Obtaining an unobtrusive scar is the main concern of surgeons and their patients. Unfortunately, while it is possible to predict the length of a scar, the quality is not always controllable and no honest surgeon can promise a perfect scar without lying.
Normal scarring
After a surgical intervention, the WOUND will heal after a period of between three and four days (eyelids) 15 to 20 days (trunk and limbs) and at the end of this period it will be possible to remove the stitches (if these cannot be reabsorbed). The operation wound then becomes a SCAR.
This will develop in several phases:
During the first phase (which will last for about one month), the scar is generally thin and colourless.
During the second phase, the scar will begin to REDDEN and will remain red for at least six months (sometimes for one or two years). While the scar usually remains thin, it can sometimes expand or start to become prominent (a HYPERTROPHIC scar).
The enlarged scar will remain wide but a bulging scar will usually flatten after eight or nine months, unless it is a CHELOID (pathological) scar which will require special care.
At first, the scar will be hard and generally attaches itself to the deeper planes (for several months) but it will then soften and detach
Factors affecting the scar
SMOKING: the act of smoking causes vasoconstriction, a source of hypo-vascularisation of the area operated on (especially if any part has become detached). This failure of vascularisation can cause necrosis of the skin which may sometimes require surgical intervention to remove a pressure sore and produce delayed scarring (sometimes this may take several months). The scar will not look nearly as good, of course. It is therefore essential to stop smoking at least one month before and after any intervention involving detaching the skin.
AGE: puberty is a period in which there is the greatest risk of a hypertrophic or even cheloid scar.
SITE: generally the face heals quite well (except behind the ear). The risk of a cheloid scar increases at the sternum (breast bone), shoulders and the region just above the pubis. There may be scarring on the back and in the bends of the knees and elbows.
SKIN COLOUR: dark skin colour tends to produce cheloid scars.
INTERVENTION if skin is removed (from a beauty spot or through an abdominal lift) the scar will tend to expand in an intervention which consists of a simple cut into the skin (deep lipoma).
Care of the scar
Avoid pulling on the scar by straining movements at right angles to it.
It is vitally important to COMPRESS it after the operation. In cosmetic surgery, this is generally achieved by wearing compression garments (bra, pants or a corset) to be worn for several months (for as long as the scar tends to be prominent).
The scar should also be MASSAGED with ointments so as to detach it.
Compression should be reinforced by wearing SILICONE GEL sheets, to be applied to the scar for several months.
If the scar is particularly prominent (hypertrophic and cheloid scars) it may be possible to perform cortisone INFILTRATIONS into the scars from the second month after the operation (these may be repeated).
What can be done about an old, unsightly scar?
Sometimes (depending on the site and skin type), it will not be possible to act.
In certain cases, it is possible to surgically DETACH a scar (adhesion scar) or to surgically DEBRIDE it with a skin operation (for a retractile scar) or exceptionally perform a skin graft.
Hypertrophic scars should benefit the maximum from localised prevention through compression (silicone gel + compression garment).
Certain cheloid scars can be reworked surgically. It will then be necessary to perform post-operative infiltrations and sometimes contact RADIOTHERAPY on the scar. It is never possible, however, to guarantee an absence of recurrence of the cheloid scar (some people will produce another cheloid scar in 100% of cases).
An enlarged scar can be reworked if the skin allows for it. In the case of colourless scar, it might be of interest to resort to tattooing.
A hyper-pigmented scar is harder to treat, certain depigmentation creams or recourse to laser treatment can sometimes improve their appearance.