Scar Correction

Anytime when the skin gets in contact with objects that injures it, cell damages occur, smaller or bigger, which, either will hea lwithout leaving any sign, or will leave a scar. The scars vary as shape, color, size, appearance,consistency, elasticity, etc.

The scarring process is represented by the stage sequencethat the skin follows, from the actual injury until the formation of the finalscar. This time frame varies based on many factors, out of which the mostimportant are the genetic factors and the ways of wound occurrence and healing.

In general, following the acute stage that takes up to 2 weeks, when usually, the suture material is extracted also, a period of notmore than 6 months follows when the freshly formed scar reframes continuously.

This is the period when the scar is called “young” or “immature” or “in progress”. Its color is red and the appearance is usually uneven. It isalso a unique period for it could be influenced by creams, balms, specialsilicon plasters, massage, etc. After approximately 6 months, a normal scar stops fromevolution and converts to a “mature” scar or a “final” scar. The scar gets white and becomes mature. The above described correspond to the physiological scarringprocess.

There are cases when scarring does not follow the physiological track and pathological scars occur that might be:

hypertrophic (bigger as volume)
retractile (generating retractile synechia at the level of natural flexion folds)
depressive (lack of volume)
hyperchromatic (colored in excess, hyperpigmented)
keloid (pathological scars very voluminous, looking like tumors), etc.

The treatments for scars are the following:

non-surgical(apply to immature scars): endermologicmassage, application of creams or special balms, application of silicone plasters, chemical peeling, medical tattoo, needling, etc.
surgical (usually applied to final scars): repeated excisionand direct suture, serial excisions, use of various crossed flaps in case of retractile scars, use of expanders to obtain skin excess, etc.

A particular category is represented by mature hypertrophic scars for which a reactivation of the remodeling process is needed. This could be obtained through injection of cortisone products such as triamcinolon acetonide. The scar reactivates, becomes red again and gets an increased volume.

This is the time to apply all non-surgical therapies to guidethe healing to a better result in aesthetical terms.

Surgical practices:

repeated excision and direct suture apply to scarringneedles that don't comply anymore with the aesthetic requirements that we wantand for which your specialist could warranty a better aesthetic result. Not all scars could actually benefit of such correction.

Once again we must specifythat the appearance of a scar depends in great measure of incision's accuracy,of suture's type, of the type of threat used and on the surgeon's hand, although it dependsa lot on the way each one of us “scars it”.

At the same time, the aspect of a scar also depends on theincision path. These must follow the force lines which are physiological atsome levels of the tegument. Any scar arranged perpendicularly to these forcelines will heal badly and will get wider in time.
serial excisionis the practice through which a big scar covering a large surface of skin is gradually excised portion by portion within few month, in such way that these gets smaller step by step. Note that there is no practice for complete removal of the scars. Even in case of these serial excisions the scar cannot be permanently excised. Although per total the appearance is well improved.
in case of retractile scars occurring specially following serious burns, it is required to make some tricks regarding incisions and their excision, meaning to make the incision by creating some crossed flaps, in such manner that we obtain a relaxation at the level of these retractile synechia.
This is appanage of the reconstructive plastic surgery and brings major benefits, specially functional, as well as aesthetic.
the use of the practice based on tissue expansion means using some silicone implants (expansion) which are inserted under the healthy skin in the immediate proximity of the scar area and left in position for few weeks, but not more than 3 months.

These will be filed-in weekly with physiological serum to obtain a “skin in excess”. When the specialist decides it has enough skin to cover the scar area, the second procedure takes place during which the expander is removed with the scar, and the skin in excess is used to cover the post-excision defect.

The results could be very good specially if before the surgery the best locations for expander insertion are chosen, in such way that all scar lines, older or newer, are minimized.

However, sometimes it is required to insert many small expanders in such way that the scar line is “pushed” to a less visible area.