Plastic surgery treatment of scars

Different types of scars need different treatments; some of these include cosmetic scar revision surgery, others are with lasers and others still by applications or injections of medicines to help the scar change its healing behavior.
A “bad” scar is in effect a scar that has not healed in a normal manner. It has had a disruption of normal healing due to either genetic factors due to the patient’s skin type or external factors such as trauma or tension on the wound.
Some of the more common methods of treatment are discussed here. Bear in mind one thing: we really do not understand what is going on in wound healing and scar formation. Medical knowledge in this area is feeble, and no matter what treatment or combination of treatments is used, recurrence of a “bad” scar is common and can occur in up to 70% of treatments.

Silicone cream and sheeting for scars

For over 40 years, silicone has been the mainstay of treatment for hypertrophic scars and keloids, especially in burn patients. Recently it has become available in a cream form and should be used as a matter of routine in all patients after cosmetic plastic surgery unless they have a silicone allergy.

Plastic surgical excision of scars

All scars can be excised and re-closed. This is usually an effective treatment. There are a number of ways to cut and revise the scar depending on its location. These include W-plasty (scar cut out and closed in repeating W shapes),and  Z-plasty (scar cut in a z shape and re-closed to alter direction of the scar).

Lasers for scars

Some scars can be improved by the use of CO2 cosmetic lasers if they are too thick. The laser will flatten the scars. Red or brown scars can be improved by special cosmetic lasers also.

Steroid injections for scars

Steroids will calm down the increased activity within hypertrophic and keloid scars. They are injected on a monthly basis for three months directly into the scar. The downside is that it sometimes does not work, and also that it can lead to atrophic (wide and thin) scars.

5-flurouracil injections for scars

5FU is an early cancer drug that has been shown to decrease the rate of scar creation. It is injected into the scar every few weeks for three to four months.

Radiation for scar therapy

Although this technique has been used historically, the side effects of radiation on the skin can be far worse than the scar. I would use this in only very selective cases, and in over 20 years of cosmetic surgery have never used it yet!
I always tell my patients that when a doctor tells you there are many ways to improve something, no single way is the best. With cosmetic scar revisions, a combination of treatment will give the best result, but remember, it’s not magic.

Botulinum toxin

The latest on scars as of 2020 is the use of Botulinum toxin injections on the scars. These injections seem to modulate the effects of fibroblasts on the scar and lead to a better result .

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