KELOIDS AND SCARS
Almost everyone has one or even more scars to remember. Even an injury that heals well can result in an unsightly scar. Now, imagine the one that has a bad evolution as a keloid (exaggerated growth and hardened due to the large production of collagen) or hypertrophic (thickened due to the disarrangement of collagen fibers)?
Besides the body, some external factors can directly influence the appearance of a scar. Age group, for example, the older you are, the slower and worse the scarring process is, leaving more marks. Depending on the part of the body – for example, knees, elbows, back and chest – the scar may worsen if they are places of more movement and effort. Incidence of sun can darken it. Consumption of sugary foods, nutritional status, the existence of chronic diseases, some medications, hormonal changes, smoking, obesity, among others, can also lead to poor scarring.
WHAT IT IS AND HOW IT IS DONE
The skin is the largest organ in the body and, after some injury, the body starts the repair process, replacing the injured tissue with new tissue. We call this process cutaneous scarring and each organism reacts in a different way, for example, to an acne or a surgical incision or a burn.
The ideal cutaneous scarring is when one side of the skin joins the other and leaves only a scratch or a very discrete, almost imperceptible spot. However, some scars have defects in their formation and can present the following aspects:
Keloids – These are hardened scars that have a growth above normal, due to a large amount of thicker, disorganized collagen bundles that extend beyond the edges of an incision or injury or wound. They can also appear spontaneously, hurt, and itch. Clinically, keloids are firm, smooth, shiny, and slightly pinkish or hyperpigmented (darker in color than the surrounding skin). Although they can develop anywhere on the body, they occur most where there is little underlying fat tissue, such as on the face, neck, ears, chest, shoulders, and upper limbs. They commonly have a genetic predisposition and are more frequent in people with darker skin.
Hypertrophic – These are thick clusters of scar tissue composed of striated bundles of collagen that develop directly at the site of scarring, aligned in the same plane as the epidermis. They are most often elevated, but remain within the limits of the lesion. They can be hyperpigmented or hypopigmented (lighter in color) in relation to the surrounding skin. Hypertrophic scars that do not regress spontaneously cause discomfort, mainly because they can become larger over time. They can occur anywhere on the body.
Atrophic – These scars become deeper in relation to the relief of the surrounding skin. They result from any type of trauma where there is loss of tissues and structures that support the skin, such as muscle and fat, leaving a kind of hole in the skin. In addition to surgical incisions and accidents, atrophic scars are often associated with acne, chickenpox, and other skin diseases. They can occur anywhere on the body.
Contractures – Also known as retracted, these occur when a large amount of tissue is lost, for example, after a burn. They are scars that restrict movement due to the approximation of the surrounding skin and underlying tissue during scarring. When contractures form where the injury joins the joints in addition to the skin itself, it restricts movement of fingers, elbows, knees, and neck, for example.
Keloid and Scar correction is performed to improve the condition or appearance of a scar anywhere on the body. It is worth pointing out that although these options can provide very pleasing aesthetic results, a scar cannot be completely erased. The goal is to make the scar as uniform as possible with the surrounding skin tone and texture, discrete, flat, and with good movement. The correction options are:
Simple topical treatments – Whitening creams, corticoid creams to reduce the volume (indicated for keloid or hypertrophic scars) and those made with silicone plates, tapes or compressive bandages. Massages with special products and vacuum treatments can also be recommended to “loosen” the scar.
Minimally invasive procedures – They can have good results for improving the appearance of lighter scars, smoothing surface irregularities, or reducing uneven pigmentation of the skin color. Surface procedures are a controlled means of mechanically removing the top layers of the skin or altering the nature of the tissue. These include chemical peeling, dermabrasion or microdermabrasion, laser, radiofrequency, ultrasound, carboxitherapy, and others.
Fillers – Injectable therapies are often used to improve the appearance of atrophic or depressed scars. They are done by filling injectable substances – hyaluronic acid, polymethylmethacrylate, or autogenous fat – under the scar, so as to make it smoother and at the same height as the surrounding skin. In hypertrophic scars, injections of corticoids can be made to decrease the formation of collagen and reduce its size and thickening. Depending on the substance and the condition of the scar, the results can last from 3 months to several years.
Plastic surgeries – When the above options fail to successfully correct the scars, then surgical approaches may be indicated. This is the case for some scars that require layered closure, used where the incision extends into tissue, below the skin surface or in areas and joints with a high degree of movement. The first stage, or layer, requires subcutaneous closure (below the skin’s surface) with absorbable or non-removable sutures, and in the final stage we suture the epidermis and do the dressings.
We can use surgical techniques that use cutting, removal or reorientation of parts of the affected skin. One of them is the flap where we use a segment of skin and subcutaneous tissue with its own vascular supply extracted from a donor area. It is indicated to reposition a scar so that it is less visible or to improve flexibility where the contracture restricts movement.
In another technique, tissue expansion is planned through an inflatable balloon that is placed under the skin near the scar site. Over time, the balloon is slowly filled with sterile solution to expand the area of healthy skin. Once the skin has been sufficiently stretched, the expander and scar are removed and the stretched skin is moved to replace the scar tissue.
Pharmaceutical tissue substitutes can be used if healthy tissue is not present to close a scar excision, most likely with the correction of severe burn scars.
Planned results may take several months to become apparent and heal completely, as for all cases of Keloid and Scar correction, repeat or other treatments, procedures or surgeries may be recommended. These can be done in the doctor’s office or in hospitals with the whole structure and the options include from local to general anesthesia, whatever is best for the patient. Although good results are expected, there is no guarantee. With success, the skin creates a scar that is much more discreet than the previous one, leaving the skin more uniform.
INDICATION
Keloid and Scar correction is a highly individualized therapy and is indicated to people of any age who are bothered by the appearance of their scarred skin, the result of a malformation or that looks aesthetically bad or that causes (or not) movement problems.
People who have positive outlooks and realistic expectations about treatment options, procedures, fillers, and plastic surgery, are physically healthy, and do not have active acne or other skin diseases in the area to be treated are the ones who can most benefit from correcting irregularities in skin texture, size, or color.
PRE AND POSTOPERATIVE
This is the typical case in which what will determine the pre and post-surgery actions is the type of Keloid and Scar correction. If the plastic surgery is indicated, it is very important to consult the page SCHEDULED THE SURGERY? which has a series of questions for us to talk about during the consultations, to help you with your doubts, and where you will find recommendations for the day of the procedure.
We follow your case and pass on all the information such as: how they are treated, where the procedure is performed, what the recovery time is, what the associated risks and complications are.
We recommend from the medications, dressings, the type of help you will need, release to return to routine and even to exercise.