Scar Treatment After Plastic Surgery

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


May 09 2008

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Can Surgical Scars Be Diminished with Treatment?

Plastic surgery and scars – unfortunately, you can't have the first without the second. Once skin has been breached, either deliberately or accidentally, the healing process begins. It always leaves behind a scar, more noticeable after procedures like breast reduction or tummy tuck, than after some less invasive procedures.

Healing of damaged tissue starts with inflammation, which leads to the formation of collagen, a fibrous protein that connects and supports bodily tissues, including skin. As collagen is laid down in the wound, a scar is born.

Various factors determine how your skin scars: the depth and size of the wound or incision, its location, your age, genetics, gender, and ethnicity. Scars are a natural part of healing. They may become less noticeable over time, but they never go away. They can, however, be treated to reduce their size and appearance.

Surgical Scars Types

There are various types of scars, but two types of poor scar formation are most closely associated with surgery: keloid scars and hypertrophic scars.

It could be said that keloid scars are the result of an overly aggressive healing process. These thick, puckered, and itchy clusters of scar tissue extend beyond the original edges of the incision. Often red or darker in color than the surrounding skin, keloids occur more often in dark-skinned people and are most common over the breastbone, on earlobes, cheeks, neck, and shoulders. Hypertrophic scars are similar to keloids in that they're raised and red, but they do not grow beyond the boundaries of the incision. Unlike keloids, hypertrophic scars often improve on their own.

Many small surgical scars fade with time to the point of near invisibility; large, thick, indented or raised scars usually need treatment to reduce their appearance.

Scar Treatments Available

A number of options are now available, including over-the-counter (OTC) or prescription topical scar treatment products (creams, ointments, and gels), silicone gel sheeting or tape, injections, lasers, and surgical scar removal or revision.

For uncomplicated surgical scars, plastic surgery patients should consult with their surgeon about OTC and prescription topicals, some of which contain corticosteroids or antihistamines for itchy or oversensitive scars. Silicone gel sheeting and tape are also readily available at your local pharmacy and surgical supply stores, and should be used as instructed by your surgeon.

In the case of protruding keloids or hypertrophic scars, your doctor may chose to inject a steroid medication directly into the scar as a stand-alone treatment or in conjunction with other treatments, but laser therapy has become the preferred treatment of choice for these scars.

Laser scar treatment is usually performed under local anesthesia as an outpatient procedure. It involves moving a pulsed dye laser (PDL) along the scar, vaporizing a layer of skin as it goes to expose a new layer below. The skin regeneration process can begin as early as four days after treatment. As the new layer heals, the scar's appearance is minimized 50% to 80%. The treatment also helps prevent the scar's recurrence. People with darker skin or disorders like psoriasis, acne, and dermatitis may not be candidates for laser scar removal.

Perhaps the most drastic scar treatment is surgical removal or revision.  For this, you should consult a board-certified plastic surgeon. Under local anesthesia, keloidal scar tissue can be cut out and the wound closed with one or more layers of stitches. Because they have a tendency to return, your surgeon may combine the removal of your keloid scar with a steroid treatment (injection or direct application) or radiation therapy. The theory is that since radiation slows skin growth, it could decrease the production of excess skin that is causing the scarring. Whatever the treatment, you may also need to wear a pressure garment over the wound for as long as a year.

Hypertrophic scars can also be improved by surgery. The plastic surgeon removes excess scar tissue and sometimes repositions the incision so it heals in a less visible pattern. To prevent the thick scar from reforming, a series of steroid injections may be used for up to two years.

Most scar treatments are considered cosmetic and not covered by medical insurance. However, if the scar impairs you physically, it's worth checking with your health insurer about coverage. Either way, plastic surgery patients are advised to wait at least a year postsurgery before deciding on a revision.