Scar Revision

It is completely NORMAL for scars to look red and lumpy after any operation. Initially, for the first couple of weeks, the scar(s) may look excellent. However, they will then become red and lumpy. This is a normal response to wound healing. Over time these scars will mature and the scars will soften, become flatter and paler. This process takes around 18 months to 2 years and may require revisions.

Specialist surgeons like Mr Banwell will always tape your scar line for the first 2 weeks after surgery. Usually this will be with brown micropore tape [this is showerproof and will stay in place as long as it is dried with a hairdryer each time it gets wet]. Ideally the scar should be taped for an additional few weeks to protect and support it.

After this time, Mr Banwell recommends a twice daily massage with a moisturizing cream (eg. Vitamin E). Do not use E45 as it is too thick and claggy!! This should continue for at least 3-6 months and ideally up to a year. The purpose of this is to speed up the natural healing and repair process and allow the scars to soften, flatten and become paler.

Absolutely!!! If immature scars (within the first year) are exposed to the sun they can become pigmented or stay red permanently. It is therefore important to cover scars with clothing or sun protection factors (SPF50) to optimize scar outcome.

Moisturisers and massage are by far the best treatment for scars but additional treatments such as silicone gel sheeting (eg. Cica-care gel) or silicone gel applications (eg. Dermatix or Kelo-cote] may also be beneficial. However, there is NO evidence for the benefit of Bio-oil but many people do use this.

Early problems following surgery include infection, bleeding and the wound pulling apart (dehiscence). Adverse scarring can also occur such as hypertrophy and keloid scarring (see below), Hypersensitivity of scars can also be a problem (this is usually due to not enough massaging in the early post-operative period).

Hypertrophic scars are red (pink) lumpy scars that continue to grow, after the original wound has healed.

We do not completely understand why hypertrophic scars arise, and there is a lot of research being undertaken to further our knowledge. It seems as if the body does not switch off the scar forming mechanism after a wound has healed, and scar tissue continues to be produced, forming a lumpy scar. This is more likely if been a delay in your wound healing, such as after an infection, or when the wound has pulled apart and has been left to heal naturally. Some areas of the body are more prone to them such as the chest and the shoulders.

Keloid scars are lumpy scars that continue to grow, long after the original wound has healed (like hypertrophic scars]. The main difference is that they continue to grow outside of the original area of surgery/injury and may be quite sizeable.

Like hypertrophic scars, we do not completely understand why keloid scars arise. Keloid scars are common in Afro-Caribbean people and also people from the Far East. They are also seen in those with pale skin and red hair. Keloids are difficult to treat – there is no known cure for them.

Hypertrophic and keloid scars can be difficult to treat. Surgery to remove the scar and re-stitch the wound may be considered in certain circumstances. This tends to be when the original wound had healing problems due to an infection – if the wound can be re-stitched and heal the second time around without an infection, it is less likely to become hypertrophic or keloid

Silicone gel – in the form of a sticky gel sheet applied to the scar or alternatively as a liquid from a tube (e.g. Dermatix or Kelo-cote).

Steroid injections – a regular course of injections into the scar itself, repeated every 6-8 weeks (this may also be performed in combination with surgery).

Rarely surgery may be performed in conjunction with radiotherapy treatment for cetain keloid scars.

The success rates of the different treatments is variable, and depends on your individual situation and the reason for having developed the hypertrophic scar.

Once the hypertrophic or keloid scar has improved in terms of size and texture it may not trouble you again. However, in some cases, the hypertrophic scar recurs and further treatment may be necessary.

If the hypertrophic scar comes back, your treatment course may be restarted or another type of treatment may be used.

A variety of different treatments may be use to improve the appearance of scarring (including acne scarring). Commencing a medical grade skin care regime on a daily basis can do wonders for your complexion and the luminosity of your skin but furthermore it can also aid the appearance of scars. Chemical peels, dermaroller, dermastamp or surgical scar revision may also be suitable treatments. Mr Banwell or one of his anaesthetic nurses would be delighted to discuss suitable treatments with you.