When we are talking about scars, we are referring to the mark that is left after the healing of an injury or wound of any aetiology. In general, wherever we have interruption of skin continuity, there is a scar. The difference of each scar is its quality and how obvious it is following healing process. Poor healing may lead to the occurrence of hard and unsightly scars. However, what is important in the final appearance of a scar are some other factors such as texture, composition, size, shape and position, as well as if it is inflamed or an ice pick scar.
Treating a scar is related to all those that have been previously mentioned and, of course, there is no ‘one fits all’ treatment. Some main categories of scars are the following:
Deformed scars: Scars that have left a deformed mark after the end of healing process (at least 1 year) which can be the result of inflammation during healing process, wound dehiscence, patients having predisposition to scars deformity or poor surgical technique.
Hypertrophic scars: Scars which are inflamed without, however, spreading beyond the boundaries of scar.
Keloids: Scars which are inflamed and are spreading beyond the boundaries of the scar. The main reason for their formation is that body continues to produce collagen after the end of healing process. The specificity of these scars implies a combination therapy for the treatment of keloids which may include surgical removal in combination with cortisone injections, silicone gel sheeting or Fractional Laser.
Contracted Scars: Scars that usually occur on flexed or extended surfaces such as the elbow, neck, knee, etc. It is not rare for them to cause high level of contraction restricting joint motion. A very common phenomenon of contracted scar is observed on body surfaces following burns.
Some scars may be operated for better aesthetic result, while others can be treated with combination methods. Thus, for example, a deformed scar can be operated, while keloids are initially treated with intralesional injection, silicone gel sheeting or by combinating methods. Dr Karmiris will evaluate your scar and will recommend you the appropriate treatment, depending on your case.
Preoperatively, no special tests are necessary unless you have blood clotting issues or the operation is performed under General Anaesthesia. It will be necessary to stop smoking preoperatively and immediately post-operatively, reducing thus the risk of healing issues. Also, you should avoid taking aspirin and any anti-inflammatory medicine, since they increase the risk of bleeding.
The surgical procedure:
The surgical removal of a scar is performed in most of the cases under local anaesthesia at the doctor’s office. Depending on what we would like to achieve, we can completely remove a deformed scar, resuturing the incision without tension. Also, we can remove larger areas on keloids and proceed with supplemental treatment with cortisone injections. In contracted or large scars, we apply special techniques such as Z-plasty and W-plasty.
After the removal or amendment of the scar, closure is performed in layers and the wound is dressed. The sutures are removed in 7-14 days, depending on the scar area.
The patient after the end of the surgical procedure can return home. He will have silicone dressing depending on the area of removal, while Dr Karmiris will give you particular instructions on how to take care of your incisions immediately post-op and when you will be seen for a follow up. External sutures are removed depending on the operated area, that is at 7 days in the area of face and at 14 days in torso.
Risks and safety information:
Complications are relatively rare. Postoperative bleeding (formation of haematoma) and inflammation are some of the complications, that although rare, can occur in a general percentage of 1-2%, while there is always possibility of poor scar healing.