The information contained gives a general idea about the operation and does not replace a consultation.
The consultation is personal and specific to the individual concerned.
All consultations involve taking a thorough medical history and a physical examination of the relevant area involved.
What are scars?
- Scars are produced by the body when it is healing.
- Scars are not normal skin – this is why they look different.
- When the skin has healed after a cut, the scar will be sealed but will still look red. This is because further healing is still ongoing in the scar requiring increased blood flow – hence why it looks red. This is called an immature scar. Scars can be immature for upto a year to 18 months.
- When the scar turns from red to white then the scar has fully healed. This is a mature scar and will not change any further.
Why do some scars look different?
- Some scars appear fine and narrow, some appear stretched and wide, whilst others are thick and heeped up.
- There are several reasons why this happens
- The main reason is how we each of us heal and that is in our genes that we have inherited. For instance, Celtic people can produce thin scars whilst Black people can produce very thick scars.
- The site of the scar also determines how it will appear. Scars over joints such as the knee will stretch. This is because scars are weaker than normal skin and so will give when there is tension across it. Also scars on the upper chest and back and over the shoulders can also become thickened – why we do not really know.
- Infections or wounds that are not closed will produce wide and sometimes thick scars.
Can scars be improved?
- Scars can be improved in several ways but does depend on the factors that are making it unsightly
- The wide/ stretched scar can be cut out and closed to produce a narrower scar in certain circumstances where the wound was previously infected or was not closed properly
- The wide/ stretched scar can be improved by changing its direction, particularly over a joint, such that the pull on it is changed from a sideways one to one that is along its length eg. The line of the scar is moved through 90 degrees so from __ to |.
- Thickened scars are more difficult to treat.
- In the first instance, silicone dressings can help by maintaining a moisture retaining layer against the scar and making the scar “soggy”. This needs to continue for several months day and night.
- If this is unhelpful, a local steroid injection into the scar helps to control the healing process which is becoming overactive and not “switching off” as it should do. This may take several injections performed at 8 week intervals. The steroid stays locally and does not enter the blood stream and so will not have any effect on the rest of the body.
- If the scar is very thick, then it may be best to actually remove the scar and inject the steroid into the skin edges to control the healing that way.
- In really extreme circumstances, the scars produced, and this is usually with black-skinned people, actually start growing beyond the original wound. This is called keloid scarring and can be very difficult to control.
- In this situation, the scar is sometimes removed and then the area treated with a low dose of radiotherapy to control the healing process that way. This is 80% effective on average but can generally only be performed once.
What are the possible complications?
- Unfortunately once you have a scar it will never go away. Some scars can be improved as stated but the healing process then begins again and can take upto a year to 18 months to fully settle and go white.
- Steroid injections can lighten the colour of the scar.
- The scar may return to being overactive and so requires close follow-up initially.
- Changing the direction of the scar can lead to a slightly longer scar but the idea is to make it more hidden.
Each circumstance will be discussed with you as the potential risks and benefits will vary on an individual basis.