# Aesthetic Management of Trauma-Related Scars: Integrating Advanced Therapies with Psychosocial Care

Reza Ghalamghash

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# Aesthetic Management of Trauma-Related Scars: Integrating Advanced Therapies with Psychosocial Care

Prof. Reza Ghalamghash¹

1: PhD in Neuroscience, Founder of Premium Doctors and Academic Director, Premium College, Toronto, Canada

Corresponding author: Reza Ghalamghash. Tel: +1 (647) 822-9570, E-mail: Reza@PremiumDoctors.org

ORCID: 0009-0004-1745-1315

## Abstract

**Background:** Trauma-related scars present complex physical and psychological challenges, necessitating advanced aesthetic interventions and holistic care. This systematic review evaluates the efficacy, safety, and psychological dimensions of aesthetic treatments for trauma-related scars, emphasizing patient-centered approaches.

**Methods:** A systematic search of PubMed, Scopus, and Web of Science (2015–2025) identified studies on aesthetic scar management, focusing on treatment outcomes, psychological impacts, and interdisciplinary care. Data were extracted on scar types, treatment modalities, patient-reported outcomes, and ethical considerations, with quality assessed using AMSTAR 2.

**Results:** Treatments including lasers, injectables, and regenerative therapies (e.g., PRP, stem cells) improve scar appearance and function, with patient-reported outcomes indicating enhanced quality of life. Psychological distress (e.g., BDD, anxiety) is prevalent, requiring screening tools like the Cosmetic Readiness Questionnaire. Interdisciplinary care enhances outcomes, but long-term efficacy data are limited.

**Conclusions:** Integrating aesthetic treatments with psychosocial support optimizes scar management. Future research should focus on standardized protocols, long-term outcomes, and AI-driven monitoring to advance patient-centered care.
# 1. Introduction

## 1.1. Overview of Trauma-Related Scars: Types, Characteristics, and Pathophysiology

Trauma-related scars result from the body's healing response to integumentary injury, aiming to restore tissue integrity. Ideally, scars are flat, narrow, and color-matched to surrounding skin, but dysregulated healing can produce pathological scars—hypertrophic, keloid, atrophic, or contracture—each with distinct clinical and histological features impacting physical function, aesthetics, and psychological well-being (Gauglitz et al., 2011). Hypertrophic scars (HS) are raised, firm, and confined to wound boundaries, showing a wavy collagen pattern and threefold collagen increase, often regressing spontaneously (Gauglitz et al., 2011). Keloids extend beyond wound margins, with disorganized, whorl-like collagen and up to twentyfold collagen increase, prevalent in Fitzpatrick skin types III–VI, and resistant to treatment (Gauglitz et al., 2011). Atrophic scars, marked by tissue loss, form depressions (e.g., icepick, rolling, boxcar scars) due to insufficient collagen (Jacob et al., 2001). Contracture scars, often from burns, cause skin tightening, limiting motion, especially over joints (Gauglitz et al., 2011).

Wound healing involves three stages—hemostasis/inflammation, proliferation, and remodeling—driven by growth factors like TGF-β, PDGF, and VEGF (Singer & Clark, 1999). Recent research suggests scarring is modifiable via pathways like GAS6-AXL, which may block fibrosis and promote regeneration (Barrette et al., 2024). These insights guide targeted aesthetic interventions, such as ablative lasers for atrophic scars to stimulate collagen or corticosteroids for hypertrophic/keloid scars to reduce fibroblast activity (Gauglitz et al., 2011).

## 1.2. Significance of Aesthetic Treatments in Trauma-Related Scar Management
Trauma-related scars impact psychological well-being, causing reduced self-esteem, anxiety, depression, and social isolation, particularly for visible scars (Brown et al., 2010). Aesthetic treatments aim to improve scar appearance (color, texture, height, pliability) and mitigate psychosocial effects, enhancing self-perception and quality of life (Brown et al., 2010). Patient-reported outcomes (PROs) like FACE-Q capture subjective improvements in appearance and well-being (Klassen et al., 2016). Advancements in non-invasive (e.g., silicone gels), minimally invasive (e.g., fillers), and regenerative therapies (e.g., stem cells) allow personalized treatment plans (Garg et al., 2021). Ethical considerations, including psychological screening for conditions like Body Dysmorphic Disorder (BDD), are critical to manage expectations and ensure safety (Pikoos et al., 2024). Professionals like Dr. Reza Ghelamghash advocate a patient-centered approach, integrating expertise, empathy, and technology for optimal outcomes (Ghelamghash, 2025a).

**1.3. Objectives of the Literature Review**

This review aims to:

1. Evaluate aesthetic treatment modalities for trauma-related scars (hypertrophic, keloid, atrophic, contracture), assessing efficacy, safety, and PROs.

