Dermatology Times - June 2011 - (Page S25)
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the scars are,” Dr. Sire says. As for technique, he says, “Usually I inject into the scar itself, creating a bleb or bolus of saline, which then expands the scar. Typically, there’s only one injection into each scar,” using a 30-gauge needle. “Benzyl alcohol, the preservative in normal saline, acts as a local anesthetic,” he says. “So the area you’re working in quickly becomes pretty well numb. We’ve also used a topical anesthetic prior to the injection for people who are more sensitive.” For patients who tend to bruise, “To be safe, we apply ice to the skin before and after treatment, as we do with dermal filler injections,” he says.
to two years. Scars don’t completely disappear, Dr. Sire says, but they diminish gradually over time. Accordingly, “We try to have patients come in for a ‘booster’ treatment once or twice a year.” Side effects include shortterm bruising and mild swelling that usually disappears in two to three hours, Dr. Sire says. Some patients experience a tiny amount of bleeding, as with any skin injection.
How it works
Dr. Sire proposes that the
contour defect.” Moreover, the saline solution’s buoyancy functions like a balloon, tenting the fibers that have been bound down by the scarring process. “As with most scars, we get slightly faster results if they’re relatively fresh and still have some inflammatory reaction in the skin, which I believe the treatment triggers a bit,” Dr. Sire says. The treatment has worked, however, for patients who have spent years trying many other treatments with other physicians. “That’s a common scenario that we’ve
“As we inject, we notice a softening of the tissue and the scar, so that there’s less pressure when you inject with a needle and syringe.”
David J. Sire, M.D. Fullerton, Calif.
Saline injection volume varies from 0.5 cc to 1 cc per injection site, Dr. Sire says. Each treatment takes about 15 minutes, and most patients see 20 to 80 percent improvement after five or six sessions. After several sessions, injecting becomes easier, as the tissue texture softens, allowing the dermis to expand. “As we inject, we notice a softening of the tissue and the scar, so that there’s less pressure when you inject with a needle and syringe,” Dr. Sire says. Results typically last one
A 24-year-old male patient before (left) and after three saline injections given two weeks apart. (Photos: David J. Sire, M.D.)
treatment’s mechanism of action stems from the fact that stretching and physical stimuli provoke fibroblasts to produce collagen and various growth factors.1-3 “The brisk dermal injection elevates the skin in a wheal-like fashion, initiating a wound-healing process that provokes the production of subtle amounts of collagen” and other extracellular matrix components, he says. “This promotes a layering of collagen, which fills in the
seen,” he says. Regarding cost, Dr. Sire says his practice charges $100 to $150 per treatment. “We like to do a series of six to nine, about two weeks apart. We’ve tried many different time intervals, and that seems to give the best chance of letting the body settle down a bit between injections.” To date, he estimates that his practice has performed the treatment on more than 100 patients. Because the proceSaline see page 26
J u n e 2011
Table of Contents for the Digital Edition of Dermatology Times - June 2011
Dermatology Times - June 2011
Dermatology Times - June 2011