EMMA PROTOCOL
For the Treatment of Scars
PROTOCOL "EMMA" (Enhancement, Modulation, and Maintenance Approach)
E - Enhancement: Improvement of the texture and quality of the scar with the CO2 laser.
M - Modulation: Modulation of skin tension through botulinum toxin injections.
M - Maintenance: Maintenance of hydration and volume with hyaluronic acid injections.
A - Approach: Combined and personalized approach for the treatment of scars.
"EMMA" Protocol
Scars can represent a significant aesthetic and/or functional problem, affecting various aspects of patients' daily lives. The state of the art in Plastic Surgery offers advanced solutions to improve the appearance of scars thanks to the combined use of innovative technologies and treatments: CO2 laser, botulinum toxin, and hyaluronic acid.
The EMMA Protocol (Enhancement, Modulation, and Maintenance Approach) is an innovative treatment to improve postoperative scars, which effectively combines three advanced techniques in a single or multiple sessions. This synergistic approach guarantees optimal results, reducing recovery times and improving the quality of the scar and the surrounding skin.
CO2 Laser for Scar Treatment
Fractional CO2 laser is one of the most effective technologies for scar treatment. This treatment works by removing thin layers of damaged skin, stimulating collagen production, and promoting skin regeneration. The main advantages of the CO2 laser include:
Reduction of scar visibility: The CO2 laser smooths the surface of the skin, making scars less noticeable.
Improvement of skin texture: By stimulating collagen production, the laser helps make the skin more even.
Long-lasting results: With proper follow-up, the improvements achieved can be permanent.
Botulinum Toxin for Scar Reduction
Botulinum toxin, commonly known as Botox, is used to reduce skin tension around scars, preventing the formation of hypertrophic or keloid scars. This treatment is particularly useful in the following cases:
Recent scars: Early application of botulinum toxin can significantly reduce the formation of prominent scars.
Scars in high-mobility areas: Helps minimize the traction forces that can widen scars.
Hyaluronic Acid for Scar Improvement
Hyaluronic acid is a substance naturally present in the skin that can be used to improve the appearance of scars. Injected into the affected areas, hyaluronic acid offers the following benefits:
Hydration and volume: Makes the surrounding skin softer and more hydrated, improving the appearance of scars.
Collagen stimulation: Promotes collagen production, helping the skin to regenerate more effectively.
Immediate results: Hyaluronic acid injections offer visible improvements immediately after the treatment.
Combined Treatments for Optimal Results
Often, the best approach for treating postoperative scars is the combined use of these technologies. By combining CO2 laser, botulinum toxin, and hyaluronic acid, we can achieve superior and more personalized results. The advantages of this combined approach include:
Personalization of treatment: Each patient receives a specific treatment plan based on the type and location of the scar.
Synergistic effects: The combination of treatments enhances the individual benefits, accelerating the healing and improvement process.
Reduced recovery times: By using multiple treatments, we can optimize recovery times and achieve faster results.
Based on the type of scar, its location, and the expectations of the individual patient, different protocols have been developed that combine the three methods either at different times or simultaneously; each protocol can be further adapted and personalized according to individual needs and each patient's response to treatment.
+ Combined Protocol for the Treatment of Delayed Postoperative Scars
1. Initial Assessment
Preliminary consultation: Complete evaluation of the scar, including type, size, location, and healing status.
Photodocumentation: Photographic shots to monitor progress.
2. Fractional CO2 Laser Treatment
Skin preparation: Thorough cleansing of the area to be treated and application of a topical anesthetic cream 30-45 minutes before the treatment.
CO2 laser application: Use of fractional CO2 laser to ablate thin layers of damaged skin, with specific settings to minimize trauma and stimulate collagen regeneration.
Post-treatment care: Application of soothing creams and sunscreen to prevent infections and accelerate healing.
3. Botulinum Toxin Injections
Timing: Injection of botulinum toxin 1-2 weeks after CO2 laser treatment to reduce skin tension and improve healing.
Dosage: Microdose injections directly around the scar to relax the surrounding muscles and prevent the formation of hypertrophic or keloid scars.
Follow-up: Evaluation of the effectiveness of the injections after 2-4 weeks, with possible dosage adjustments.
4. Hyaluronic Acid Injections
Timing: Hyaluronic acid injections can be performed 3-4 weeks after botulinum toxin injections.
Technique: Injection of hyaluronic acid filler into the scar and surrounding areas to improve hydration, texture, and stimulate collagen production.
Customization: Choice of type of hyaluronic acid (cross-linked or non-cross-linked) based on the depth and type of scar.
5. Monitoring and Maintenance
Regular follow-up: Check-up visits at 1, 3, and 6 months post-treatment to monitor progress and assess the need for further treatments.
Additional treatments: Any further CO2 laser sessions or injections of botulinum toxin and hyaluronic acid based on individual response and observed progress.
Home care: Advice on topical skin care products, such as moisturizers, silicone gel or sheets, and daily sun protection.
+ Combined Protocol for the Treatment of Postoperative Scars in the Same Session
1. Pre-Treatment Assessment
Preliminary consultation: Detailed analysis of the scar, evaluation of the patient's medical history, and discussion of treatment goals.
Photodocumentation: Photographic shots before treatment to monitor the results.
2. Skin Preparation
Skin cleansing: Thorough cleansing of the area to be treated.
Topical anesthesia: Application of a topical anesthetic cream at least 30-45 minutes before the treatment to reduce discomfort.
3. Combined Treatment
3.1. Fractional CO2 Laser
Laser settings: Selection of specific parameters of the fractional CO2 laser based on the depth and type of scar.
Laser application: Treatment of the scar area with the CO2 laser, ablating thin layers of skin and stimulating collagen production.
3.2. Botulinum Toxin Injections
Timing: Immediately after CO2 laser treatment.
Injection technique: Use of microdoses of botulinum toxin injected around the scar to reduce skin tension and prevent the formation of hypertrophic scars.
Dosage: Customized according to the size and location of the scar, generally 2-5 units per injection point.
3.3. Hyaluronic Acid Injections
Timing: Performed in the same session after botulinum toxin injections.
Injection technique: Injection of hyaluronic acid directly into the scar and surrounding areas to improve hydration and skin texture.
Type of hyaluronic acid: Choice between cross-linked hyaluronic acid for deeper scars and non-cross-linked for superficial scars.
4. Post-Treatment Care
Topical treatments: Application of soothing and protective creams to the treated area.
Sun protection: I recommend using a broad-spectrum sunscreen to prevent post-inflammatory hyperpigmentation.
5. Monitoring and Follow-Up
First follow-up visit: 2 weeks after the treatment to assess the initial response and the possible need for touch-ups.
Subsequent visits: Follow-up at 1 month and 3 months post-treatment to monitor progress and plan any further treatments if necessary.
Home care: Advice on topical products to maintain results, such as moisturizers, silicone gel or sheets, and daily sun protection.
Final Considerations
The combined protocol aims to harness the synergistic effects of the three technologies to achieve optimal results in scar treatment. Each phase of the treatment is customized according to the specific needs of the patient, ensuring a holistic and targeted approach to improve the appearance and functionality of scars and the quality of the surrounding skin.
