keloid scars is a non-surgical procedure known as cryotherapy.  Cryotherapy involves the application of an ultra-cold solution to the scars in order to induce scar reduction and atrophy of scar tissue. The treatment takes as little as a few minutes to perform and can be completed in an outpatient clinic with minimal downtime.


Scar cryotherapy is an effective non-surgical modality for difficult scars when used alone or in combination with surgery.  Treatments are spaced 3 to 4 weeks apart and patients typically have to return several times in order to obtain best results.


Scar recurrence can be decreased in patients who undergo multimodality treatment of scars, including cryotherapy.  Risks of cryotherapy include atrophy of scars and hypopigmentation.


Dr. Karamanoukian can discuss your options for surgical or non-surgical scar revision, including your candidacy for scar cryotherapy. Please call our office to schedule a consultation.


Scar revision combines many different types of surgical and non surgical modalities, all of which can work together to minimize the appearance of scars and make them less visible in normal circumstances.  Scars can cause both cosmetic and functional problems, resulting in an abnormality.  Cosmetic scar problems usually are discolored, raised, thickened, or red, leading them to be different when compared to the normal surrounding skin.  Functional problems with scars arise from deeper scar tissue that begins to encroach on adjacent structures or limits movement. Our office sees functional scar tissue often in cases of keloids, lip scars, and burn scars.  These scars can begin to impair normal activities of daily living. 


All of this leads to the question of what the most ideal scar treatment is.  As you can imagine, each scar is different, and thus an appropriate scar treatment incorporates many different modalities of treatment in order to improve the scar’s appearance.  Our office uses lasers, scar revision surgery, dermabrasion, microdermabrasion, fractional ablative treatments, and resurfacing peels.


How do resurfacing peels work for scars? Our office recommends different types of resurfacing peels to treat scars.  Most of these peels work well to reduce discoloration and pigmentation from inflammation and skin trauma.  Scars on the face, legs, and arms usually become discolored as a result of abnormal pigmentation and melanin deposition.  The MelaPeel was developed to exfoliate the top layers of skin and remove discoloration and pigmentation on the skin.  The MelaPeel uses a combination of exfoliating medicines that work in concert to remove existing pigmentation and halt melanin production by blocking the enzyme that controls abnormal deposition of melanin.   Most MelaPeel treatments can be performed in a normal workday, with patients returning to normal activities within one hour of their procedure. Patients notice some mild redness for 24 to 48 hours, followed by light peeling two days after the procedure. The peeling is a stimulating point in the MelaPeel process, as the exfoliation removes old skin and  epidermal and dermal melanin.  



Keloid Scar Treatment in Los Angeles


Fractionated or medical radiation has been used to control scars for many years.  Radiation is mostly used to treat disfiguring or recalcitrant keloid scars that are not amenable to conventional scar treatment options such as cortisone injections, surgery, and pressure therapy.  In most cases, radiation is paired with surgery in order to minimize recurrence rates for difficult keloid scars.


One of the most effective therapies for difficult keloid scars is the use of radiation therapy within 24 hours of surgical excision and scar revision.  This is thought to yield a high cure rate for difficult keloids.  In comparison to surgical excision alone, combined treatment with radiation and surgery will almost always yield a lower rate of scar recurrence. 


The typical amount of radiation given to keloid scars is approximately 300 to 400 cGy for three to four fractions, according to a report in the Plastic and Reconstructive Journal (Oct. 2008).  The downsides to radiation therapy is the theoretical increased risk of malignant transformation in radiated tissue and the increased rate of obliterative endarteritis.


Dr. Karamanoukian typically sees difficult keloid scars in consultation in his two Los Angeles offices.  If you are considering radiation therapy for your keloid scars or are seeking a second opinion after being recommended radiation treatment, please feel free to schedule a consultation to discuss your candidacy for the treatment, longterm risks, and alternatives.


How common are keloids in the Asian population?

Oily skin and previous trauma are risk factors for keloid formation in all ethnic groups.  Asians are particularly prone to develop keloid, particularly in patients specific island descents, Southeast Asians, Indonesian, Chinese, Koreans, Cambodians, Vietnamese, and Malaysians.  These ethnic groups have no greater predisposition to develop keloids than others, but they are frequently seen among these patient population.  Dr. Karamanoukian sees patients from all over the world, including patients who travel from far east and the middle east for development of keloid scars.  Most treatment require minimal surgery and will require diligent pre and post treatment care including the combination of IIT, pressure treatment, intralesional injections, and possibly surgery.  If you are having problems with keloid scars on any part of the body, Dr. Karamanoukian can develop a surgical plan or nonsurgical plan to address your keloid scars.


