When the skin continuity is broken by a cut, by surgery, or by injury, the body forms scar tissue to unite the cut ends. The amount of the scar could vary due to various factors like the person’s age, heredity, race skin characteristics and the direction, depth, size and location of the wound.
Basic Healing and Scar Maturation
It a sutured wound, during the first two weeks the basic scar is formed. During the next eight weeks the scar overgrows (proliferates). At the end of the proliferative stage the scar is red, slightly raised and somewhat lumpy. It takes approximately 6 months from the time of injury or surgery for a scar to fully mature. A mature scar is pale or white, soft and flat. (The younger the age of the patient, the longer the time to mature)
When a scar is removed by a scar correction operation, a new scar is formed by the body in its place. So, a scar cannot be removed, it can only be revised.
By scar revision or scar correction operations, many scars can be improved upon in their appearance or the amount of the scars can be reduced or the disfigurement can be corrected. These scar correction operations are not undertaken until the original scars are fully matured. There are rare exceptions to this rule.
Some types of scars have much better chance for improvement by surgery than other types of scars. Some areas of the body form better scars. After surgery, than other areas. These facts are taken into consideration when a decision is made for a scar revision surgery, after the scar revision surgery, the scars once again go through the stage of healing, proliferation and maturing.
Skin graft means removing skin from one area and placing it in another area. Only on rare occasions, after removing a large scar a skin graft is applied skin grafts look like a patch forever.
The normal lines of the forehead are horizontally placed. So an old, irregular or wide horizontal scar of the forehead is removed and a new, finer scar is made in the same direction. But, after removing a vertical or oblique scar of the forehead the new scar is made into a zigzag line to make it blend better with the natural lines. In other locations, like in the forehead, depending upon the direction of the natural lines the above two techniques are applied.
Some scars are improved upon by Dermabrasion (like small pox scars or pimple scars) Dermabrasion means sanding of the skin and it is almost like sanding the wood patients with darker complexion are not good candidates for Dermabrasion surgery. Also, patients with deeper scar get less improvement than patients with superficial scars by Dermabrasion surgery.
Most scar revision procedures are done in the operating room under local or general anesthesia and may require overnight stay in the hospital.
Keloid scar is not a normal scar It grows continuously, even after the first 8 weeks. It is thick, itchy and appers like a tumor. The commonest places for keloids are the ear lobes and anterior chest wall. When a keloid is removed, to prevent new keloid formation, a course of cortisone injections are given into the wound edges and on rare accessions a mild radiation treatment may be given. Some keloids recur even after the above methods of treatment.