Whenever the skin comes into contact with objects and it is injured, smaller or larger cellular destructions occur, which will heal without a trace or will leave a scar.
Scars vary in shape, color, size, appearance, texture, elasticity etc. The healing process is the sequence of steps that through which the skin goes from injury to definitive scar formation. This time varies depending on many factors, among which the most important are genetic factors and modes of production and wound healing.
Usually, after the acute phase that lasts up to 2 weeks, during which usually the suture material is extracted, up to six months following is a period in which the newly formed scar evolves continuously. It is the period in which the scar is called "young " or "immature" or "evolving".
It has a reddish coloration and appearance is usually uneven. It is also the only time it can be influenced by creams, ointments, patches, especially silicon, massage etc.
After about 6 months a normal scar stops evolving and it will turn into a "mature" or "final" scar . The scar turns white and becomes uniform.
Described above is the physiological healing process. There are cases when scarring does not follow the physiological path and pathological scarring can occur:
- Hypertrophic (greater volume)
- retractile (retractable clamps produce the natural flexion creases)
- depression (lack of volume)
- hyperchromic (colored in excess hyperpigmented)
- keloid (very bulky pathological scars appear like tumors) etc.
Methods of scar treatment are:
- nonsurgical (for immature scars) - endermologic massage, special applications of creams or ointments, applying patches with silicone, chemical peeling, medical tatooing, subscision etc.
- surgical (for final scars) - reexcizia and direct scar suture, serial excision, use of various folded flaps for retractile scars etc.
A special category is composed by the mature hypertrophic scars for which a reactivation of the remodeling process is desired. This can be achieved by injecting cortisone products such as triamcinolone acetonide.
The scar is reactivated and it becomes reddish and increased in volume again. During this time non-surgical therapies can be applied for a better healing result in terms of aesthetics.
- reexcision and direct scar suture applies to those who do not meet their aesthetic criteria and for whom their specialist can guarantee a better aesthetic result. Not all scars may benefit from such a treatment. It must be specified again that the appearance of a scar depends to a great extent on the accuracy of the cuts, the way the suture is done, the type of yarn used and the surgeons skill, but it depends also a lot on the way each of us "scars".
The appearance of a scar depends also on the path of the cuts. The cuts must follow the physiological force lines that are at various levels of the skin. Any scar disposed perpendicular to these lines of force will heal poorly and will grow wider in time.
- The serial excision is the method by which a large scar covering a large area of skin is excised at intervals of a few months a portion so it shrinks with each step. It must be mentioned that there is no method to completely removal the scar. Even if these serial excisions can not excise the scar permanently, the overall look will greatly improve.
- In the case of retractile scars that occur espacially after severe burns, special “tricks” are required in terms of their incisions and excision, namely the creation of folded flaps, so that we can get a retractable seating for these clamps. It is the prerogative of plastic reconstructive surgery and it brings major benefits, especially functional and aesthetic.
- using this method by means of tissue expansion requires using silicone implants (swelling) that are inserted under the healthy skin in the immediate vicinity of the scar area and left in place for a few weeks, up to three months. These implants will filled weekly with saline, thus obtaining "excess skin". When the specialist decides that he has enough skin to cover the scar, the second intervention takes place and the expander is removed, as well as the scar tissue and the excess skin is used to cover the postexcizional defect. The results can be very good especially if before the surgery the best areas for implants insertion are chosen, so that all lines minimize scarring. It takes sometimes several smaller implant insertions in order to “push” the scar line to a less visible area.
Although these treatments are very effective, 1% of the patients do not achieve the desired results!