Are keloid scars genetic if there is a family history of keloids in my family?

Many patients who present to Dr. Raffy Karamanoukian have a history of keloid scars in the family.  Keloid scars are often a result of overactive acne or oil glands in the skin, coupled by dermal injury as a result of cystic acne, previous surgery or biopsy or trauma.  Although there are genetic and family related risk factors, early management of keloid scars may prevent progression into a true keloid.  The problem with keloid is the formation of an inflammatory cycle, which induce its fibroblast stimulation, Dr. Karamanoukian will address not only the keloid scar, but textural changes of the skin and most importantly, the inflammatory cycle.  The patients from New York and the East Coast are often candidates for nonsurgical treatment with Dr. Raffy Karamanoukian.  Please call our office at 310-998-5533 to schedule a comprehensive consultation or discussion with Dr. Karamanoukian.  If you are traveling from out of town or has difficulty consulting with Dr. Karamanoukian, the Los Angeles office can provide you with several options for evaluation.


Is it possible for my keloids to recur?

Keloid scars are caused by active inflammation of fibroblast and are prone to recur if diligent and protocol based measures are not followed.  Many patients have had long term cures with the keloid treatments with Dr. Raffy Karamanoukian, however a loss to follow up or noncompliance may cause recurrence of the keloid scar.  Dr. Karamanoukian will address these requirements during your consultation and emphasize the need for strict followup for all patients who have keloids.  If you have specific questions about keloid recurrence or keloid treatment on your body, Dr. Karamanoukian and his staff can address these issues.


Breast Scar Treatment:


Breast scars are created during cosmetic breast surgery or as a result of medical procedures such as a lumpectomy, mastectomy, or breast biopsy.  Although, at the time of the original surgery, there was little risk of developing a breast scar, months or years after a procedure, a scar may begin to look more noticeable.  Breast scars often become thickened, widened, or discolored.  The majority of breast scar thickening and widening occurs in the first year after the procedure, but a lack of treatment may cause a progressive problem that can continue after the one year point.


A thickened breast surgery scar can be due to tension lines or as a direct result of suture reaction or suture allergies that cause inflammation and scar thickening.  These scars are often inflamed, red, and thickened.  A reactive breast scar is often seen along the inframammary crease, along the lower part of the breast, around the nipple and areola, and in the armpit.  Once the thickening has occurred, it often takes years and years for the scars to subside in size or dimension.


Areolar scars are often seen in patients who have undergone a breast lift or breast reduction.  In these two procedures, a scar is usually made around the areola and eventually sutured.  These sutures may react with the body, causing the wound to become red and inflamed.   If this occurs, the type of suture should be duly noted in order to prevent the suture reaction from ever happening again.



The scars on the areola and inframammary crease can be treated with a number of different options, including laser therapy, intralesional injections, pressure treatment, and silicone. Treatment of areolar scars can also be managed with surgery, and scar revision is a viable option for many of these patients who have suffered from less than optimal cosmetic results.


Lumpectomy and mastectomy scars can also become thickened, raised, or widened.  These incisions are usually made in the breast skin and are unpredictable in terms of scar development.  Sometimes a scar can turn out barely invisible, while others may be associated with thickening and widening.



Breast surgery scars can be treated with ablative and non-ablative laser.  These scar therapy lasers can reduce redness, improve surface texture, and camouflage the scar relative to the surrounding tissue.


If you are contemplating scar revision for your breast scar, schedule an appointment with board certified plastic surgeon Dr. Raffy Karamanoukian.  During your consultation, he will review all applicable treatment options for your scars and provide you with full details regardind cost, type of treatment, and recovery.


One of the most difficult types of breast scars to treat without surgery includes white or hypopigmented breast scars that have widened and lost skin color.  These atrophic scars have lost their ability to make normal skin melanin, thus resulting in a blanching of the skin and ultimate hypopigmentation.  Loss of pigment can be seen as a white scar with thinning of the dermis.


Treatment of white scars can begin with surgical excision of the whitened portion of the scar, followed by retexturizing ablative laser such as the fractional CO2.  This combination may camouflage the scar so that it blends in with the surrounding tissue.


