Plastic surgeons are not only professionals in the treatment of wounds but are also skilled in the treatment of scars. Scars from abrasions, cuts, acne, surgery and other injuries can leave scars after they heal.
Generally, if the injury extends into the dermis, the scar will remain. The deeper the scar, the more visible it becomes and the more cosmetically problematic it becomes.
Mature Scars
The normal process of scarring is for scars to start out red and hard and over time become skin-colored to almost white, referred to as "mature scars". Mature scars are a normal part of the wound healing process of an injury and are often not covered by health insurance.
Hypertrophic Scars
Sometimes scars become red and swollen like an earthworm. This is called a "hypertrophic scar”. They may occur on deep scars, joints, the neck, and other areas that are often moved and pulled. It may take several years for the inflammation to subside.
Keloids
A condition that is more inflammatory than hypertrophic scarring is called a "keloid”. A "keloid constitution" can be problematic. It can occur casually, such as from acne or folliculitis. They often occur on the chest, shoulders, abdomen and pierced ears. There are various causes of keloids but early treatment can prevent the condition from worsening.
Scar Contractures
Scars on joints and other parts of the body can cause twitching. This is called a "scar contracture”. If functional impairment is observed, a surgery is considered.
Treatment for Scars
Conservative Therapy
Oral Medicine
Tranilast (RizabenⓇ) is considered effective. This is an anti-allergic drug that suppresses the chemical messengers of inflammatory cells produced by scars, thereby reducing itching and calming the lesions. The Chinese herbal medicine SaireitoⓇ may also be used. These are used in combination with other treatments as their effects by themselves are not strong.
Ointment
These include steroid ointments and creams such as AntebateⓇ, non-steroidal anti-inflammatory drugs and Hirudoid Soft OintmentⓇ. These are also often used in combination with other treatments.
Patches
Steroid-containing tapes are used. EclerⓇ plasters are effective for adults with thick skin. DrenisonⓇ tape or flurandrenolide is often used for children and the elderly with thin skin. Since it is applied for a long period of time, it should be used with caution to avoid rashes.
Rest and compression
Hypertrophic scars and keloids often occur in areas where the skin is pulled and makes it worse. Therefore it is important to immobilize the scar so that it can remain in a resting position. Silicone tape, surgical tape (paper), silicone gel sheets, bandages and supporters are used.
Injections
Steroids (KenacortⓇ) are injected into the scar.Reduction of redness, raised areas, itching and pain can be expected. If the effect is strong, it may reverse and cause indentation, thinning of the surrounding skin and dilation of capillaries. Women should be aware that it may cause menstrual irregularities.
Laser therapy and others
There are treatments such as laser irradiation to reduce redness and fractional laser, which applies fine holes to help skin regeneration and make it less noticeable. We use Dermapen and RF needling to achieve the same effect as fractional lasers.
BotoxⓇ injections and fat injections
BotoxⓇ has been reported to improve scarring and is used in facelift surgery. When used during scar excision, it may reduce the risk of recurrence. Similarly, there have been reports of scarring symptoms improved by taking out your own fat from your thighs, purifying it and injecting it into the scar. Fat grafting often improves skin texture as well and is expected to treat scars.
Surgical treatment
Hypertrophic scars and keloids can improve without surgery but if they become a cosmetic problem due to scar contracture or located in a prominent place, a surgery may be performed. To prevent recurrence after the surgery, plastic surgeons can reduce this risk by using different stitching techniques and postoperative radiation therapy at university hospitals, depending on the case.
Surgical Removal
Excision of a hard scar tissue under anesthesia. Stitches are raised and stitched so that tension is not applied to the scar.
Scar contracture formation
If the scar is located on a joint or neck and pulled causing functional disability, the scar may be re-sutured to divide the scar (Z-plasty, W-plasty, etc.), or a local skin graft may be used to insert a nearby normal skin into the scar. Postoperatively, it is important to keep the wound in a stable condition. Silicone tape or surgical tape is used to secure the wound and steroid tape is used to eliminate inflammation.