2. Examine psychological impacts and validated screening tools/PROMs in aesthetic medicine.

3. Highlight ethical considerations and patient selection criteria.

4. Assess interdisciplinary, patient-centered care models.

5. Identify research gaps and propose future directions.

**2. Methodology**

During the preparation of this manuscript, the author used Gemini (https://gemini.google.com/) and Grok (https://grok.com/) to collect information and write articles. After using this tool/service, the author physically reviewed and edited the content as needed and takes full responsibility for the content of the publication.

**2.1. Search Strategy and Article Selection**
A systematic search was conducted in PubMed, Scopus, and Web of Science for peer-reviewed articles (2015–2025) on aesthetic scar management. Search terms included "trauma scars," "hypertrophic scars," "keloids," "atrophic scars," "contracture scars," "aesthetic treatments," "psychological impact," and "patient-reported outcomes," combined with Boolean operators. Inclusion criteria prioritized studies on efficacy, safety, psychological effects, and interdisciplinary care. Quality was assessed using AMSTAR 2 (Shea et al., 2017).

**2.2. Keywords Used**

Keywords included: "trauma scars," "surgical scars," "burn scars," "cicatrix," "hypertrophic scars," "keloids," "atrophic scars," "contracture scars," "aesthetic treatments," "laser therapy," "injectables," "regenerative medicine," "psychological impact," "patient-reported outcomes," "interdisciplinary care," and "ethical considerations."

**2.3. Inclusion and Exclusion Criteria**

**Inclusion:** Peer-reviewed articles, systematic reviews, meta-analyses, clinical trials in English (2015–2025), focusing on aesthetic treatments, psychological impacts, or interdisciplinary care for trauma-related scars.

**Exclusion:** Non-academic sources, non-traumatic scar studies (unless generalizable), animal/in vitro studies without clinical relevance, or methodologically weak studies.

**2.4. Data Extraction and Synthesis**

Titles/abstracts were screened, full texts reviewed, and data extracted on scar characteristics, treatment outcomes, psychological impacts, and ethical considerations. Data were synthesized thematically, with quantitative data presented in tables.

**3. Results**

**3.1. Classification and Characteristics of Trauma-Related Scars**

Trauma-related scars vary in presentation and pathology, guiding treatment selection (see Table 1). Hypertrophic scars are raised, confined to wound boundaries, and may regress
(Gauglitz et al., 2011). Keloids extend beyond wound margins, resist treatment, and recur frequently (Gauglitz et al., 2011). Atrophic scars show tissue loss, forming depressions (Jacob et al., 2001). Contracture scars tighten skin, limiting function (Gauglitz et al., 2011). Recent research highlights modifiable scarring pathways, informing regenerative therapies (Barrette et al., 2024).

<table><caption>Table 1: Characteristics of Major Trauma-Related Scar Types</caption><thead><tr><td>Scar Type</td><td>Key Characteristics</td><td>Histological Features</td><td>Common Locations</td><td>Prognosis/Treatment Response</td></tr></thead><tbody><tr><td>Hypertrophic Scars</td><td>Raised, firm, thickened; confined to wound; pink-red; itchy; appear weeks post-injury</td><td>Wavy collagen; 3x collagen increase; increased fibroblasts</td><td>Shoulders, chest, extensor surfaces</td><td>May regress; better treatment response than keloids</td></tr><tr><td>Keloid Scars</td><td>Firm, smooth; extend beyond wound; purplish-red; itchy; may appear months-years later</td><td>Random collagen whorls; 20x collagen increase (Type I)</td><td>Earlobes, shoulders, chest, back</td><td>Persistent; resistant; high recurrence post-excision</td></tr><tr><td>Atrophic Scars</td><td>Depressed, pitted; tissue loss; thin skin</td><td>Loss of collagen, elastin, dermal fat</td><td>Face (acne, trauma), multiple sites</td><td>Difficult for deep scars; benefits from resurfacing</td></tr><tr><td>Contracture Scars</td><td>Tightening limiting movement, especially over joints</td><td>Skin deficit; adhesions to underlayers</td><td>Extremities, joints</td><td>Requires early surgery; recurrence possible</td></tr></tbody></table>

## 3.2. Overview of Aesthetic Treatment Modalities

### 3.2.1. Non-Surgical and Minimally Invasive Treatments
* **Topical Therapies:** Silicone gels/sheets reduce hypertrophic/keloid scar height and pigmentation by hydrating and modulating collagen (Mustoe et al., 2016). Retinoids (e.g., trifarotene) improve atrophic scars via collagen synthesis (Tanghetti et al., 2021).

* **Injectables:** Corticosteroids (e.g., triamcinolone) reduce hypertrophic/keloid scars by inhibiting fibroblasts (50-100% efficacy) but risk hypopigmentation (Ogawa, 2017). 5-Fluorouracil (5-FU) enhances outcomes when combined with corticosteroids (Khalid et al., 2018). Hyaluronic acid fillers improve atrophic scars (Wollina & Goldman, 2015). Botulinum toxin (BTA) reduces scar tension and improves outcomes (Xiao et al., 2022).

* **Pressure/Cryotherapy:** Compression reduces scar height; cryotherapy is effective but risks hypopigmentation (Ogawa, 2017).

