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Scar Treatments

There are various reasons people develop unsatisfactory scars. These could be secondary to injury or trauma or an operation. Sometimes they can develop for unknown reasons but usually this will be due to an injury which the patient is not aware such as picking at a pimple.

Scars can be raised (hypertrophic and keloidal), widened or stretched, depressed, atrophic, pigmented or depigmented.

Treatment

Hypertrophic scars are more responsive to treatment than keloidal scars. It is important not to embark on any invasive treatment until after due consideration as most scars improve with time.

Non-surgical

Massaging the scar with moisturising cream three to four times a day for a period of about three months can help. The scar is firmly kneaded with the tips of the finger, using the cream as a lubricant.

Pressure therapy – pressure garments can be applied. These are more effective with hypertrophic scars. With respect to the ears, custom made clip-on earrings which apply pressure can be made. These will need to be worn for at least six months.

Silicone – this is available in sheets or in a gel form. Prolonged use of this treatment is required. The use of the recently available gel form has increased usage of this method of treatment.

Steroids – these can be put directly onto the scar using adhesive tape or injected into the scar. This can be done in the out-patient clinic. Most children will require some form of quick general anaesthetic. These injections are normally administered usually every four to six weeks. Most patients require a few injections for a consistent effect.

Side-effects of the use of steroids include thinning of the skin (atrophy), loss of pigment (this can be quite troublesome in black skinned people) and development of thread veins (telangiectasia).

Radiotherapy – usually reserved for keloid scars that have not responded to any other form of treatment and usually combined with surgical excision. The risks of radiotherapy include skin changes and in the long term risks of malignancy including skin cancer.

Surgical

Usually combined with the previously mentioned modes of therapy. The most common form of excision is an intralesional excision where the bulk of the scar is reduced, leaving only the rim. This is followed by intralesional injection of steroids at the operation and interval intralesional injection of the steroids (at six week intervals) to reduce the chances of recurrence.

HYPERTROPHIC

Scars are usually red, itchy raised scars which are confined to the limits of the initial injury or incision. They tend to regress and become better with time.

KELOIDS

Are also raised scars but they usually extend beyond the limits of the original wound. They are more difficult to treat. Keloid scars are more common in black skin and may be worse in certain black families. The most common sites where these raised scars develop are in between the breast area (the sternum), the shoulders and earlobes.

DEPRESSED

Scars can be treated by excising the scar and use of zig-zag operation (z-plasty) underneath the skin to elevate that level of skin. More recently fat transfer or injectable synthetic fillers can also be used to elevate the scar.

Did you know!

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.
How long is the operation?
This is usually under an hour.
What kind of anaesthetic is used?
Most can be done under local anaesthesia. The larger and more extensive scars will require general anaesthesia.
How long will I stay in hospital?
Most patients go home the same day.
What is the normal behaviour of scars?
The natural history of scars is that they are initially red, with time they lose their redness, become more mature and paler than the normal skin on white skin and on black skin can become darker than normal skin.
Other methods of revising the scars include:
Simple excisim and proper re-stitching may suffice. Small flap operations or Z-plasties where the skin is rearranged, skin grafts, dermabrasion, use of lasers to reduce the redness, staged or serial excision, tissue expansion where balloons which are progressively filled with saline and put on the normal skin to expand it enough to excise the scar and close the wound directly and free tissue transfer where skin and other soft tissue is transferred by microvascilar techniques from one part of the body to the involved area.
What are the risks of scar revision?
This will depend on the type of treatment received but is similar with any surgery such as bleeding, infection, wound breakdown. There is always a risk of recurrence.

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