Improve Scar Appearance by Scar Revision

Understanding the different types of scars and how such scars develop is an important part of knowing what to do about them.  Most people, if not all, do not want scars, especially on the face and other visible parts of our body.  When a scar heals well, a fine line will be the result with a smooth contour.  Then, the scar may fade with time, which may take many years, to become inconspicuous.

When a scar is noticeable, the scar is wide or thick and raised with a reddish or darker pigment.  When there are contour irregularities caused by the scar, this makes the scar more obvious.

The best way to understand scars is by going over some basic questions.

1)  What is a keloid?   A keloid is an abnormal thick, raised scar that mushroom out from the surface of your skin.  The scar goes beyond the edges of the scar that makes it much larger.  Common areas to develop a keloid scar are the earlobe (triggered by ear piercing) and chest.  Do not confuse a hypertrophic scar (described next) for a keloid.  Treatment of keloid include injection of steroids and surgical removal with postoperative radiation treatment.

2)  What is a hypertrophic scar?  A hypertrophic scar is the most common form of bad looking scars.  A hypertrophic scar is thick and raised but does not mushroom beyond its borders the way that a keloid does.  Hypertrophic scars can occur from traumatic cuts and scrapes and surgical operations.  It is common to see hypertrophic scars on the shoulder, chest, and back and less common to see hypertrophic scars in the face.  A hypertrophic scar may turn into a flat and wide scar.  This usually occurs if a person develops a hypertrophic scar after an operation early on.  If the thick, raised scar softens after a year, a flat but wide scar may be the final result.  Treatment for hypertrophic scars depends on how the hypertrophic scar originally developed.  If the hypertrophic scar is from a traumatic injury or poor surgical technique, then a procedure to remove the hypertrophic scar is recommended.  However, if the hypertrophic scar is in a location where the hypertrophic scar is likely to form again, then the risk of recurrence of the hypertrophic scar has to be factored into deciding whether or not to revise the scar.

3)  What is a wide scar?  A wide scar is any scar that is wider than a fine line of a scar.   It can be a couple of millimeters or a centimeter or greater.  This can occur after an operation, especially when the wound is closed under a great degree of tension or in areas that create tension (like the knee or upper lip).  It also can occur from a cut that has been repaired with only external sutures.  Revision of a wide scar is recommended because the outcome is predictably good and the risk of recurrence of the wide scar is very low, that is, if the operative technique is done properly.

4)  How do I prevent scars from forming?  There is no way to prevent a scar from forming once you have a deep cut on the skin from trauma or an operation.  The best possible outcome is a fine line of a scar that fades over many years to blend in with your normal skin.  Certain areas like the face, palmar surface of your hands, and breasts will do better than other areas, such as the chest, shoulder and back.

5)  How do I prevent a scar from turning into a hypertrophic or wide scar?  Hopefully, your body will create a good scar as a natural response to an operation or injury.  In general, the scar becomes fully mature (meaning that it has returned to a normal condition) after one year.  That is why plastic surgeons like to wait a year before deciding on performing another operation in the same location.  Surgical technique, suture choice and release of tension are all important factors that only a high quality surgeon would be able to control.  If there is any suggestion of a thickening of a scar after an operation or repair of a laceration, a silicone gel may be applied to help prevent or reduce formation of a hypertrophic scar.  This should be under the direction of a plastic surgeon or dermatologist for optimal results.   Sometimes, there is nothing that will prevent a wide or hypertrophic scar or keloid from forming because this is the way your body responds to healing a wound.

6)  What about burn scars?  Some areas are thick and other areas are not.  Why?  When you get burned, let’s say by scalding hot water, the depth of burn will determine how your body will scar.  The deeper the burn, the more likely you will develop a hypertrophic scar.  Whenever you get a burn, the most important treatment is to cool the area of burn as fast as possible and then seek medical treatment.  If the burns are extensive, this will require hospital care at a burn intensive care unit.  Please go to the burn reconstruction section on this website for more information.

The Natural Look

The Natural Look for scars can only be achieved with a proper understanding of the human anatomy and a treatment algorithm that is used to target each different problem in a harmonious way. Dr. Kim is a board certified plastic surgeon, who has developed a thoughtful algorithm to treat scars.  Dr. Kim serves the Manhattan communities of West Village, Greenwich Village, Soho, Gramercy, Union Square, East Village, Lower East Side, Tribeca, Bronx, Brooklyn, Queens, Long Island, Staten Island, as well as Westchester county and Greenwich, CT.