Types of scars
Every wound, whether from an accident, a burn or an operation, heals by scarring. The process continues for up to a year: at first the scar is red and slightly raised, then it gradually becomes paler and softer. Sometimes, however, healing does not go ideally:
- Hypertrophic scars are raised and red but stay within the original wound; they often improve with time.
- Keloid scars grow beyond the edges of the wound and can come back after excision; they are more common in some people and on the earlobes, breastbone or shoulders.
- Contracted scars pull on the surrounding tissue and can limit movement, especially over joints, the neck, the hand or the eyelids.
- Widened or depressed scars are unsightly but cause no functional problems.
When to operate
Scars are usually corrected once they have matured, about 9–12 months after the injury. The exception is contracted scars that limit movement or function, which can be treated earlier.
Techniques
- Excision and layered closure: the old scar is removed and the edges are brought together carefully, without tension.
- Z- or W-plasty: changes the direction of the scar and aligns it with the natural lines of the skin, releasing the pull.
- Skin grafts or local flaps, for larger defects.
- Tissue expansion, for extensive scars: an expander placed under the healthy skin nearby stretches it gradually, and the new skin then covers the scarred area (two stages).
- Complementary treatments: corticosteroid injections, silicone gels and sheets, compression, laser or fat transfer for tethered scars.
Recovery
For simple excisions under local anaesthesia, you return to normal activity almost immediately; stitches come out after 5–14 days, depending on the area. Sun protection and the recommended care in the following months matter for the final appearance.
Risks and things to know
- the new scar also goes through all the stages of maturing;
- recurrence, especially with keloids, which is why complementary treatments are added;
- infection or the wound opening, both rare.
Results vary from one patient to another.
