Scars -whether they're
caused by accidents or by surgery- are unpredictable.
The way a scar develops depends as much on how your
body heals as it does on the original injury or on the
surgeon's skills. Many variables can affect the severity
of scarring, including the size and depth of the wound,
the blood supply to the area, the thickness and color
of your skin, and the direction of the scar.
While no scar can be
removed completely, plastic surgeons can often improve
the appearance of a scar, making it less obvious through
the injection or application of certain steroid medications
or through surgical procedures known as scar revisions.
Many scars that appear
large and unattractive at first may become less noticeable
with time. Some can be treated with steroids to relieve
symptoms such as tenderness and itching. For these reasons,
we recommend that you wait from 6 months to a year after
an injury or surgery before you decide to have scar
Keloids are thick,
itchy clusters of scar tissue that grow beyond the edges
of the wound or incision. They are often red or darker
in color than the surrounding skin. Keloids can appear
anywhere on the body, but they're most common over the
breastbone, on the earlobes, and on the shoulders. They
occur more often in dark-skinned people.
Keloids are often treated
by injecting a steroid medication directly into the
scar tissue to reduce redness, itching, and burning.
In some cases, this will also shrink the scar.
If steroid treatment
is inadequate, the scar tissue can be cut out and the
wound closed with one or more layers of stitches. A
skin graft is occasionally used, although the site from
which the graft was taken may then develop a keloid.
No matter what approach
is taken, keloids have a stubborn tendency to recur,
sometimes even larger than before. To discourage this,
we may combine the scar removal with steroid injections.
A pressure garment may be helpful in preventing recurrence
are often confused with keloids, since both tend to
be thick, red, and raised. Hypertrophic scars, however,
remain within the boundaries of the original incision
or wound. They often improve on their own-though it
may take a year or more-or with the help of steroid
applications or injections.
If a conservative approach
doesn't appear to be effective, hypertrophic scars can
often be improved surgically. After removal of excess
scar tissue, the incision is repositioned so that it
heals in a less visible pattern. This surgery may be
done under local or general anesthesia, depending on
the scar's location. You may receive steroid injections
during surgery and at intervals afterward to prevent
the thick scar from reforming.
Burns or other injuries
resulting in the loss of a large area of skin may form
a scar that pulls the edges of the skin together, a
process called contraction. The resulting contracture
may affect the adjacent muscles and tendons, restricting
Correcting a contracture
usually involves cutting out the scar and replacing
it with a skin graft or a flap. In some cases a procedure
known as Z-plasty may be used. And new techniques, such
as tissue expansion, are playing an increasingly important
role. If the contracture has existed for some time,
you may need physical therapy after surgery to restore
Because of its location, a facial scar
is frequently considered a cosmetic problem, whether
or not it is hypertrophic. There are several ways to
make a facial scar less noticeable. Often it is simply
cut out and closed with tiny stitches, leaving a thinner,
less noticeable scar. If the scar lies across the natural
skin creases we may be able to reposition it to run
parallel to these lines, where it will be less conspicuous.
Z-plasty is a surgical technique used
to reposition a scar so that it more closely conforms
to the natural lines and creases of the skin, where
it will be less noticeable. It can also relieve the
tension caused by contracture. Not all scars lend themselves
In this procedure, the old scar is
removed and new incisions are made on each side, creating
small triangular flaps of skin. These flaps are then
rearranged to cover the wound at a different angle,
giving the scar a "Z"pattern. The wound is closed with
fine stitches, which are removed a few days later. Z-plasty
is usually performed as an outpatient procedure underlocal
SKIN GRAFTING AND FLAP SURGERY
Skin grafts and flaps
are more complex than other forms of scar surgery and
are more likely performed as inpatient procedure, using
general anesthesia. The treated area may take several
weeks or to heal, and a compression garment may be required
during this period.
Grafting involves the
transfer of skin from a healthy part of the body (the
donor site) to cover the injured area. Most grafts
from a person's own skin are successful. However, all
grafts leave some scarring at the donor and recipient
Flap surgery is a complex
procedure in which skin, along with the underlying fat,
blood vessels, and sometimes the muscle, is moved from
a healthy part of the body to the injured site. In some
flaps, the blood supply remains attached at one end
to the donor site; in others, the blood vessels in the
flap are reattached to vessels at the new site using
Skin grafting and flap
surgery can greatly improve the function of a scarred
area. In general, flap surgery produces better cosmetic
results than skin grafts.
WHAT WILL MY RECOVERY
With any kind
of scar revision, it's very important to follow your surgeon's
instructions after surgery to make sure the wound heals
properly. You may be required to message the scar regularly,
wear compression garment or use certain creams or gels
to assist in the healing process.
As you heal, keep in
mind that no scar can be made to disappear completely;
the degree of improvement depends on the size and direction
of your scar, the nature and quality of your skin, and
how well you care for the wound after the operation.
If your scar looks worse at first, don't panic-the final
results of your surgery may not be apparent for a year