Every time the skin is cut or damaged through its full thickness it will heal with a scar. Some people naturally make better scars than others. We cannot accurately predict this but in general we are aware that patients with a black skin and at the opposite end of the spectrum patients with fair freckled skin and red hair will tend to produce poor scars including hypertrophic scars and keloids.
Certain areas of the body produce worse scars than others. The worst area being the middle of the chest which can on rare occasions produce keloids spontaneously without any known injury. The tip of the shoulder is poor, but fortunately the face and neck make good scars generally. Scars which lie in the lines of skin tension tend to be better than ones that run across them. Surgeons will try and choose a good site and direction, but if the scar is due to an injury, there is no choice.
What is the difference between a hypertrophic scar and a Keloid?
There is a whole range of scars but at the poor end there is the hypertrophic scar which occurs when the wound heals to become red, raised and itchy for a few months but will then resolve to become flat and pale. A keloid is similar but the scar continues to grow encroaching upon normal tissue and may need specific treatment.
The treatment of active scars
Time is the best healer as eventually normal scars and hypertrophic scars will mature and become pale. We tend however to try and treat the severer hypertrophic scars and keloids.
The simplest is the application of a steroid containing tape which is worn day and night for extended periods. Strong steroids such as Triamcinalone can be injected into the scar itself. It is usually given as a course at 4 to 6 week intervals. Scar revision surgery is usually done under local anaesthesia when it is felt that a scar can be improved because of particular circumstances or complications of healing in the first instance, or because the procedure is likely to be carried out in a better manner. The old scar is
removed surgery and is repaired. Post operative pain is usually minimal. Sutures are usually removed in 4 to 6 days from the face and 7 to 10 days from other parts of the body. Stitch marks are much less likely to appear on the face as the stitches are removed early. All new scars will initially be red. Fading occurs within 6 to 24 months depending on the scar’s location and the patient’s skin type.
Scars caused by active acne are difficult to treat. On the face it is sometimes possible to cut out the deep scars or to lift them to normal skin level. Dermabrasion and chemical peels have been used to reduce the overall depth of scars and to tighten the skin. More recently laser resurfacing has been used for the same purpose and has become very popular. It should be stressed that these treatments do not remove the scars and at best give a moderate improvement. None of these surgical procedures are suitable away from the face.
These are a difficult and unresolved problem. The easiest to treat are earlobe keloids which sometimes appear after piercing and
often simple excision is adequate.
Elsewhere courses of steroid injections are the main treatment, rarely, excision using some other treatment to try and reduce recurrence of keloids can be helpful. With any surgical revision there is a risk that another keloid may form, but with regular treatment follow-ups and modern treatments, this may be prevented.
If you have an unwanted scar or scars, why not let us take a look.
How do I book an appointment?
You can either call Elan Medical Skin Clinic in Essex on 01268 770660 between 9.30am and 5pm Monday to Saturday or you can book your minor surgery appointment in Essex by going to our online booking form and one of our reception team will contact you by phone or email, whichever you prefer.
We charge £95 for a this consultation. You will be asked to pay your initial consultation fee by credit or debit card on confirming your appointment.