Any time you break your skin there is a potential to develop tissue on the healed wound that wasn’t there before. This tissue is a scar. In the care of my patients who’ve had any injury or surgery, my goal is to have the skin look as though there is no apparent scar. The best scenario would be that the patient heals so cleanly that no one else would know the skin had ever been broken.
There are things you can do to minimize scarring such as treating a wound with hydrogen peroxide, keeping it moist with petroleum jelly, and using an adhesive bandage. That said, everybody has a different way to heal. Even if you do everything correctly, my experience has taught me that some patients heal very well and others heal abnormally.
There are two types of abnormal scarring: hypertrophic and keloid. A hypertrophic scar is a firm, raised scar limited only to the incision site. It’s more common on certain areas of the body such as the chest, neck, back, and shoulder. A keloid scar is very firm and, while it can grow anywhere on the body, usually appears on the chest, back, shoulders, and ears in darker skin. It will grow beyond the border of the injury like a tumor and may appear similar to a cauliflower.
There are ways to treat both types of scars. A hypertrophic scar will soften and usually flatten over time, but it can be reduced in size by steroid injections, such as triamcinolone, a simple and very effective treatment. Another simple treatment is dermabrasion, which “sands” the skin to hide the scar line. It’s best done when a wound is fully healed and does not have any abnormal scarring. On the other hand, a keloid scar requires a lot of attention, as it’s very difficult to get rid of this scar tumor. Like a hypertrophic scar you can inject a keloid scar with triamcinolone. Other options include injection with a chemotherapy agent like bleomycin or 5FU, use of a topical cream such as imiquimod, or exposure to radiation therapy (usually immediately after incision). Unfortunately, none of these treatments is definitively effective individually, and even when combined together, there is a high rate of keloid recurrence.
When patients undergo surgery, much care is taken by the physician to minimize scarring. In time, most scars become less red and less elevated, and eventually appear white and smooth. Scar tissue is not like normal skin tissue. It lacks hair follicles, pigment, and a rich supply of blood vessels.
When it comes to scarring, there are some things that are out of your hands. Some individuals have a genetic disposition for keloid scars. People with darker skin or of Asian, Hispanic, or African American descent seem to have a greater likelihood of developing a keloid scar. Where the scar is located on your body also contributes to how it develops. Hypertrophic scars will be bigger and thicker if they occur in areas with high movement and skin tension.
There are some things you can control, however, that will minimize scarring. As I mentioned earlier, keep the wound covered and moist during the healing process. I also recommend that you
- Choose the right doctor. Look for a doctor who has experience in different surgical techniques, as this will affect the size of your scar.
- Support healing. Don’t smoke, do eat well, and do supplement your diet with Vitamin C and zinc, since these are involved in wound repair.
- Follow up with your doctor. He or she can determine if you are indeed developing an abnormal scar response.
I had a patient who had an irregular scar on the cheek. I was able to recommend dermabrasion. The procedure took only 3 minutes, but the results were great and the patient was very pleased. There was no apparent scar visible after the area healed. Without this simple treatment, my patient would have had a slightly apparent scar on the cheek. Instead, the scar is now imperceptible and we are both incredibly pleased.