A scar is the body’s response to any trauma. This can be the result of an accident or even the planned trauma from a surgical procedure. Whereas the incisions with a surgery can be designed in such a way to minimize the eye’s ability to see them, this is not always the case with traumatic scars. And even some planned incisions may not have been placed in the best location originally as most surgeons do not have the level of training of a facial plastic surgeon. Other incisions may not have had any option to be placed better depending on the requirements of surgery at that time. Scarring from acne can also create an uneven surface to the skin which is readily noticeable.
With any trauma, the body goes through a natural progression of healing. The first step is the body stops bleeding. If this step doesn’t happen then the rest of the steps don’t matter. This stage can be impaired by the use of blood thinners or congenital issues that inhibit the formation of clots such as hemophilia and Von Willebrand’s disease. The second phase of healing is the inflammatory phase which lasts about 3-7 days. This is the reason that any wound or trauma will begin to become swollen which increases for the first few days. This is when the wound is its most tender. The third phase is the proliferation phase lasting from about the first week until 1 month. At this point the body begins to form scar tissue and clean up the tissue that was destroyed from the trauma. In this phase the wound begins to elevate and become more firm. The final phase of wound healing is the maturation phase. This can last for up to 18 months in younger patients and as little as a few months in older patients. At this point, the body is trying to remake the wound so it will tend to shrink the size of the scar and begin to flatten.
In an ideal world, all of the steps of the healing process go without a hitch and the resulting scar is nice and acceptable. However, this is not always the case. Problematic scars may be elevated, depressed, widened, have a poor color, irregular texture, or have been placed in a poor location. The good news is scars can be improved regardless of their cause.
But the process of scar revision is just that, a process. Early on local wound care may be all that is needed. The appropriate use of topical ointments and cleaning can do wonders for a scar. It is also important to avoid getting the new scar tanned as it will lead to a permanent discoloration of the scar. However, many people don’t present for evaluation early on and the initial wound care becomes less of an option.
Therefore, scar revision may involve removing your old scar and creating a new one under less tension, as tension is the enemy of a beautiful scar. This traditionally involves the placement of deeper, absorbable sutures and sometimes the placement of tape over the wound for extended periods. It may involve changing the angle of your scar to make it less noticeable to the eye. This can be done in a process known as a Z plasty, W plasty, or geometric line closure. Each one of these accomplishes something different and will be discussed with you if appropriate for your scar.
Scar revision may and usually does involve resurfacing procedures to blend it better with the surrounding tissue including lasers and dermabrasion. What these do is they help to make the lines of a scar less noticeable by improving the transition from the scar to the surrounding tissue. The eye is drawn to shadows and these techniques help to soften those shadows. These are best when performed about 4-6 weeks after the initial injury. They can also be used on more mature scars to some extent. If your scar begins to elevate too much, forms a keloid or hypertrophic scar, or becomes too firm the use of steroid injections are often needed. The medicine is a time release medication so the injections are performed on a monthly basis and work to soften and flatten the scar.
For wounds that are prone to form keloids or hypertrophic scars, the use of topical silicone products has been shown to help. For those not prone to these scars, topical silicone has also been shown to help the overall wound healing process for the first three months. We carry both a silicone ointment (BioCorneum) that includes an SPF30 as well as silicone sheets (Embrace) in various sizes.
As time goes on, the wound will begin to improve on its own without any intervention. However, for scars with the above characteristics, time will likely not be sufficient to improve the scar to your liking. Frequently it takes a combination of techniques at various time intervals to achieve the most cosmetically pleasing scar. Whatever the problem, Dr. Guy can discuss the best approach to improving your scar at the time of consultation.