For those patients who have undergone traditional breast lift surgery or breast reduction surgery with a Wise pattern incision composed of a vertical infraareolar incision and an inframammary incision, early scar management is an important part of your recovery.  These two types of scars can become thickened and widened, necessitating further corrective surgery if not addressed.  If you have already developed a thick scar along the bottom of your breast lift or breast reduction incision, then surgical and non surgical options for scar revision are available.


At the same time of your breast scar revision consultation, Dr. Raffy Karamanoukian can also speak to you about any corrective or cosmetic breast procedures that you may need or desire.  It is quite easy to incorporate cosmetic procedures into any scar revision treatments for the breast.  If a revision breast lift, revision breast reduction, or breast implant exchange is needed, it is quite common and prudent to perform these procedures at the same time as your scar revision procedure.


Finally, if you believe that your breast scar tissue is internal as a result of capsular contracture or reaction to your breast implants, you may be a candidate for corrective breast implant revision.  Capsular contracture is a common problem in women who have undergone breast implant surgery.  The problem arises from an inflammatory process within the breast itself as it begins to react with the saline or silicone breast implant.  If the problem is not addressed early, the breast implant tissue capsule may begin to thicken and harden, ultimately changing the pocket in which the breast implant resides.  This thickened tissue capsule can begin to cause pain, discomfort, and ultimately, changes in the breast tissue.  Women often note a change in their breast shape, size, or density.  These changes often represent late capsular contracture, resulting in non-reversible changes in the tissue capsule.  Capsular contracture is a real phenomenon, and may ultimately lead to breast implant rupture.  If you feel as though the breast implant has shifted or that there are palpable changes in your breast as a result of a breast implant, you may be a candidate for breast implant revision.  


Tummy Tuck and Belly Button Scars


Belly button, nasal, cheek, ear, and lip piercings are unquestionably popular, but few people are informed of the longterm scar risks of the procedure.  All piercings cause an epithelialized tract to form along the piercing, often leading to contracture of the scar.  When the piercing is finally removed, the piercing hole does not go away, but may be very evident, with a dimpling in or tethering of the hole.


Piercing scars are often difficult to treat in sensitive areas of the body, such as the nose, lips, and cheeks.  However, there are very good options for treatment that can virtually eliminate the visibility of the scar.  Dr. Karamanoukian performs these piercing scar revisions in an accredited outpatient surgical center under sterile conditions.  The piercing scars are excised and sutures are placed in the skin overlying the scar. 


Piercing scars are common.  If you are concerned about your piercing scar, please call our office to schedule a consultation.  The earlier you repair the scar, the simpler it is to recontour the soft tissue surrounding the scar.


Recommendations for scar revision in Santa Monica, Los Angeles?  Dr. Karamanoukian is a double board certified plastic surgeon practicing in Santa Monica.  Our office serves the greater Los Angeles and Southern California areas.  Dr. Karamanoukian is an expert in scar revision and uses a combination of topical treatments, laser scar removal, and surgical treatments to improve scars.


Schedule a consultation with Dr. Karamanoukian by calling (310) 998-5533.  Dr. Karamanoukian practices in Santa Monica and Los Angeles and serves the entire Northern and Southern California areas.  He is a board certified plastic surgeon and a graduate of the UCLA School of Medicine.


Pulsed dye scar laser treatment


The appearance of scars can vary depending on the type of skin that you have and the depth and severity of injury within the skin layers.  The skin is divided into different components, beginning with the most superficial layer of the dermis and extending into the deeper layers of the dermis.  Scars can occur from a superficial injury involving only the epidermis or deeper injuries extending through the dermis into the subcutaneous layer and even through the fascia and periosteum.  The depth of injury and the amount of tension on the wound will determine final outcome.  Some scars may appear hyperpigmented or discolored, whereas others may become widened or thickened, while others remain red and hypervascular for an extended period of time.  Reddish scars usually have a heightened level of vascularity, causing them to appear red in normal light.  If you look at these scars closely, you will see that they have a blood vessel undertone composed of tiny micro vessels which cause characteristic blushing and redness.  The reddish may also be associated with inflammation and or active scar formation growth.  The pulsed dye scar laser (PDSL) offer by board certified plastic surgeon Dr. Raffy Karamanoukian is an innovative nonablative laser treatment that is used to reduce redness, reduce vascularity of a scar, soften a scar, and decrease the proliferative phase of scar formation.  Dr. Karamanoukian and his clinical staff use the PDSL laser for keloid, hypertrophic scar, inflamed scars, and other types of proliferative or actively growing scar tissue.  The laser can also be used for acne scars that appear red or discolored.  The PDSL treatment is very effective for thickened scars and scars that are actively in a growth phase.


