Any injury that penetrates the full thickness of the skin will leave a scar. This includes traumatic lacerations, burns or surgery. Scars can have a variety of appearances depending on the mechanism of injury, the location and the skin type. Scars over mobile parts of the body (eg back and shoulders) may become stretched and widened by the action of the underlying muscles. Some skin types are particularly prone to developing thick, lumpy scars called hypertrophic scars. If the lumpiness extends beyond the site of the original scar these are then called keloid scars.
It is important to realise that scars cannot be completely removed. The appearance can be improved by reducing the width, reducing the thickness / lumpiness or re-orientating the direction. Bright red scars can also be encouraged to fade making them less obvious.
The most effective way of producing good scars following trauma or surgery is to manage them appropriately during the initial healing period. This involves meticulous surgical technique when closing the wound, supporting the scar edges with paper tape for 4-6 weeks following surgery, massaging and moisturising the scar with Vitamin E preparation +/- the use of topical silicone products.
Once a scar is established, it is still possible to improve the appearance to a degree without further surgery, but the results may not be particularly dramatic. I approach these scars using a step-wise progression of treatments:
1. Scar massage and moisturising
2. Topical silicone strips or gel
3. Steroid injections
4. Surgical revision of scar +/- intraoperative steroid injection
5. Surgical revision followed by radiotherapy
For further information about scar revision
http://www.plasticsurgeryfoundation.org.au/patient-information/procedures/reconstructive-surgery/scar-revision/
