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Scar Tissue and Scar Removal Treatment Options

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Scar Care

Any time the body is cut or injured, it heals itself by forming scar tissue. Although minor wounds may heal with little or no visible scarring, most will form a scar, and the size and prominence of that scar depends on several factors.

When the skin is injured, a clot forms to minimize blood loss. The body then forms a scab over the top of the wound, which acts like a natural bandage. The skin starts to create new fibers of collagen at the site of the injury, and by the time the scab falls off, most of the initial repair has been finished. But depending on the size and location of the scar, it can take up to several years for it to completely mature. Larger wounds are more likely to form visible scars than smaller ones, in general.

Scars go through several stages in their healing. They may start out red and raised and look rather bad. It may take months, but eventually the scar will fade and smooth out.

Some people do not scar well. Anyone with circulatory problems will tend to heal slower and form more prominent, visible scars than someone who does not. Diabetics may take a long time in healing. If you are diabetic and planning to have surgery, you should make sure that your blood sugar levels are under control and that your surgeon and anesthesiologist know about your diabetes.

Smokers do not heal well and are more likely to form bad-looking scars than are people who do not smoke. If you smoke and are planning any type of cosmetic surgery (or any surgery at all, for that matter), you really should try to quit smoking. At the very least, stop smoking 2 weeks before your scheduled surgery and for at least 2 weeks afterward.

Two forms of poor scar formation are keloids and hypertrophic scarring. They are not the same thing, but are both forms of too much scar formation. Both are more likely to occur where the skin is under tension, such as on the shoulders or chest.

A keloid is one form of overgrowth of scar formation. Keloids occur more commonly in people with darker skin, but they can occur in anyone who is prone to them. Keloids are more likely to form on the shoulders, head, and chest. The scar becomes large and starts to grow past the edges of the original wound. A keloid can become a very large lump, although it is benign (not cancerous).

Hypertrophic scarring is another type of scar overgrowth, but it is confined to the boundaries of the original wound. Hypertrophic scars may look raised, red and very unsightly. However, unlike keloids, a hypertrophic scar may regress on its own, and it is more amenable to treatment than is a keloid.

Treating a Scar

Scar revision is a common procedure in plastic surgery. Plastic surgeons are often called on to correct a badly formed scar, a scar that has contracted, or one that is unsightly. However, the saying among plastic surgeons is "You can improve the scar, but you cannot remove the scar." This doesn't mean that they cannot help a prominent scar; often the scar becomes almost invisible or very inconspicuous after treatment. However, the scar is still there.

One common scar treatment is silicone gel or silicone sheets. The gel or the sheets are applied on top of the scar and help soften and smooth out a scar. Silicone gels are said not to work as well as silicone sheeting, however. Paper surgical tape is also used often on incisions after they have started to heal and is said to work similarly.

For many years, people were advised to put vitamin E oil on an incision or wound after it had closed. This was said to help keep scarring minimal. However, there have been studies showing that topical vitamin E does not work well and that some people develop contact dermatitis where they've applied the oil.

Physicians treat keloids and hypertrophic scars with injections of corticosteroid drugs. The drug is injected directly into the scar tissue itself and helps to minimize it. Treatments are done every few weeks.

Some types of scars, such as acne scars, can be minimized with dermabrasion. This is a treatment that abrades away the raised scar tissue or the top level of the skin to or near to the level of the scar. Other forms of skin resurfacing, such as laser and acid peels, are used similarly to treat acne scarring.

A scar can also be revised with surgery. In many cases, a plastic surgeon can revise a scar so that it is less visible. However, surgical scar revision should be done very carefully and conservatively with keloids or hypertrophic scarring, since the excessive scarring can recur.

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