Scar Revision vs. Scar Care: When to cut and when to care.
- Posted on: Jun 29 2014
Scar formation is the bodies normal healing response to injury. Any break in the outer layers of the skin can lead to a scar. The normal phase of healing includes an inflammatory phase which signals collagen production. Initially, this collagen is immature and is then replaced by a more mature and organized collagen type.
- Over-production of collagen can lead to thick and raised scars which can be referred to as a hypertrophic scar. These are common over areas of continuous movement and may relate to genetics.
- Persistent immature collagen in scars can lead to red scars.
- Thick, mature scar bands can limit movement over joint extremities leading to contractures and open wounds.
- As scars mature, they can widen leading to a more noticeable scar.
- Abnormal scar formation can cause scar growth, as seen in Keloid scars.
Indications for scar revision:
- Wide scars
- Depressed scars
- Scar Contractures
- Open Wounds
- Persistent Scar Hypertrophy
Scar revision typically removes the scarred area (scar excision) and removes tension on the scar through Z-plasty which elongates the area over the scar, or moves unscarred tissue into the area as seen in a rotational or pedicle flap. Scar revision are surgical options which recreate the injury to the tissue in a controlled fashion. Movement limitation with splinting and deep supportive sutures may be needed to ensure proper healing. After scar revision, active scar care is needed to help guide the new healing process, so the clock is reset on the scar.
Scar care can help to guide the bodies normal scar formation and healing creating an environment which optimizes the phases of collagen production and remodeling. Active scar care can help to ensure proper healing of difficult scars and can ultimately decrease the need for scar revision.
Positive Effects of Active Scar Care:
- Hydrate: moisturizers and moisture barriers (silicone sheeting) are typically applied to scars daily to help prevent scars from drying out.
- Compress: this can help to flatten raised scars and help to control movement around the scar. This can be provided with silicone sheeting and taping of the scar. Silicone sheeting is available online through NewGel®
- Fade: as collagen matures it normally progresses from a red scar to a more neutral tone. Sun protection over the scar can prevent permanent darkening of the immature scar. Sunscreen application on exposed scars is vital to ensure normal fading of the scars. Silicone sheeting and gel, can help to decrease redness of the scar. Topical steroids or scar gel can help fade scars too
Negative Effects of Active Scar Care:
- Daily care regimen: scar care is a slow process which requires a daily regimen that needs to be followed. This can seem daunting, but Dr. Trussler will develop an individualized scar care protocol that is right for you and your scar. There are typically products which are more appropriate for each scarred area and for use in the day and the night.
- Widening: some scar care products can be over used and lead to thinning and widening of the scar. Silicone sheeting and steroid application can lead to this if not followed by a physician.
- Expense: scar care regimens are typically applied for a minimum of 3 months. Scar care does not have to be costly and a simple regimen can easily be develops with one to two components available on-line, over the counter, or through the office of Dr. Trussler.
Dermabrasion can help to even and smooth raised or depressed early scars
Laser light therapy can help to fade redness in the scar and flatten dense, firm scars
Dr. Trussler in his plastic surgery practice in Austin Texas will provide scar care instructions after each procedure and develop a scar care regimen that is individualized for your lifestyle and your scar.
Posted in: Scar Therapy