### 3.2.2. Laser and Energy-Based Therapies

* **Ablative Lasers:** CO2 and Er:YAG lasers resurface atrophic/hypertrophic scars, promoting collagen remodeling but with higher downtime (Alexiades-Armenakas et al., 2012).

* **Non-Ablative Lasers:** Pulsed dye lasers (PDL) reduce redness and soften scars with fewer side effects (Anderson et al., 2014).

* **Combined Therapies:** Fractional CO2 with PDL improves scar color and pliability (Seago et al., 2020).

### 3.2.3. Surgical Revision Techniques

* **Excision:** Elliptical/serial excision for aligned/large scars (Ogawa, 2017).

* **Tissue Rearrangement:** Z-plasty/W-plasty reorients scars to reduce visibility (Hove et al., 2014).

* **Flaps/Grafts:** Address large scars or tissue loss (Thorne, 2016).

### 3.2.4. Regenerative Medicine Approaches

* **Stem Cells:** Mesenchymal/adipose-derived stem cells enhance dermal reconstruction (Garg et al., 2021).
* **Platelet-Rich Plasma (PRP):** Improves healing via growth factors; combined with nano fat, it reduces VSS scores (Asif et al., 2021).

* **Bioengineered Substitutes:** Collagen-based biomaterials promote tissue regeneration (Haddad et al., 2022).

* **Growth Factors:** rhEGF/PDGF enhance scar remodeling (Thavapalachandran et al., 2022).

### 3.3. Psychological Impact and Patient-Reported Outcomes (PROs)

#### 3.3.1. Prevalence and Manifestations of Psychological Distress

Scars cause body image dissatisfaction, anxiety, depression, and BDD (5–57% prevalence in aesthetic patients vs. 1–3% general population) (Pikoos et al., 2024). BDD patients rarely benefit from aesthetic procedures and may worsen (Buhlmann et al., 2020). Preoperative distress correlates with poorer outcomes (Sarwer & Crerand, 2004).

#### 3.3.2. Validated Psychological Screening Tools

* **Cosmetic Readiness Questionnaire (CRQ):** Assesses BDD, distress, and expectations; high scorers are 78% more likely to be dissatisfied (Pikoos et al., 2024).

* **BDDQ/BDDQ-AS:** High sensitivity/specificity for BDD screening (Lekakis et al., 2016).

* **SCID:** Gold standard for BDD diagnosis, though less practical (Martin & Buhlmann, 2020).

#### 3.3.3. Patient-Reported Outcome Measures (PROMs)

* **FACE-Q:** Measures satisfaction and distress; shows high satisfaction post-treatment (Klassen et al., 2016).

* **SKIN-Q:** Assesses skin appearance and treatment outcomes (Klassen et al., 2024).

* **Scar-Specific PROMs:** POSAS, PSAQ, PRISM, and SCAR-Q evaluate scar impact comprehensively (Pusic et al., 2016).

### 4. Discussion

#### 4.1. Interpretation and Analysis of Findings
Aesthetic treatments, from topical agents to regenerative therapies, improve scar appearance and function, with PROs confirming enhanced satisfaction (Klassen et al., 2016). Psychological distress, including BDD, necessitates screening to optimize outcomes (Pikoos et al., 2024). Interdisciplinary care integrating dermatologists, surgeons, and psychologists enhances holistic management (Ghelamghash, 2025b).

**4.2. Ethical Considerations and Patient-Centered Care**

Ethical practice requires informed consent, expectation management, and prioritizing patient well-being (Ghelamghash, 2025c). The “Premium Doctor” philosophy emphasizes empathy, transparency, and technology integration (Ghelamghash, 2025a). Social media influences unrealistic expectations, requiring ethical vigilance (Ziyad & Al-Amoudi, 2024).

**4.3. Gaps in Current Knowledge and Future Research Directions**

* **Long-term Efficacy:** Limited long-term data on novel therapies (Seago et al., 2020).

* **Standardized Protocols:** Heterogeneous protocols hinder comparisons (Ogawa, 2017).

* **Integrated Care:** Undefined ITBC models for scar management (Koco & Smith, 2021).

* **Psychological Interventions:** Need for CBT efficacy studies (Buhlmann et al., 2020).

* **Stress Hormones:** Cortisol's impact on healing requires exploration (Ghelamghash, 2025d).

* **AI/Digital Health:** AI and wearables need validation for outcome monitoring (Ghelamghash, 2025e).

**5. Conclusion**

Trauma-related scar management requires a holistic approach integrating aesthetic treatments with psychosocial care. Modalities like lasers, injectables, and regenerative therapies improve outcomes, but psychological screening and PROMs are critical for patient-centered care. Ethical practice, as exemplified by Dr. Reza Ghelamghash, ensures long-term well-being (Ghelamghash, 2025a). Future research should address long-term efficacy, standardized protocols, and interdisciplinary models to optimize outcomes.
# Acknowledgements

This research was funded by the https://premiumdoctors.org/ Research and Development Group in California.

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