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December 01, 2005

Leg Scar

By Dr. Perry Dela Cruz

Dear Dr. Dela Cruz,

I have a problem about a big scar on my right leg. I have consulted known doctors about it, some of who have told me that the best way to remedy it is by injecting fat cells to straighten the skin, since my scar was caused by a deep wound. A cream will be applied after the procedure to beautify the surface. But another doctor said that my problem is hopeless.

I know that you are a noted doctor so I am writing to you for help. In fact, I was encouraged to write after reading that particular article published in September, 2004 about small and big scars on the leg. I’m embarrassed about others seeing my scar especially now that I’m already in my teen years. Hoping you can help make my scar disappear so that I can start wearing dresses.

Josephine

Dear Josephine,

If your leg scar is just depressed and without hyperpigmentation (darkening), fat transplantation or "injection of fat cells" would be ideal even if it is indeed big. The idea of the procedure is to even out the depression by injecting a "filler" in the form of fats. But this has to be autologous, meaning, the fat to be injected should be taken from you. This can be done in one seating or in a series of treatments depending on the degree of the defect.

We call the harvesting of fat in this particular procedure as micro-liposuction. The suctioning of fat to be transplanted is done manually without the use of a liposuction machine. The ideal donor sites are the abdomen, the inner thighs, and the inner upper arms. Since the fat to be used is autologous, the risk of rejection is minimized, unless infection sets in. The fat injected is soon vascularized (blood vessels develop), and it becomes part and parcel of the surrounding tissues.

However, since the fat transplanted becomes a living tissue, it will also undergo the aging process. Absorption and shrinkage becomes inevitable. If and when that happens, rectification procedure will have to be done. Besides fat transplantation, there are several tissue "fillers" now available in the market like hyaluronic acid and hydrogel. The latter is a more permanent filler than hyaluronic acid which gets absorbed after sometime.

On the other hand, if the color of your scar does not blend with the color of the surrounding skin, excision (surgical removal) should be done. This can be done in one session if the scar is small enough to permit primary closure of the wound, or in series if it is big, spaced anywhere from three to six months per session. However, if the pigmentation is light to moderate, a depigmenting solution (whitening cream or lotion) may be used after correcting the depression by using autologous fat transplantation, or any of the soft tissue fillers mentioned.

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