Scar Revision and poor scars

Whenever an injury or operation involves a full-thickness skin cut a scar will inevitably result. Plastic surgeons will usually try and place their incisions and the resultant scars in favourable natural skin creases and lines, which are often called lines of relaxed skin tension. There will always be a scar, though, and the trick is to try and camouflage it so that it is less noticeable to the patient and casual observer.What can you do to improve your scar?

Scars take about 6-9 months to fully mature and reach a steady state. There is good evidence that scars can be helped during this maturation phase by gentle massage (no particular lotion is recommended and the benefit is probably purely mechanical), taping, sun protection and sometimes by the use of silicone gel preparations – usually if the scar becomes a little lumpy.

The problem scar

Problems arise when scars have been made by some injury or accident, including burns, or by surgeons who may either not understand skin tension lines or who have no alternative but to use a particular surgical incision. Some people may also react to such an injury or incision by forming abnormal scars – hypertrophic and keloid scars – which are often on a genetic basis. Afro-Caribbean people and Caucasians with Celtic colouring (red hair, freckles and pale skin) are especially prone to forming keloids, while the head, neck and torso are especially vulnerable anatomical areas.

Plastic surgeons are often called upon to improve scars – they cannot completely remove a pre-existing scar, but they can disguise it by making it thinner, changing its direction or helping abnormal scars to heal in an improved fashion.

These procedures are tailored to the particular problem, so it is difficult to generalise, but commonly scar revision is done on a day-case outpatient basis under local anaesthetic. Unwanted tattoos also fall into this category. Hypertrophic and Keloid scars usually require pre-surgical treatment, including steroid injection, pressure therapy (silicone gel as above or specially made pressure garments) and sometimes antibiotics. Surgery for keloids is often followed by a single dose of radiotherapy.