When treating a bothersome scar, the type of scar is of crucial importance. Furthermore, its location and size are particularly significant. A normal scar usually heals flat after an initial phase of redness, swelling, and roughness, and in children and adults, it fades to skin color, leaving a fine white line. Scar healing is usually complete after 3 to 4 months.
A so-called atrophic scar often becomes sunken and wider due to connective tissue weakness.
A thick and raised scar (hypertrophic scar) is limited in size but exhibits excessive growth and is typically characterized by prolonged redness, swelling, roughness, and sometimes even itching.
The extreme example of all scars is the so-called keloid scar, which can grow far beyond the scar’s borders and often appears very voluminous in both width and height. After surgical removal, keloid formation frequently recurs.
Redheads, people with dark skin, and Asians are more prone to keloids than people with fair skin.
There are a variety of treatment options, and specialized consultation is required:
Conservative treatments:
Silicone patches or gels, compression therapy using compression garments (possibly in combination with silicone patches), and corticosteroid injections
Surgical correction:
Repeat scar correction, if necessary with Z-plasty, particularly in cases of keloid formation, followed by additional X-ray radiation for 5 days at 4 to 5 Gray per treatment. For very large scars or scar plates (such as those resulting from burns), serial excision is recommended. This means that the plastic surgeon removes a portion of the scar at intervals of approximately 3 to 6 months. He then performs another series of excisions until only a fine line remains visible. In some patients, a so-called skin expander is also necessary. This is a balloon that the treating physician implants under the healthy skin and fills with fluid via a valve. The healthy skin stretches during this process until, after the expander is removed, it can be used to cover a defect (e.g., excision of a large scar plate).
Another form of treatment is skin resurfacing (dermabrasion):
We would be happy to send you additional informational material on this topic. I would be delighted to welcome you to a consultation at my clinic.
Basics of Scar Treatment:
Compared to healthy tissue, scar tissue has a distinctive characteristic: it is rigid and inelastic because it contains few elastic collagen fibers, causing it to shrink and harden. Scar tissue often does not tan because, during regeneration, there is no (or only very minimal—depending on the depth of the injury) formation of new melanocytes. Furthermore, in the case of large scars, skin appendages such as hair, sebaceous glands, and sweat glands may be absent.
The goal of scar treatment at a cosmetic clinic is to improve the appearance of the scar.
Hypertrophic Scars
- Hypertrophic scars can develop as a result of excessive production of connective tissue. These protrude above the surrounding skin level; they are raised and thickened. They are often reddened and cause itching. A hypertrophic scar usually develops when the wound is subjected to constant movement during the healing process.
Atrophic Scars
- These are scars that lie below the surrounding skin level. They often look like small dimples. In these cases, insufficient connective tissue fibers were formed due to impaired wound healing. They often appear in connection with acne.
Keloid Scars
- These are raised scar growths. They are caused by an overproduction of connective tissue. Keloid scars tend to spread over the surrounding healthy tissue. They are usually larger and more raised than hypertrophic scars. A tendency toward keloids is often hereditary.
Contractures
- These are extensive scars, primarily resulting from burns and scalds, which usually heal through tissue contraction. Such scars are not only disfiguring; they also frequently impair the functionality of the affected body part.
Which scars can be treated at a cosmetic clinic?
Hypertrophic scars
Atrophic scars
Scar revision is performed under local or general anesthesia. In uncomplicated cases, it is sometimes sufficient to excise the scar and suture it closed again. As a rule, however, it is necessary to use a special incision technique to relieve tension on the wound edges and prevent the scar from contracting again. The incision is made along the skin’s natural creases as much as possible.
There are several options here:
- Performing the surgery in several separate steps; between procedures, the skin is specifically massaged to loosen it.
- Inserting an expander (plastic balloon) under the surrounding healthy skin. By slowly filling the expander over several weeks, the skin is gradually stretched.
There are also methods to cover the excised scar area with healthy skin. However, these result in additional scarring:
- Local flap plasty: In this procedure, adjacent healthy skin is repositioned to cover the defect.
- Distant flap plasty: Tissue from a more distant part of the body is transplanted along with its blood vessels. This can be done either through microvascular anastomosis, so that blood flow in the recipient area is immediately restored, or by suturing while maintaining a bridge between the donor and recipient areas, which ensures blood flow. Once new blood vessels have grown into the recipient area, the bridge can then be severed. This is usually possible after about 3 weeks.
- Skin grafting: A superficial section of skin is harvested from a body region farther away from the scar and transplanted into the scar defect. At the donor site, the skin heals as it would after a scrape.
I will select the procedure that is best suited for you and discuss it with you in detail. I would be delighted to welcome you to my clinic for a consultation regarding scar correction.
Another method of scar correction is dermabrasion. This treatment is effective for healed scars that are no longer active. An active scar can be recognized by lingering slight redness and swelling, as very fine capillaries are still embedded in the scar tissue. A scar is generally fully healed after 8 to 12 weeks. In rare cases, however, healing can take 12 to 24 months. Dermabrasion should usually only be performed once a scar is fully healed to ensure success. Dermabrasion only alters the height or prominence of the scar, not its width.
Another treatment option for scar correction is laser therapy. I personally do not perform laser treatments, but I am happy to recommend an experienced colleague (dermatologist) upon request. We would be happy to send you additional informational material on this topic.
