Jeffrey Rapaport, MD
這個方式是一位美國紐澤西州的皮膚科醫師Rapaport近幾年提出的多重拉提痘疤治療,原理是一次使用多種的痘疤治療分別在不同的皮膚層內產生不同的效應,進而達到最好的治療效果。
表面的皮膚凹疤使用飛梭類雷射可以達到最佳的恢復,因為飛梭類雷射可以將表面皮膚的不平組織瓦解並在短時間內癒合並不會造成流血傷口,所以術後並不需要照顧傷口,再者,飛梭類雷射的能量可以達到皮膚的深度比一般傳統磨皮雷射還要深,可以刺激真皮的膠原纖維細胞增生與膠原蛋白重新排列一次,讓皮膚有重新生長的機會。
而真皮凹陷與纖維化造成的月球表面則是可以利用皮下切開術,將連接於真皮與皮下疤痕的纖維化組織切開,放鬆真皮層的組織使凹陷處可以恢復彈性,改善皮膚的質地使皮膚底面更光滑,不過皮下切開術的缺點是容易造成皮下的出血與瘀青,如果患有凝血障礙或是服用抗凝血劑的病人在施術時要特別小心,必須避免皮下血腫的產生。
至於較大型的疤痕組織,則可以使用開刀方式取下,延著皮膚紋理縫合的疤痕會比較平順也比較不明顯,有些病人的表現上這些手術疤痕,肉眼是看不清的,如果在恢復期之後手術疤痕還是很明顯的話,則可以輕易地使用飛梭類雷射就可以完全消除。
至於痘斑與色素沉澱則是可以利用換膚術快速淡化,也可以減少新痘痘與粉刺的產生,但對於凹洞則沒有太大的幫助。
痘疤治療目前並非難事,只要找對觀念清楚與可以提供專業的醫師,就可以事半功倍,不過最重要的還是病人與醫師的良性溝通,才能達到最好的效果。
以上中文部份由【朱芃年醫師】所提供
How Are Acne Scars Treated?
痘疤如何治療
Since acne scars come in various sizes and shapes, individualizing treatments becomes necessary to maximize the results. At the consultation, Dr. Rapaport chooses one or a number of different methods that are customized to patient’s needs. For example, subcision (undermining), the TCA CROS Method, Fraxel resurfacing, CO2 or Erbium Laser Resurfacing, and the use of filler substances are appropriate for different types of lesions.
痘疤有不同的形狀及大小,針對痘疤「個別化」的治療是達成最好結果的必要選擇。Rapaport醫師選擇了多種不同的方式來滿足不足病人的需求。例如:皮下切開、局部化學性換膚、飛梭雷射、二氧化碳或Erbium雷射及真皮填充物。 << 免責聲明:療程效果因人而異,不保證結果絕對相同 >>
Smooth-Walled (Rolling) Depressed Scars: For smooth-walled (rolling) depressed scars, Dr. Rapaport usually treats the scars with subcision and the NLite laser. During a subcision session, Dr. Rapaport uses a specialized needle to break up scar tissue underneath the depression. The ensuing wound repair process results in the production of collagen in the treated area, causing the depression to slowly fill in from underneath. NLite treatments are recommended within a few days of subcision to bring about a more dramatic collagen production response.
「滾動型」(rolling)圓形疤:Rapaport醫師主要靠皮下切開術及NLite雷射。靠切開後的傷口修復過程會新增膠原蛋白,以填補圓形痘疤。手術後幾天則建議立即使用NLite雷射以產生更多的膠原蛋白。
“Box Car” Depressions: For “box car” depressions and certain types of sharper edged scars, subcision in combination with the Fraxel laser has been highly effective. The Fraxel has proven to be an excellent tool to smooth out sharper borders non-ablatively with results that are superior to those resulting from more invasive resurfacing technologies (i.e. CO2). In fact, if the scars being treated are superficial, subcision can probably be circumvented altogether. Additionally, patients being treated with the Fraxel benefit from the laser’s inherent ability to reduce the visibility of pores, a common problem for people plagued with acne.
「車廂型」(boxcar)疤:主要靠皮下切開合併飛梭雷射。飛梭雷射可以淡化凹疤的邊緣,並且不會產生傷口,效果甚至比起一些磨皮雷射還要好。事實上,如果治療是比較淺的痘疤,則同時可進行皮下切開術。並且,飛梭雷射可同時縮小毛孔,一舉兩得。
Pitted Scars: For certain kinds of pitted scars, Dr. Rapaport will often recommend the TCA localized Peeling (also called the TCA CROSS Method). During such treatment, a high concentration of Trichlorocetic acid is introduced just inside the scar. The resurfacing response that occurs inside the depression stimulates collagen production that, over multiple sessions, causes the scar to rise up and close in on itself.
「冰錐型」(icepick)疤:對某些這類型的疤,Rapaport醫師建議採化學換膚術處理,能增加凹疤內的膠原蛋白合成,並且在多次治療後,能夠慢慢填平凹洞。
Excision is recommended to treat pitted scars that are not amenable to the CROS Method. As a general rule, for those patients requiring multiple excisions, at least a localized laser resurfacing is done afterwards to smooth over the remaining stitch marks.
如果化學換膚術無法處理者,則建議採用切除法。總之,在接受過多次治療之後,可在局部進行雷射磨皮以減低縫線的痕跡。
Other Conditions: Many types of elevated scars can also be treated by flattening or leveling with laser resurfacing or Radio Frequency surgery.
其他情況:很多凸出的疤,可以靠雷射或電燒手術磨平。
以上原文部分轉貼自:http://www.elanmedispa.com/cosmetic-treatments/acne-scar-treatments.asp
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感想:針對痘疤「個別化」、「個人化」的治療是達成最好外觀及美好膚質的必要選擇。並非一台飛梭雷射可以解決所有病患的全部問題,綜合性的治療-多重拉提痘疤重建治療,已是國際趨勢,這與個人對於痘疤的治療觀念不謀而合,希望各位有痘疤困擾的朋友可以多多參考關於痘疤治療的文章,網路上醫師、診所的評比,價格/價值比,及醫師的專業度,去選擇最好、最實在的痘疤治療方案,期待各位都能得到最好、最專業的治療。
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