Most of us have at least a few scars – some with an interesting back story, some from routine surgeries like appendectomies. These scars often fade away within 18 months, but some people have problems with red, raised and stiff scars, known as keloid scars.
These can be unsightly and even painful and some keloid scars carry on spreading long after the wound has healed. Up until recently, surgeons outside the plastic surgery field didn’t pay much attention to scarring, but now they are offering help and advice to make sure their patients feel happy and comfortable with the results of their surgery.
Scars may fade even further
Previously, surgical patients were often sent home with some antibiotic cream and told not to scratch, but patients now have more options to reduce and even prevent scars.
How are scars formed?
If a wound reaches the dermis, the lower layers of the skin, it’ll leave a scar, but the severity of the mark depends on how well the skin repairs and how the collagen behaves.
Collagen is a fibrous protein that ideally should arrange itself in a criss-cross pattern. With successful healing, the skin around the wound edges closes together with the help of collagen and it forms a flat, thin, smooth appearance. With efficient healing, scarring can take 18 months to finish and to stabilise, losing colour and bumpiness.
However, sometimes fibroblasts – cells responsible for repairing the skin – go overboard and a new set of blood vessels forms, which feeds the scar. This sets off extra collagen production, which instead of criss-crossing neatly, lays itself down in thick, parallel lines, gluing layers of tissue together and forming rigid bumps.
How to help scarring go to plan
Silicone is available as a gel, a spray or as a sheet and it keeps the wound moist, stopping it from becoming rigid; many plastic surgeons prefer to use a spray that dries in minutes to become breathable, flexible and invisible. Many surgeons recommend it for preventing keloid scars and it should be applied as soon as the wound is healed. If you have a breast reduction you should ask about silicon scar treatments, especially if you’re at risk from keloid scarring.
Cortisone cream or tape
Cortisone calms down the fibroblasts and also softens the scar. This treatment works best when scars are less than six months old. Creams are the cheaper option, with tape acting as a slow-release delivery system.
Why do some people get keloids
It’s not fully understood, but factors like genetic predisposition, poor cutting technique and the location of the incision are important. In keloid scarring, the collagen escapes beyond the actual wound, getting into healthy tissue and even continuing to grow after healing. Keloids are 15 times more likely in people with dark skin, although fair-skinned red-haired Celtic people get them more often too.
Age is also a factor, with people under 30 sometimes “over-repairing” injuries.
The shoulders, chest, back and ear lobes are particularly keloid-prone, as well as the skin over moving joints.
If you’re worried
Talk to your surgeon before the procedure and explain how important the appearance of the scar is to you, especially if you’re having plastic surgery.