What are Scars?
Scars are areas of fibrous tissue (fibrosis) that replace normal skin after injury. They form as part of the body's natural wound-healing process. However, sometimes this process goes wrong and forms hypertrophic or keloid scars. Hypertrophic scars are red, raised unsightly scars, within the boundary of the initial injury. Conversely, keloid scars do extend beyond the boundaries of the original tissue injury. Keloids become progressively larger (like a benign growth), forming large hard lumps of scar tissue that can be itchy, painful and very distressing. Other forms of abnormal scars include atrophic scars, in which the scar tissue is thinner than normal, forming an indentation in the surrounding tissue. Common examples include acne scars and stretched scars where there is abnormal widening and thinning of the scar.
Why choose Centre Of Dental Excellence?
All Centre Of Dental Excellence doctors have years of experience in assessing and treating scarring-stanmore. Our knowledge allows us to avoid complications and achieve significant improvements in scar symptoms and appearance. We use only the best quality products and will advise you through every step of the treatment pathway. Your skin and your health is our priority.
The science of Scarring:
The scientific definition of a hypertrophic scar is any elevated scar that remains within the boundaries of the original injury, whereas a keloid scar grows outside the original wound borders. Both conditions are remarkable for overproduction of all components of the extracellular matrix –essentially the scaffolding of the cell. Any factor that affects the time to complete wound-healing, e.g. infection, wound breakdown, other medical conditions, increases the risk of hypertrophic scar formation. With keloid scars, the precise cause remains unknown; genetics, ethnicity, family history and hormones have all been linked with keloid formation.
With all wound-healing and scarring, it is important to appreciate that normal wound-healing is a long process, taking up to 2 years for the final scar to be formed. Wounds strength reaches its maximum at 6 weeks post-injury, but this is at best still only 80% of normal skin strength, hence the risk of scar stretching, especially across joints. It must be remembered that all scars are permanent – treatment can improve their appearance but they will never go away completely. There is significant scar variation between people, and, within each individual, the anatomical site of a scar can significantly affect how the scar develops.
Generally, the longer a wound takes to heal, the more significant the scarring-stanmore. Over the first 18-24 months, non surgical measures are the mainstay of scar management.
How can scars be managed?
Time is often all that is required. Scars that are initially lumpy and red can mature in 18 -24 months into barely visible thin white linear scars.
Twice daily firm, circular massage of scars is thought to aid in re-orientating the collagen fibres, speeding scar remodelling. There is no evidence that any single cream or oil is better than any other – it is purely the massage technique that is important.
There are many silicone gels and sheets available. Their mechanism of action is unknown and their impact varies between individuals – some people will get significant benefit whereas others will have no response at all. Silicone products can be used to treat hypertophic scars, or on recent, immature scars as a preventative measure agains hypertrophy. When stored in the fridge and then applied to the scarred area, they can also help to sooth pain, itching and irritation. The sheets can be applied continuously over the scar, whereas the gels have the additional benefit of combination with massage therapy. Again, there is no evidence to date that any silicone preparation is clinically better than another.
Pressure garments may have a role in speeding scar maturation. They can often offer a good way of hiding a scar, but they can also be impractical and uncomfortable.
Antihistamines may be prescribed to try to counteract itchy scars – there are many types and patient responses vary. Piriton is the first choice for itchy scars – if this does not work it may be worth trying other available antihistamines.
Steroid injections should not be considered until a scar has matured. Injections are performed every 6-8 weeks until symptoms have settled, and before the side effects of hypo-pigmentation, scar depression, atrophy, or opaque white steroid deposits occur. Injections can be performed without anaesthetic, under local anaesthetic or with topical anaesthetic cream. Steroids are often also beneficial in relieving itching and tingling scar sensations.
Camouflage make-up is an excellent option for disguising scars. It can be extremely helpful throughout the scar healing process, allowing patients to cope better socially. Although make-up will not improve the wound healing process, it can allow people to manage the time required to allow a scar to fully heal (up to 24 months) before considering the need for more invasive treatments.
Scar revision is should be used as a last resort and should not be performed any earlier than 18 months post the initial injury. Scar revision can be performed under local anaesthetic. The best possible result that can be achieved is to remove hypertrophic or keloid scars with the hope that the future scar will heal better. It is impossible to eliminate a scar; it is only possible to improve its appearance.
For scars that are very depressed, tethered or atrophic, fillers can be used to fill out the scar by injecting filler under the scarred skin. This can be a very effective method to improve the scar contour.
For acne scarring on the face and trunk, peels can be a good option to reduce the appearance of scars and improve the overall skin quality.
Things to consider…
It is important to manage your expectation during scar treatments. It is never possible to eliminate the scar completely. It is only possible to improve the appearance and address scar symptoms. Time and patience are key.
Most of the treatments used in scarring have minimal or no side effects. However, the more invasive treatments do have recognised side effects which cannot always be prevented – however, we are fully trained to recognise and treat any issues early and safely.
What our Patients Say
"I would recommend this practice to friends or family. I was treated with dignity and respect by staff at the practice at all times. I was treated very well and the procedure to be carried was fully explained to me as was the cost. I would recommend this practice to everyone. Wonderful service and treatment."
- John Langton -