EMMA PROTOCOL
for Scar Treatment
EMMA Protocol" (Enhancement, Modulation, and Maintenance Approach)
E - Enhancement: Improvement of scar texture and quality with CO2 laser treatment.
M - Modulation: Tension modulation through botulinum toxin injections.
M - Maintenance: Hydration and volume maintenance with hyaluronic acid injections.
A - Approach: A combined and personalised approach for scar treatment.
EMMA Protocol
Scars can present significant aesthetic and/or functional challenges, impacting various aspects of daily life. Advances in Plastic Surgery now offer state-of-the-art solutions for enhancing the appearance of scars through a combination of innovative technologies and treatments: CO2 laser, botulinum toxin, and hyaluronic acid.
The EMMA Protocol (Enhancement, Modulation, and Maintenance Approach) is a cutting-edge scar improvement treatment that effectively combines three advanced techniques in one or more sessions. This synergistic approach ensures optimal results, reducing recovery time while enhancing scar quality and surrounding skin.
CO2 Laser for Scar Treatment
Fractional CO2 laser is one of the most effective technologies for scar treatment. It works by removing thin layers of damaged skin, stimulating collagen production, and promoting skin regeneration. Key benefits include:
Reduced Scar Visibility: CO2 laser smooths the skin surface, making scars less noticeable.
Enhanced Skin Texture: Collagen stimulation helps create a more uniform skin texture.
Long-Lasting Results: With appropriate follow-up, improvements can be permanent.
Botulinum Toxin for Scar Reduction
Botulinum toxin, commonly known as Botox, is used to reduce skin tension around scars, preventing hypertrophic or keloid scar formation. It’s especially beneficial for:
Recent Scars: Early application can significantly reduce prominent scar formation.
Scars in High-Mobility Areas: Minimises traction forces that can widen scars.
Hyaluronic Acid for Scar Improvement
Hyaluronic acid, naturally found in skin, is used to enhance scar appearance. Injected into the target areas, it provides:
Hydration and Volume: Softens and hydrates surrounding skin, improving scar appearance.
Collagen Stimulation: Promotes collagen production, aiding skin regeneration.
Immediate Results: Visible improvements right after treatment.
Combined Treatments for Optimal Results
Often, the best approach for post-operative scar treatment involves combining these technologies. By integrating CO2 laser, botulinum toxin, and hyaluronic acid, superior, personalised results can be achieved. Benefits of this combined approach include:
Treatment Personalisation: Each patient receives a specific treatment plan based on scar type and location.
Synergistic Effects: Combined treatments enhance individual benefits, accelerating healing and improvement.
Reduced Recovery Time: Multiple treatments optimise recovery time and yield faster results.
EMMA Protocol Options
Depending on scar type, location, and individual patient expectations, various protocols combining the three techniques have been developed, either sequentially or in tandem; each can be further customised to meet individual needs and response to treatment.
Combined Protocol for Delayed Post-Operative Scar Treatment
1. Initial Assessment
Preliminary Consultation: Comprehensive scar evaluation, including type, size, location, and healing status.
Photo Documentation: Photographs taken to monitor progress.
2. Fractional CO2 Laser Treatment
Skin Preparation: Thorough cleaning and application of a topical anaesthetic 30-45 minutes prior.
CO2 Laser Application: Fractional CO2 laser used to ablate thin layers of damaged skin, stimulating collagen regeneration with specific settings to minimise trauma.
Post-Treatment Care: Application of soothing creams and sun protection to prevent infection and speed healing.
3. Botulinum Toxin Injections
Timing: Botulinum toxin injections 1-2 weeks post-CO2 laser treatment to reduce skin tension and promote healing.
Dosage: Microdoses injected around the scar to relax surrounding muscles, preventing hypertrophic or keloid formation.
Follow-Up: Efficacy assessment 2-4 weeks later, with dosage adjustments if necessary.
4. Hyaluronic Acid Injections
Timing: Hyaluronic acid injections 3-4 weeks after botulinum toxin treatment.
Technique: Filler injected into the scar and surrounding areas to improve hydration, texture, and stimulate collagen production.
Personalisation: Choice of cross-linked or non-cross-linked hyaluronic acid based on scar depth and type.
5. Monitoring and Maintenance
Regular Follow-Up: Check-ups at 1, 3, and 6 months post-treatment to monitor progress and assess the need for further treatments.
Additional Treatments: Further sessions of CO2 laser, botulinum toxin, or hyaluronic acid injections as required.
Home Care: Recommendations for topical skin care products, such as moisturisers, silicone gel or sheets, and daily sun protection.
Combined Protocol for Same-Session Post-Operative Scar Treatment
1. Pre-Treatment Assessment
Preliminary Consultation: Detailed scar analysis, patient history review, and discussion of treatment goals.
Photo Documentation: Pre-treatment photographs to monitor results.
2. Skin Preparation
Cleansing: Thorough cleansing of the target area.
Topical Anaesthesia: Application of topical anaesthetic cream 30-45 minutes before treatment to minimise discomfort.
3. Combined Treatment
3.1 CO2 Laser
- Laser Settings: CO2 laser parameters selected according to scar depth and type.
- Laser Application: Treatment of scar area with CO2 laser, ablating thin layers and stimulating collagen production.
3.2 Botulinum Toxin Injections
- Timing: Immediately after CO2 laser treatment.
- Injection Technique: Microdoses injected around the scar to reduce skin tension and prevent hypertrophic scar formation.
- Dosage: Customised based on scar size and location, typically 2-5 units per injection point.
3.3 Hyaluronic Acid Injections
- Timing: Performed in the same session, following botulinum toxin injections.
- Injection Technique: Hyaluronic acid injected directly into the scar and surrounding areas to enhance skin hydration and texture.
- Hyaluronic Acid Type: Choice between cross-linked for deeper scars and non-cross-linked for superficial scars.
4. Post-Treatment Care
Topical Treatments: Application of soothing and protective creams on the treated area.
Sun Protection: Use of broad-spectrum sunscreen to prevent post-inflammatory hyperpigmentation.
5. Monitoring and Follow-Up
Initial Follow-Up: 2 weeks post-treatment to assess initial response and potential need for touch-ups.
Subsequent Visits: Follow-ups at 1 and 3 months post-treatment to monitor progress and plan further treatments as needed.
Home Care: Recommendations on products for maintaining results, including moisturisers, silicone gels or sheets, and daily sun protection.
Final Considerations
The combined protocol leverages the synergistic effects of the three technologies to achieve optimal results in scar treatment. Each phase is tailored to meet specific patient needs, providing a holistic and targeted approach to enhance the appearance and functionality of scars and improve surrounding skin quality.
