There’s no avoiding it, having surgery will always leave you with a scar. Sometimes these scars can grow to be big and ugly, making you self conscious about your appearance. So why do scars grow out of control like this? Our body may sometimes overreact during the healing process, leading to an overgrowth of scar tissue and making a scar unusually red and thick over time. This excessive scarring, referred to as Hypertrophic scarring, can be very unsightly and may cause you great discomfort when they are located in visible areas. Though the scar will never completely go away, there are some techniques that can help reduce its size and appearance.
Why Excessive Scarring Happens
The key elements of scar production are the extent and duration of inflammation and the amount of mechanical tension acting on the scar. If your surgical wound becomes infected or if there are foreign bodies present in the wound then the amount of inflammation in the area increases, as does the possibility of hypertrophic scar formation. Hypertrophic scars also form if there is too much mechanical skin tension acting on the healing wound. Scars on the chest, shoulders, and upper back are frequently hypertrophic because of the mechanical tension located in these areas of the body.
The main reason people want to get rid of their scars is purely cosmetic. By trying to control the key elements of scar formation mentioned above, we can limit excessive scar formation. The following are some of the more common ways to treat scars:
Corticosteroids have long been the mainstay of treatment for excessive scarring. Corticosteroids reduce excessive scarring by decreasing collagen synthesis and reducing production of inflammatory mediators and connective tissue proliferation during wound healing. The most commonly used corticosteroid is triamcinolone which is given as an injection directly into the scar at 4- to 6-week intervals.
Complications of repeated corticosteroid injections include skin degeneration, telangiectasia formation, and altered pigmentation.
Antihistamines are usually used to control symptoms of scar itching, but they also seem to have an anti-inflammatory effect on scars, resulting in reduced scar formation and increased comfort. The inflamed scar is scratched less, which will prevent scar growth and thickening. Antihistamines are also well known to inhibit collagen synthesis. Diphenhydramine (Benadryl) and Hydroxazine (Atarax) are the most commonly used antihistamines for scar management.
- Occlusive dressings
Occlusive dressings include silicone gel sheets, non-silicone occlusive sheets, and Cordran tape. They have been used with varied success. Their effects appear to result from a combination of occlusion and hydration, rather than from an effect of the silicone.
Silicone gel sheeting is waterproof, flexible and works by flattening, softening and fading red and raised scars. Their flexibility makes them comfortable to wear and easy to apply, even on awkward areas such as joints. The sheet is easily cut to fit the scar. The silicone gel sheeting works by moisturizing and covering the scar area. This helps to reduce the size and improve the color of a scar and can improve elasticity of the tissue.
Cordran tape is a clear surgical tape that contains flurandrenolide, a steroid that is uniformly distributed on each square centimeter of the tape, and it has been shown to soften and flatten scars over time.
- Pressure Garments
After elastic pressure wrap dressings of healing burn scars were observed to be effective in the reduction of scar hypertrophy, they began being used for the prevention of hypertrophic scar prevention of surgical scars. Pressure Garments are usually custom made to fit like a second skin of elastic fabric. They work best when worn 24 hrs a day for 6-12 months, and often in combination with silicone gel sheeting. Though their exact mechanism of action is unknown, it is thought that continuous pressure on the surface blood vessels over a period of months causes scars to become softer, flatter, thinner and paler.
- Botulinum toxin A (BOTOX)
Botulinum toxin A (BOTOX) is a neurotoxin that causes a paralysis of the local musculature and reduces skin tension. This reduction in the skin tensile force during the course of wound healing may represent a novel therapeutic target for treating excessive scarring. Though promising, larger and better controlled studies are needed to determine the true effectiveness of BOTOX in the treatment of hypertrophic scars.
- Onion extract
Onion extract is a bioflavonoid with antibacterial, antihistamine-releasing, and anti-proliferative effects on both normal and malignant cells that can be found in onions and apples, red wine, and black tea.
Studies have shown onion extract to cause cell death and inhibit collagen synthesis along with the activation of several key proteins in the insulin-like growth factor family which results in a reduction of scar tissue formation.
For the treatment of preexisting scars, the combination of onion extract with other agents seems to generate better results than onion extract alone.
- Vitamin E
Vitamin E (tocopherol) is a lipid-soluble antioxidant with multiple biological effects, including the reduction of reactive oxygen species, which hamper healing and cause damage to the DNA molecule, cellular membranes, and lipids. In addition, vitamin E also alters collagen production and inhibits the spread of peroxidation of lipids in cellular membranes, thus acting as a membrane-stabilizing agent. Only anecdotal reports have shown that vitamin E speeds wound healing and improves the cosmetic appearance of scars.
Dermabrasion can be used to reduce irregularities in the skin surface associated with scarring. This involves the removal of the surface of the skin with specialist equipment and usually involves general anesthesia. It may be useful in situations where the scar is raised above the level of the surrounding skin but, is not helpful when the scar is sunken or pitted.
- Laser Surgery & Resurfacing
The role of laser surgery in the management of scars is limited. The color of a red scar may be improved by management with a vascular laser. It has also been suggested that removing the surface layers of the skin with a carbon dioxide laser may help to flatten scars. However, there are very few long-term studies to prove the effectiveness and safety of this therapy. It is important to establish that a fully trained medical practitioner carries out any laser therapy with experience in improving scars.
Any surgical removal will always leave a new scar that will take up to a year to mature. Surgery will never remove a scar but can be used to alter its position, alignment or shape. Sometimes, surgery will actually make the scar longer; although its appearance is improved overall. This is particularly important to bear in mind when the scar is in a visible location (e.g. face). Surgery may be necessary to release a tight scar near a joint that is restricting movement. Although the outcome of surgery may be desirable in the short term, surgical revision of hypertrophic or keloid scars is followed by a high recurrence rate.
No single therapeutic modality is best for treatment of excessive scarring. No matter which form of therapy you choose, it is important to be patient with the scar treatment process. It may take a while to lessen the appearance of surgical scars, but you will see results over time if you stick to your treatment plan.