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Scars are the body’s reaction to healing skin. Unfortunately, when injuries occur, the size, shape, and location of wounds are unpredictable. Wounds heal by laying down scar tissue. Scars affect appearance, can limit movement of a joint, may retard growth of a child, and may be painful, bleed or ulcerate. Scars that cause functional impairment are almost always revised. Physicians are unable to consistently predict how a patient will heal for a given injury.
The skin of persons of ethnic descent, Blacks, Hispanics, Asians, and Mediterranean, has a higher likelihood of healing with hyperpigmentation. Caucasian skin tends to heal with hypopigmentation. Keloids are seen in all races, but are more common in darker-skinned individuals. Keloid scars are abnormal scars that grow beyond the boundaries of the injury. For example, a simple ear piercing may lead to a marble size keloid. Keloid scars are difficult to treat and are many times misdiagnosed by physicians and patients.
When a surgeon performs a cosmetic procedure, scars are placed in locations that are cosmetically acceptable. Most physicians would not recommend scar revision for a minimum of six months to one year after the initial injury or surgery. In addition to the expertise of the surgeon in limiting scarring, other factors such as size, location, shape, age of the patient, and healing ability play a role in the final result. Even with scar revision, which can be performed by several techniques, the resulting scar may be better, worse, or the same. Therefore, it is important to revise only those scars that are cosmetically unacceptable and have a high probability of improvement. With appropriate wound care, a scar revision will continue to heal and look its best one to two years post injury.
Non-surgical treatments of scars include laser treatment, sun avoidance, vitamin E, steroid applications, steroid injections, or the use of silastic gel sheeting.
It is the public’s misperception that plastic surgeons operate without producing scars. Plastic surgeons are specialized surgeons who are trained in wound closure techniques to minimize scarring. Where appropriate, plastic surgeons place scars in locations or directions that are likely to result in the best possible scar.
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