What is a scar?

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What is a scar?

Scar formation is a natural part of the healing process after injury caused by surgery, accidents, or diseases.  The depth and size of the wound and the location of the injury will impact the scar’s characteristics.

Various factors, such as age, heredity, sex, and ethnicity will influence the appearance of a scar.  Most commonly, inflammation and redness may occur, but this will gradually fade.

The formation of a scar can be affected by many different factors including, but not limited to, one’s age and the location on the body.  Scars may appear more prominent in locations where the skin is tighter, for instance the jaw line.  Skin can appear to be uneven due to an indented or raised scar that casts an irregular shadow.  A scar that crosses natural expression lines, or is wider than a wrinkle, will be more apparent because it will not follow a natural pattern, nor look like a natural occurring line.

Treatment can greatly improve the appearance and result of a scar, whether it is healthy or not.  Some scars may improve on their own over 6 to 18 months.

What can and cannot be done for scars?

Scars usually fade over time but never go away completely.  Several techniques can help minimize a scar.  Though rare, only severe scars may require anesthesia or hospitalization.

Surgical scar revision can improve the way scars look by changing the size, depth, or color.  Each scar is different and will require a different approach for each individual person.  Though a scar can never be completely erased, surgical scar revision can create a less obvious mark.

Consultation between the patient and the dermatologist is the most important step in the treatment of scars.  It allows the dermatologist to understand the patient and analyze what treatment would be best for that individual.

Scar Treatment

Surgical Scar Revision – Using the skin’s natural elasticity, surgical scar revision removes the scar and rejoins the normal skin to create a smoother surface.  Scars that have healed in a particular pattern or shape, or those that are in prominent places are best suitable for surgical removal.  Wide scars can often be cut out and closed, resulting in a thinner scar, and long scars can be made shorter.  Rather than using straight-line incisions, a technique of irregular or staggered incision lines may be used.  A scar can be made to look less noticeable by changing its direction and allowing it to fall into a natural junction, such as a wrinkle or a hairline.  Best results are obtained when the scar is removed and wound edges are brought together without tension or pull on the skin.

Dermabrasion – is a method of treating acne scars, pockmarks, some surgical scars, or minor irregularities of the skin’s surface.  To give a more even contour to the surface of the skin, a dermatologist will use an electrical machine to remove the top layers of the skin.  While this method can offer improvement, no scar can be completely erased.  Each individual patient is different and the amount of sessions needed may vary based on the level of defect and how extensive the scars are. Most patients can usually return to work within a week.

Laser Resurfacing and Pulsed Dye Laser Scar Revision – Another method of improving surgical scars, acne, chicken pox, and other scars is laser scar revision.  This method uses a high energy light to remove or remodel unwanted damaged skin.  Skin may stay pink for several weeks or months, but individual results may vary.  Several different lasers are available to best suit the needs of each patient.  Acne scars or other indented (atrophic) scars can be improved with laser skin resurfacing.  Hypertrophic (thick, raised) scars or keloids typically need two or more pulsed dye laser treatments every two months.

Soft Tissue Fillers – Various injectable substances are available to elevate indented soft scars.  The amount of material injected will vary with the size and firmness of the scar.  Dermatologists use a variety of soft tissue fillers, including human and bovine collagen, hyaluronic acid, fat removed from another part of the patient’s body, polymer implants, and other related materials.  Although improvement is immediate, the results are not permanent and often need to be repeated.  Some injections last longer than others.  After consultation, a dermatologist will help decide which injectable substance best suits the needs of the patient.

Punch Grafts and Punch Excisions – Punch grafts are small pieces of normal skin used to replace scarred skin.  A small tool is used to cut out the scar.  A skin graft is usually taken from behind the ear to fill the void.  The graft is held in place with sutures, steri-strips, or skin glue as they heal.  Punch excisions, on the other hand, involve the use of stitches to close the holes produced by the tiny skin punch.  Local anesthesia is applied to the area and an extension tool is used to cut out the scar and its surrounding edges.  The skin is then pulled and stitched together.  The stitches are removed in five to seven days.  Even though the punch grafts and excisions form scars of their own, they provide a smoother skin surface which is less visible than depressed scars.  Punch grafts or excisions are typically used for scars that are considered wide or deep, such as those associated with severe acne or chicken pox.

Chemical Peels – To give the skin a more even color and smoother appearance, a chemical peel procedure is used.  This procedure uses chemicals to remove the top layer of skin.

Using a cotton tipped applicator or gauze, the chemical is first applied to the forehead and continuously applied down until it meets the chin.  Depending on the peel that’s selected, the amount of scarring and color change may vary.  Different chemicals are available for each patient’s specific needs.  Light peels require no healing time while deeper peels can require up to two weeks to heal.

Other Scar Treatment Methods

Pressure bandages and massages can flatten some scars if used on a regular basis for several months.

Silicone-containing gels, creams, and bandages have also been helpful in reducing scar thickness and pain.  The results will vary and they must be used regularly.  In addition to injections of scar tissue, patients can use silicone impregnated gels at home to remodel elevated scars.

Cryosurgery involves a dermatologist using liquid nitrogen to destroy the scar by freezing it.  This treatment is usually only mildly painful and is often effective, although repeated treatments may be necessary.  Freezing works by causing a blister to form under and around the scar.  Then, the dead tissue sloughs off within a week or so.

Cortisone (steroid) injections or tape are effective in softening very firm scars causing them to shrink and flatten.  This treatment, along with pulsed dye laser therapy, is popular for hypertrophic scars and keloids.

Interferon improves the hardness and cosmetic appearance of a scar by chemical injection.

Cosmetics can be an excellent concealment when covering up the appearance of scars.  While healing is in progress, makeup will improve the appearance of the skin.

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