Operations and injuries that cause scarring

Operations and injuries that cause scarring

Alarplasty Scar

alarplasty.jpgWhen alaraplasty is performed the incisions are placed in the crease where the nostril wall meets the cheek. Alarplasty scars tend to stay slightly red/pink for the first month or two depending upon skin type and coloration. The alarplasty scars generally heal very well and are not noticeable after that time.

Burn Scar

burn2.jpgA non-superficial burn (e.g. the deep partial thickness and full thickness burns) will always result in a burn scar. The scar’s severity will depend on the wound’s thickness as well as other factors, such as site of the scar, its healing process, age, sex, race of the patient, etc.

Burn scars may lead to three different types of abnormal scarring:  keloid scars, hypertrophic scars, and scar contractures. Keloid scars are an overgrowth of scar tissue with the scar growing beyond the site of the injury. These scars are generally red or pink and will become dark over time. Hypertrophic scars are red, thick and raised, however they differ from keloid scars in that they do not develop beyond the site of the injury or incision. A contracture scar is a permanent tightening of the skin that may affect the underlying muscles and tendons, limit mobility and possibly lead to damage or degeneration of the nerves.

To prevent abnormal scar tissue International Clinical Recommendations on Scar Management recommend treatment of widespread burn scars with a first-line therapy of silicone gel sheeting and pressure garments.

Cesarean Section (C-Section) Scar

csection.jpgIn a cesarean birth (C-section), the baby is delivered through an incision in the mother's abdomen and uterus (womb). The size of your C-section scar will depend on several factors: size and position of the baby, whether the C-section was planned or not, etc. Generally, the C-section scar is around 4-6 inches (10-15 cm) long and 1/8 inch (0.3 cm) wide.

Usually the “bikini cut” incision is used but sometimes the “classical” incision will be made vertically from just below the belly button (naval) to just above the pubic bone. To close the wound, some surgeons prefer to use staples whereas others still use suture; there is little statistical evidence to show that one way or another will increase or decrease the size or the appearance of the scar.

Initially, the C-section scar will be red, raised and could itch. After the wound is closed you should start using Strataderm to make the scar softer, flatter and smoother and to relieve itching. The majority of women will develop "mature" C-section scars by the sixth month after delivery. If you have darker skin and/or are prone to keloids you should consult a physician before the C-Section.

Acne Scars

acne.jpgAcne is the most common skin disorder, affecting around 15% of the adult population and up to 80% of adolescents. Facial scarring because of acne occurs to some degree in most cases. The majority acne scars are flat and depressed below the surrounding skin, generally small and often round with an indented or inverted centre. To prevent scars, do not pop, squeeze, or pick at acne; do not pull scabs of acne; seek treatment early for acne that does not respond to OTC medications.

Types of Acne Scars:

  • red and/or hyperpigmented marks, a post-inflammatory change that usually disappears in 6-12 months
  • acne scars – icepick: depressed scars, deep, narrow and sharp; usually too deep for dermabrasion or laser skin resurfacing
  • acne scars – boxcar: depressed scars, round with sharp edges
  • rolling acne scars: depressed scars, wavy texture in the skin
  • keloids and hypertrophic scars are raised acne scars that may become larger and more noticeable, sometimes painful and itchy. 

Silicone is effective for treatment of acne scars and prevention of keloids and hypertrophic scars. Other effective treatments for depressed acne scars include laser skin resurfacing, dermabrasion, scar surgery (punch excision, punch elevation, punch graft, subcutaneous incision), fillers, chemical peel, microdermabrasion and similar procedures that you should discuss with your dermatologist. For raised acne scars, like keloid and hypertrophic scars, your doctor might consider options like intralesional injections, cryotherapy, surgery, laser and light therapy. Your dermatologist will be able to create a treatment plan based on the type of your acne acne scars, results you can expect, and your medical history.

Keloid Scars

keloid.jpgWhen your wound starts to heal the body produces more collagen which gathers around the damaged tissue and seals it. However, in keloid scars the collagen production doesn’t stop and the scar extends beyond the borders of the original wound in the form of dense fibrous tissue.

Keloid scars are raised and range in consistency from soft and doughy to hard and rubbery. They can appear anywhere on the body although they usually form in the area of shoulders, cheeks, earlobes and neck area. Burn scars or infected lesions, including acne, are more likely to form keloids. Keloid scars sometimes itch and may be painful. Keloid scars are 15 times more likely to occur in darker-skinned individuals, may be familial, and tend to develop more readily during and after puberty.

While keloid scars are difficult to treat, combination treatments seem to be the most effective. International Clinical Recommendations on Scar Management highlight a primary role for silicone and intralesional corticosteroids in the management of a wide variety of abnormal scars including keloids. Silicone is also recommended as first-line prophylaxis for keloid scars. Other options include surgery (high risk of recurrence), radiotherapy, cryotherapy, and laser.

If your skin is keloid prone, you should avoid piercings, tattoo and any unnecessary incisions, such as plastic surgery. You should treat acne thoroughly to reduce lesions and potential for scarring or, if surgery is necessary, silicone may be combined with intralesional steroids or other treatments (above) to reduce the likelihood or size of keloid scarring.

Breast augmentation scars

breast.jpgThe scar will usually depend on the type of incision used:

Inframammary incision, placed in the proximity of the crease where the breast and chest come together, is probably the most common breast augmentation incision used today. The incision is located to secure proper placement of the implant, but also to reduce the scar visibility. Scarring from properly located inframammary incisions should be easily hidden under a swimsuit top.

A periareolar incision (nipple incision) is placed along the outline of the areola, or the brown or pink pigmented region surrounding the nipple. The goal of the incision is to place it in the transition area between the dark areola and surrounding breast skin where it can be hidden. One advantage of the procedure is that there may be no visible scar, because of the color and texture characteristics of the areola border. In some cases, a scar may be visible. This scar tends to heal well, concealing it from easy detection.

Transaxillary incisions utilize one of the breast implants incision sites that involve no cutting of the breasts. Instead, the transaxillary breast augmentation incision allows breast implants to be inserted through the armpit. There is no scar on the breast and the armpit scar is not visible.

Rhinoplasty scar

rhino.jpgNasal surgery can change your nose by reshaping the underlying cartilage and bone. Most of the incisions are made internally and scars will not be visible. If you have an open procedure, you will have a small scar on the base of your nose, between the nostrils. This is usually not noticeable upon normal observation. Complications (including a visible scar) are rare.

 

Eyelid Surgery (Blepharoplasty) Scar

eyelid-surgery.jpgMost upper eyelid scars heal very well. Sometimes, if more skin is removed, there can be a noticeable transition between thicker skin of the upper part of the lid and the thinner skin of the lower part of the lid.

 

 

Dog Bite Scar

dogbite.jpgDog bites can be complicated with deep punctures and some tissue shredding dependent upon the type of dog. Minor cuts generally only require a thorough cleaning and bandaging of the wound. However, if infection is suspected, it is important to immediately contact a doctor who can provide the dog bite treatment needed. Signs of infection may include redness, swelling, red streaking, and fever. Seeking proper dog bite treatment is crucial to patient recovery. Other reasons to seek medical care include: a gaping wound, a wound that does not stop bleeding, open wounds on the face. Some of these are best treated with scar revision plus or minus tissue expansion.