As a consequence of an injury or surgery, all patients heal with the development of a scar. The appearance of the scar will depend upon several factors. Factors include, severity of injury, blood supply to the region, skin color, location on the body and genetic tendency toward poor scar formation.
Once a scar had developed it is impossible to remove it entirely or make it invisible. There are, however, a number of treatments available, which can minimize and improve the final appearance of a scar.
All scars go through a maturation process, once a laceration, injury or surgery has occurred. Initially there is a build up of collagen as the body repairs the injury. This results in a raised, red, firm scar. This is usually seen approximately one month after the injury.
Following this period, there is a gradual softening of the scar with a decrease in color and flattening of the scar. This process may take as long a one year to reach its final stage. In a sense, the "final appearance" of any scar will not be known until this period of time has elapsed.
In certain individuals, scar tissue formation becomes exaggerated resulting in a keloid. A keloid is a scar that has grown outside of the initial boundaries of the incision. The lesion represents a "tumor" of scar tissue. A keloid is often hard, irritated and frequently itchy. This most frequently develops in dark-skinned patients.
Other patients may develop a scar that is somewhat larger than expected, although the scar is generally confined to the borders of the initial laceration. In these cases, the scar is called "hypertrophic", rather than a true keloid
Typical appearance of an earlobe keloid. This keloid has been removed, leaving a small scar.
There are a variety of treatments that are available to treat hypertrophic and keloid scars. In some patients steroids are injected directly into the scar tissue to soften and flatten the scar. Steroids can also be applied topically using creams, ointments and tapes. A newer method of treatment, silicone gel sheeting and ointment has become popular. Over several months, many patients will note improvement in the scars' appearance. A thorough discussion of all the above treatment methods will be done during your consultation.
For many patients, you and Dr. Bromley may decide to undergo a surgical scar revision. This procedure is done so that the scar can be improved. It is essential to understand that the scar cannot be "removed" or made to disappear.
For some patients, scar revision may consist simply of excision of the previous scar and subsequent closure using plastic surgical techniques. In certain patient, after the old scar has been removed, the skin surrounding the area may be rearranged so that the new scar falls into natural skin crease lines. This procedure will make the new scar less visible. The procedure is commonly known as a "Z-plasty".
In some cases, large scars may require a more extensive procedure. Skin grafting may be needed to cover a large area of skin/scar that has been removed. Unfortunately, a skin graft does not have the same texture and thickness of the original skin. In other patients, it may be possible to create additional skin through a process known as tissue expansion. This additional skin can then be used to reconstruct the defect.
If you have any questions regarding scar revision, or any other plastic surgical procedure please contact our office. Photo galleries, in addition to 3D animation of this procedure can be found at the American Society of Plastic Surgeons website.
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