Improving the appearance of scars
Why should you have to feel marked?
The healing of deep skin wounds due to accidents, surgery, or burns ends with a scar. This is not typical for the skin structure of three layers – the epidermis, dermis and subcutaneous tissue, but is made up of connective cells and fibres, which in their structure and function, most resemble the dermis and are covered with a thin layer of collagen.
The connective fibres in normal skin are reasonably arranged according to the operations designated for that part of the skin. The fibres of scar tissue are randomly scattered in a criss-cross manner.
Prior to achieving its final appearance, the scar goes through several stages of maturation:
The first phase is called the inflammatory phase
It begins immediately after the injury of the tissue (or cutting of an old scar) and lasts two to six days. A blood clot closes the wound, the white cells to fight against the invasion of bacteria, binding cells begin to generate collagen fibres, mixed in a random network designed to adhere to scar together. In this phase, the wound is red, swollen, painful and warmer. If it is located above a joint, it is harder to move.
The second phase is characterized by rich growth of connective tissue
It is called the proliferation phase. It can last a week or two. The growing crowd of binding collagen fibres increases the resistance of the fresh scars against external forces of traction or tension. Blood vessels grow within the scar, bring more oxygen and glucose, which promote the growth of collagen fibres.
The edges of the wound thicken; red knotty tissue may appear, which is known as granulation tissue. It consists of young blood vessels; white blood cells that help clean the wound and bacteria. The surface of the wound is then whitish or yellowish. If there is a large number of bacteria present in the wound, it is infected. Yellowish pus flows from the wound.
The maturation phase is the final phase
Duration may be several weeks or even several years. The new collagen fibres to a lesser extent, are still emerging and are made in line with most external forces, while the old, redundant ones decompose. When the rate of formation of collagen fibres is equal to the rate of breakdown, the process of healing the wound has ended.
The scar becomes firm, gradually shrinks and becomes thinner until it is level with the rest of the skin. Fair-skinned people have pale scars; dark-skinned people have scars with more pigment than their skin has.
The shape and appearance of scars depends on several factors
Scars are always uglier, thicker and wider, when their course is different from the natural course of skin wrinkles. Children and adolescents have firmer skin and their scars are exposed to more forces that with older people with withered skin. Therefore, the risk of formation of thick scar tissue in young people is greater than in the elderly. The scars of children grow together with them until the growing process has ended. Deep burns, which were not treated with skin grafting, heal with terrible scars, which may even restrict the mobility of joints (contracture).
There are two known disorders in the maturing of scar tissue:
- A scar is hypertrophic when it becomes thick, but is still within the limits of the wound from which it arose.
- If it strongly protrudes, binds into the healthy skin and extends beyond the borders of the original wound, this is keloid.
Both disorders can cause tingling or burning pain. The final appearance of scars largely depends upon our genetic make-up and racial origin. Keloids usually affect those of African descent. In the past, many tribes deliberately created Keloids and regarded them as a permanent form of decoration.
Since the time of the German junkers, when scars from duels were something of pride, especially on the face, has passed, scars are no longer considered to be decorations in western culture.
The goal of scar repair is to improve its shape
We must emphasize that no technique can completely eliminate scars; we also cannot ensure that the final result of the treatment will be ideal, even though we perform our operations with the highest integrity, The healing of wounds does not only depend on the quality of surgical techniques. But also on the characteristics of your body. For several months, the scar may remain swollen, red, itchy and even painful.
If the direction of the scar is not correct, it can remain wide, thick and distracting. It sometimes gets stuck to the muscle or tendon and the skin is pulled when moving the limb or normal movement of the joint is prevented.
If you have a scar you would like to be consulted on, come to us for an exam. The plastic surgeon will examine you, ask what your expectations are and assess whether or not they can be met with a surgical procedure. Many scars can be repairs and we will agree on how this can be done. If we cannot change the shape of a scar, sometimes it is better to leave it there and cover it up with decorative cosmetics.
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