Scars are formed on the surface of the skin whenever the deeper layers of the skin are damaged.  Through the process of scarring the skin heals. If the damage or the wound is only restricted to the outermost layer of the skin a scar may not be produced. Any change in the normal structure of the skin can produce a scar. Scars not only change the color of the skin but also the appearance.  The type of scar that forms on the skin depends on the type of wound and the area of the skin where it is formed.

Since scars are mostly caused due to natural healing process, they do not require any treatment. Typically scars are flat but in some cases the scars may be raised because of excessive production of collagen. Such scars are known as keloid scars or hypertrophic scars. In cases where the area of the skin on which the scars are formed loses fat a sunken scar may be formed. Although there are many methods for scar removal by which the scars can be treated, the modern medical advancements have made scar revision surgery the most preferred method for scar reduction or removal in cases where other methods have proven to be ineffective.

Scar revision surgery is done to modify the appearance of the scars so as to reduce their visibility. Also, scar revision surgery may also help in improving the elasticity of the skin around the scar. Before opting for surgery, the patient should remember that even with scar revision surgery the scars are not completely removed, only the appearance can be improve to merge with the surrounding skin.

Types of scars:-

The surgery for removal of scars is done according to the types of scars, which can be broadly classified as:-

  1. Hypertrophic scars
  2. Keloid scars
  3. Facial scars
  4. Contractions

Keloid scars:-

Keloid scars consist of thick tissues which extend beyond the edges of the wound.  Generally keloid scars are very distinct in appearance as they are thicker and darker in color in comparison to the surrounding skin. Such scars occur more commonly in people with darker skin colors and the probability of having keloid scars generally reduces with age.  Sometimes such scars are treated with steroids which are given directly to the scar but in some cases surgery is required. The surgery for scar removal is carried out under local anesthesia. Keloid scars have a tendency to recur. To avoid recurrence, surgeons often combine surgery with steroids. Sometimes during surgery steroids may be used directly or surgery may be followed by radiation to minimize the possibility of recurrence of keloids.

Hypertrophic scars:-

The appearance of hypertrophic scars is quite similar to keloid scars with the only difference being that hypertrophic scars remain inside the boundaries of the wound. They generally improve on their own but sometimes surgery may be required where the surgeon will perform the procedure to reposition the incision so that it heals in a concealed manner.

Contractures:-

Sometimes due to burns or any other traumatic injury large pieces of tissue may form a scar which pulls the surrounding tissues of the skin. This may hamper normal movement of muscles and tendons.  In such cases scar removal is done by removing the damaged tissue and replacing it with a graft or flap.  Sometimes to treat such scars through surgery, a procedure known as Z-plasty may be performed. This procedure improves the cosmetic appearance and function of the scars. This technique helps in achieving a better cosmetic result because the scar can be repositioned in the skin line of least tension or the natural folds of the skin. Z-plasty gets its name from the techniques which involves transposition of two triangular flaps of skin which are created at an angle of 60 degrees of each other. The surgery can result in lengthening of the scars. Primarily, z-plasty is used for thin and linear scars. Most commonly, z-plasty is used for scars which do not improve cosmetically or functionally even after sufficient remodeling period.

Facial scars:-

Facial scars are most commonly treated due to cosmetic reasons. Surgeons generally completely cut out the scar and then make smaller and less noticeable stitches to reduce the appearance of the scar.

W-plasty is another type of surgical technique used for scar removal in which several “W” shaped stitches are placed on either side of the scar so that the two sides of the scar will interpose once the scar is excised.  When w-plasty is carried out there is no change in the length of the scar. W-plasty is a straightforward procedure. The end result of a w-plasty is a continuous zigzag pattern which closely resembles the alphabet “W”.

Conclusion:-

Various methods for camouflaging of scars may be utilized which may include the use of procedures such as dermabrasion, steroids, radiation therapy, surgery etc. The most suitable treatment modality for scar removal is chosen according to the type of scar, its location, its structure and the response of scars to various other treatments which precede the surgery. A surgeon may use one or a combination of various methods to treat a scar completely. Dr. Debraj Shome is a highly reputed cosmetic surgeon based in Mumbai. Book yourself an appointment to find out more about scar revision surgery and the best treatment options for your condition.


About Dr. Debraj Shome

Debraj Shome-2
Debraj Shome, MD, DO, DNB, FRCS (Glasgow), FICO (USA), MNAMS, MBA (Healthcare Management, Vanderbilt University, USA), is Consultant Facial Plastic Surgeon, Oculoplastic Surgeon & Cosmetic Surgeon at Nova Specialty Surgery, Mumbai, India..Read more

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