An acid attack left her suffering with burns on most of her body. Now, new advances in lasers are melting away her scars and giving her her life back.
“More than the pain I could remember the smell of burning flesh,” Tanya St. Arnauld told Ivanhoe.
Tanya St. Arnauld remembers vividly when her then boyfriend attacked, spraying corrosive acid in her face.
“I said. Oh my god he’s going to kill me. I have to get out of here,” Tanya said.
She escaped, but not before the entire bottle of acid had been dumped on her, burning 70 percent of her body.
“In the beginning you see holes in your body and you see tissue and it’s so gruesome,” Tanya explained.
She lost huge chunks of hair and much of her mobility multiple skin grafts left mangled scars.
“I was thinking to myself, I’m just 29 and I’m a total handicap,” Tanya said.
But looking at her now, you can see that hope would come when she found one of the top scar experts in the U.S., Dr. Jill Waibel.
“Most doctors don’t even know, let alone patients that we have these great technologies,” Jill S. Waibel, MD, Miami Dermatology & Laser Institute, Assistant Professor Miller School of Medicine, Miami University (Voluntary), Chief of Dermatology, Baptist Hospital, Miami Florida, told Ivanhoe.
A second laser, known as Lumenis UltraPulse, penetrates deeply into the skin, allowing steroids and other topical treatments to be delivered where it’s needed most.
“In this case it’s Kenilog, which is going to help synergistically flatten the scar,” Dr. Waibel said.
Dr. Waibel says the trick is getting to the scars early.
“We’ve found the sooner you get the lasers on the burn scars, we think we can actually prevent the scars from forming,” Dr. Waibel said.
For Tanya, it’s a welcome pain.
“I’m anxious to suffer again every month,” Tanya said. “It’s weird to say but I love this pain now because it’s so beautiful after.”
Tanya wants to try to begin rebuilding her hairstyling career that was effectively put on hold as a result of her injuries. Yet more daunting is the prospect of facing her alleged attacker in court during his trial that’s currently scheduled for August.
BACKGROUND: When the skin comes in contact with something hot, cells in the skin die. The depth of the injury depends on the intensity of the heat and length of time that it is applied. If severe enough, the full thickness of the skin can be destroyed, along with tissues under it. Burns can also result from contact with certain chemicals. Burns are classified by the depth of each the injury so that the appropriate treatment is used.
* First Degree: superficial-redness of skin without blisters
* Second Degree: partial thickness skin damage-blisters
* Third Degree: full thickness skin damage-skin is white and leathery
* Fourth Degree: 3rd degree with damage to deeper structures, like tendons, joints, and bone (Source: http://www.assh.org)
TYPES: There are many different types of burns. Heat burns (thermal) are caused by fire, hot objects, heat, steam, or hot liquids. Cold temperature burns are caused by skin exposure to windy, wet, or cold conditions. Chemical burns are caused by contact with household or industrial chemicals in a liquid, solid, or gas form. Natural foods, like chili peppers, contain a substance that irritates the skin and cause a burning sensation. Electrical burns are caused by contact with electrical sources or by lightning. Radiation burns are caused by the sun, sunlamps, tanning beds, X-rays, or radiation therapy for cancer treatment. Friction burns are caused by contact with any hard surface like roads, carpets, or gym floor surfaces. Breathing in hot air or gases can injure your lungs. Breathing in toxic gases, like carbon monoxide, can cause poisoning in the lungs. (Source: www.webmd.com)
DR. WAIBEL: “The basis of scar treatments are what we call the fractional ablative lasers. And one of the ones I use the most is the Luminous UltraPulse. There’s a group of physicians across you know really the world, but definitely here in the United States and when we got together and we said to luminous, you know one of the things we need is a laser that can go as deep as the scar. Because some of these scars are very thick especially on the back and burn scars. And so luminous created some software called scar effects and that software can go 4000 microns deep. Our current thinking and what we’ve seen improves scars. The Luminous UltraPulse coupled with that new software has really been a great tool to help with scars.”
