Scars are the body's reaction to healing skin. Unfortunately, when injuries occur, the size, shape, and location of wounds are unpredictable. Wounds heal by laying down scar tissue. Physicians are unable to consistently predict how a patient will heal for a given injury. Ethnic skin, such as African Americans, Hispanics, Asians, and patients of Mediterranean decent have a higher incidence of healing with hyperpigmentation. Caucasian skin tends to heal with hypopigmentation.
Keloids are seen in all races, but are more common in darker-skinned individuals. Keloid scars are abnormal scars that grow beyond the boundaries of the injury. For example, a simple ear piercing may lead to a marble size keloid. Keloid scars are difficult to treat and are many times misdiagnosed by physicians and patients.
Keep in mind, when a Plastic Surgeon performs a cosmetic procedure, scars are placed in locations that are cosmetically acceptable, unlike traumatic wounds. It is important after appropriate cleansing and wound care that a patient understands that a scar will continue to heal and look its best 1 to 2 years post injury. Most physicians would not recommend scar revision for a minimum of 6 months to 1 year after the injury/surgery. Besides the expertise of the surgeon, to limit scarring, other factors, such as size, location, shape, age of the patient, and healing ability play a role in the final result. Even with scar revision, which can be performed by several techniques, the resulting scar may be better, worse, or the same. Therefore, it is important that the patient and the physician revise scars that are cosmetically unacceptable and have a high probability of improvement.
Scars play a role in appearance, but can limit movement of a joint, retard growth of a child, and may be painful, bleed or ulcerate. Scars that cause functional impairment are almost always revised. Non-surgical treatments of scars include sun avoidance, Vitamin E, steroid applications, steroid injections, or the use of silastic gel sheeting. It is the public's misperception that Plastic Surgeons operate without producing scars.
Plastic Surgeons are specialized surgeons that are trained in wound closure as to minimize scarring, and where appropriate will place scars in locations, or in certain directions that will leave the patient with the best possible scar.
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