Nose scars


The nose is an obvious area of trauma due to accidents or injury because of its unique position on the surface of the face.  In addition, nose surgery such as rhinoplasty or septoplasty make the nose an ideal location for small incisions used for corrective or cosmetic procedures.  Common areas for nose scars include the nasal bridge, the dorsum of the nose, alar scars, nostrils scars, columellar scars, and open rhinoplasty scars.  Finally, Dr. Karamanoukian evaluates patients with nasal mucosal scars as a result of vestibular stenosis and vestibular collapse.  The treatment of nasal scars depends on the mode of injury and the depth of the scar itself.  Scars on the nasal bridge or along the ala or columella may be amendable to pulsed dye scar laser treatment or IIIT.  These two modes of nonsurgical scar revision may reduce further scarring, reduce redness and hyperpigmentation, and reduce the hyperproliferative stage of scar growth on the nose.


Lip Scar Removal and Treatment in Los Angeles


The lips are important anatomic unit of the face. Hence, scars on the upper or lower lip can present significant problems for patients. Lips scars can occur from a variety of conditions, including injury from surgery, cosmetic surgery, birth defects, cleft lips, skin cancer surgery, mole removal, hemangioma removal, facial filler injections, or silicone (silicon) injection. Some patients have lip deformites as a result of Juvederm or Restylane injections to the lips.

Lip Scar Revision and lip scars can be improved with plastic surgery techniques in the office of Dr. Raffy Karamanoukian in Los Angeles

Dr. Karamanoukian is a board certified plastic surgeon and an expert on scar revision. He has been featured on popular television series regarding his comprehensive approach to scars, including iatrogenic scars, keloid scars, and hypertrophic scars.


In all cases, lips scars can present significant emotional and physical debility to a patient who is concerned about the aesthetic look of the lip.


All lip scars are different, depending on which part of the lip they involve. Lip scars can cross the skin mucosa barrier and involve both the pink of the lip as well as the skin of the upper or lower lip. These scars are generally more difficult to treat, Dr. Karamanoukian employs meticulous reconstructive techniques to  remove or camouflage lip scars and make them less noticeable.


Lip scars that are formed from a cleft lip or a previous cleft lip repair can also be reduced and corrected using a combination of surgical and non-surgical management techniques which include laser, electrodesiccation, chemical peel, dermabrasion, V plasty, W plasty and other scar revision techniques. Patients who have had cleft lips as children often feel that they have no alternatives but to hide their cleft lip scar. Dr. Karamanoukian can discuss your cleft lip scar, even if it decades old, and devise a plan to improve the aesthetic outcome of the lip.


Lip deformities that are caused by silicone (silicon) injections and/or facial filler injections can cause nodules, lumps, and significant asymmetry. These lip scars can also be corrected in an appropriate fashion using both surgical and non-surgical scar management techniques, surgery, laser and TAC injection. Silicone in the lips can cause deformity resulting from swelling, silicone migration, inflammation, nodules, granulomas, and lumps. Dr. Karamanoukian sees patients from around the world for silicone lip deformities and can provide reassuring measures to improve silicone lip deformities.




Can I have lip scar revision under local anesthesia?  Lip scars can be repaired using local anesthesia only.  Our Los Angeles plastic surgery practice is fully certified and contains an accredited operating room that adheres to the highest standards of the AAAHC. If you wish to have the procedure performed under general anesthesia, please discuss these options with Dr. Raffy Karamanoukian during your consultation and preoperative workup. 


Can Dr. Karamanoukian fix cleft lip scars?  Cleft lip scars can be repaired using conventional scar revision techniques to increase lip length and lip contour.  Cleft lip repairs can be improved dramatically.


If you have a lip scar that is a result of trauma, an accident, or surgery,  you may be a candidate for surgical scar revision of your lip scar. Dr. Karamanoukian is available for consultation in his two Los Angeles plastic surgery offices. Please call our office at (310) 998-5534  to schedule a consultation for lip scar revision.

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