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Jill S. Waibel, M.D., Miami Dermatology & Laser Institute, Assistant Professor Miller School of Medicine, Miami University (Voluntary), Chief of Dermatology, Baptist Hospital, Miami Florida, talks about zapping scars with lasers.
Tell me a little bit about all these folks overseas that are coming back badly burned. Have been able to save their lives?
Dr. Waibel: So, you know a scar is actually the body’s physiologic response to heal. It is not a great response, but it’s sending in collagen to cover that wound, if that wound stayed open patients can die. So, a scar is actually a good thing. Now, unfortunately the worst the wound, whether it’s a burn or a dramatic car accident, you can get horrendous scarring and not only is it a cosmetically a problem, but it’s also functionally a problem. And one of the greatest advances in medicine I think in the last couple decades has been that the military physicians have figured out how to save the wounded warriors lives. The lasers have been revolutionary in that journey.
Can you talk about the Lumenis laser?
Dr. Waibel: The basis of scar treatments are what we call the fractional ablative lasers. And one of the ones I use the most is the Lumenis UltraPulse. There’s a group of physicians across you know really the world, but definitely here in the United States and when we got together and we said to Lumenis, you know one of the things we need is a laser that can go as deep as the scar. Because some of these scars are very thick especially on the back and burn scars. And so Lumenis created some software called SCAAR FX and that software can go 4000 microns deep. Our current thinking and what we’ve seen improves scars. The Lumenis UltraPulse coupled with that new software has really been a great tool to help with scars.
And that goes four times more than your normal laser?
Dr. Waibel: That is correct.
I mean what is it that makes this particular technology so special besides it being able to penetrate deeper?
Dr. Waibel: It’s really the size of the laser beam. In the old days we used to just take off layers of skin and then kind of cross our fingers and hope it healed will. And that’s how we treated wrinkles. In 2004, there was a laser that came out called the fractional laser and this one was non-ablative and it creates teeny tiny like 200 to 300 microns, just small columns of injury. The body has never seen a wound that small and it’s smaller than a pinpoint, smaller than anything and the body can heal that wound within 48 hours and it heals it without a scar. It- you know it’s pretty amazing. So, then in 2007 Lumenis and several other companies came out with the fractional ablative lasers that heats the collagen and the scar tissue over 100 degrees centigrade. We are basically heating up the scar so hot that you’ll see when we treat the patient we have a smoke evacuator to suck up the skin that we’re vaporizing. We are literally creating a third degree burn, very small, removing that damaged skin and then brand-new skin grows into that.
What have been some of the results from that? Do you have some preliminary results? You are doing animal studies right now right?
Dr. Waibel: These are in a pig study, but we have shown a scarless wound. We have also shown that the stem cells live not only in where we put them, but they also travel to other parts of the body and they are viable and they actually function; so they divide, they create new skin. So, it’s very encouraging because one of the problems is when you have a big injury there’s enough normal skin there’s grafts taken, but grafts mean you create a scar in another body location. The grafts don’t always fit the right color, the right shape, the right texture. And some patients when they burn 90% of their body there’s not enough place to graft them. So you know there are all kinds of challenges now by saving the lives of big trauma and burn patients. So, if we had something that we could just put stem cells on patients and heal them within 48 hours it would be exciting.
I think that’s such a big thing because it’s one thing to have your life saved.
Dr. Waibel: Well, we call it a new scar paradigm and you’re exactly right. We used to say if, you know, if we save the life and limb then we were done. And you know again I am so impressed with my colleagues who are the acute burn surgeons and the traumatic surgeons and the military doctors that save these patients lives, they’re amazing. However, the new paradigm is we’re not done with reconstruction until we have optimal appearance and function. Because a lot of these patients also have range of motion issues, they can’t move very well, they have a lot of itching and burning and the laser fixes all of these things. It helps increase range of motion, it helps decrease the way the scars feel, and it helps decrease itching and burning. So it is a nice tool to put in our toolbox to help these patients.
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