White & Hypopigmented Scars

Hypopigmented Scars

  • Best Results9-12 months
  • Treatment Recovery1-10 days
  • Procedure Time60-120 minutes
  • Skin SpecialistDavin Lim
  • Duration of ResultsPermanent
  • AnaestheticBlocks & numbing
  • Back to Work0-8 days
  • Cost$-$$$$

White & Hypopigmented Scars

White scars, known as hypopigmented scars can be due to acne, burns, drug use & trauma. They can be challenging to treat. The focus is to get your pigment cells to produce more melanin. Lasers, topicals, microneedling & melanocyte surgical transfer are methods to achieve this. The highest success is seen in autologous surgical melanocyte transfer via micrografting.

FactsFacts on treating white & hypopigmented scars

  • If pigment cells are viable, simple microneedling can be effective
  • Microneedling is best combined with creams that stimulate melanin production
  • Lasers can be used to increase pigment production in some cases
  • Micrografting gives the most predictable results as it transfers pigment cells
  • Phototherapy after melanocyte transfer accelerates pigment production
  • Cosmetic tattooing can give great results, if performed correctly
  • Autologous cultured melanocyte transfer & stem cells are several years away
  • ReCell can be effective in some cases

What is the concept of Hypopigmented Scars revision?

Logically scars are contour changes, color changes, or both. Fix these two variables and the scar is improved. For hypopigmented-white skin scars, the aim of treatment is twofold.

  1. Firstly get pigment back within the scar (re-pigment white areas)
  2. Secondly, reduce the contrast of surrounding skin. 

Hence to revise the look of scars, we need to concentrate on the above factors.

Why are white scars hard to treat?

White or hypopigmented scars have a lack of pigment, this means that pigment cells known as melanocytes are either low in number or non-existent. In order to improve pigment, I must either transfer new melanocytes or awaken sleeping cells in the scars. This is the only way to get pigment back.

Melanocytes account for one in thirty-five cells that form the basal layer of skin. Their job is to produce pigment. Pigment packets are then transferred to the keratinocytes. In hypopigmented or white scars, the number is reduced. Hence pigment is either greatly diminished or non-existent.

How to reduce the contrast of surrounding skin?

Firstly, reduce tanning. Simple sunscreen twice a day to the unaffected areas will reduce pigment in these areas. From there you can add AHAs like glycolic or lactic acid creams & serums. Lasers including pico, fractional Fraxel, nano-dermal toning & other can be effective. Chemical peels with AHAs can also reduce contrast.

What is my preferred method of treating white/hypopigmented scars?

My preferred method is micrografting with autologous melanocytes. This is an involving treatment as it requires surgery with healing times. Micrografting is successful in most, but not all cases.

This procedure transfers pigment cells from a donor site (most commonly the inner arm, upper thigh or buttock) to the recipient site (hypopigmented scar). This is a form of autologous cell transfer.

In more detail-

  • A sliver of skin including melanocytes are harvested by hand using a blade.
  • Donor site harvesting is painless as I use local analgesia
  • Pigment cells are processed into small units
  • Recipient site is prepared with either manual dermabrasion or laser
  • Cells are placed on the hypopigmented scars
  • Pigment cells populate the recipient site over the next 10 days
  • Pigment starts to develop at week 3
  • Maximal pigment is achieved at 9 to 12 months after the surgery

What is ReCell, & is it effective for white scars?

ReCell is marketed as a spray on skin. It uses your own skin cell as a donor & transfers melanocytes to the areas of hypopigmentation. A special enzymatic process breaks down the donor skin into small pieces. This is then sprayed or painted on to the affected sites. I normally get a team of specialists based in Western Australia to assist in this procedures.

I have used ReCell for the past 7 years, I prefer micrografting manually over processed skin as the results *in my hands* is better. Manual micrografting is more cost effective for the patient.

Davin’s Viewpoint on treating hypopigmented scars

In the context of changes of colour, scars can only have one of three variables (it’s not that hard), darker than the surrounding skin (post inflammatory hyperpigmentation), lighter than the surrounding tissue (post inflammatory hypopigmentation) or red, post inflammatory erythema.

Red marks are the easiest to treat- hit hard with a vascular laser. Dark scars are somewhat easier if you have a pico laser (exception is dusky grey dermal dropout). This leaves white scars. They are by far the most difficult to treat as one has to increase the number of active melanocytes or pigment cells. If your cells are asleep, one can wake them up with microneedling, lasers, PGE analogues & topicals.

Inflammation & trauma (scratch, accident, burn) can reduce melanocyte numbers. If this happens, I need to transfer pigment cells from one area to another. This is surgical. There is no other way to reliably replace melanocytes. (Yes, I do know the theory about stem cells, but this is not reliable. I would recommend straight forward cell transfer, compared to transferring a cell that may or maynot give rise to a pigment cell. That may or may not be active!!!)

Hypopigmented scars take time to heal & repigment, especially with lasers, microneedling & topicals. Melanocyte transfer is faster, I often get re-pigmentation within 3-8 weeks of surgery. The scar-recipient site looks somewhat patchy for many months before evening up at 12 months. You are in it for the long haul. Unlike pigment transfer for vitiligo, melanocyte transfer is more stable in scar tissue.

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