Category Archives: Scars

An Overview of Burn Scars

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Burn Reconstruction

Burns caused by heat, chemicals and fires can result in the most traumatic types of scaring. The severity of burns is classified as first, second and third degree burn. This designation is based on the dept of damage to the outer and deeper layers of the epidermis (skin) and dermis (inner skin) tissue.

Burns can leave patients with severe physical disfigurements.
The emotional trauma can often exceed the physical trauma as self image is an integral part of an individual’s self esteem. Scar revision surgery for all types of scars is often elected to positively affect the patient’s emotional well being.

Burn treatments usually involve skin grafting and cosmetic reconstruction, and may be performed in an emergency facility or later on. These treatments also focus on restoring function to the burned skin to reduce the risk of complications such as loss of mobility or a loss of one of the senses.
Acute Burn Care

Any type of burn on the skin requires immediate medical attention to stabilize the patient, clean the wound and reduce the risk of complications such as infection, scarring, breathing problems and limited bone and joint mobility. Initial burn care focuses on assessing and treating the initial burn symptoms, prevents infections and other potential further risks. Additional treatment may be required at a later time for skin reconstruction. It is also important for patients to remain hydrated after a burn, so fluids may be administered intravenously to prevent dehydration.

Comprehensive burn care that includes an evaluation of:
• the burn and any related conditions
• thorough wound care
• proper dressing
• pain mitigation through medications
• emergency surgery as may be required.
Burn Scars

Most burns will usually leave a scar,The appearance of the scar depends on the size, location and severity of the burn. Scars usually become less noticeable over time, however when they scar is obvious patients seek reconstructive treatment to improve their appearance of scars that are physically unattractive or disfiguring. Reconstructive procedures are most often performed after the burn has fully healed, which may be nine months to a year after the original injury.

Scar reconstruction is usually performed through an outpatient surgical procedure that may involve skin and tissue grafts, skin flaps or injectable fillers to restore a more natural appearance, while also correcting any functional problems caused by the scar and improving the patient’s self-confidence as well.

Contractures

A contracture is a complication of burn scarring that involves a tightening and thickening of the burn scar that in turn restricts movement of the affected area. It is important for patients to take precautions to prevent contractures from occurring, by exercising, wearing a splint and continuing to promote everyday activities that require movement.

Treatment for contracture scars often involves surgery to release the contracture and restore normal movement to the skin. A skin flap or graft may be used to restore the appearance of the skin in the treated area, while also improving movement and flexibility that may have been affected by the contracture. Physical therapy will often be needed after surgery to stretch the joints and restore movement and function.

Scar Revision Insurance Coverage

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The unpredictability of scars is a part of the human experience. Many scars are unobtrusive and we often forget about them. It is not uncommon especially among machismo male culture to embellish the history of a scar as a rite of passage. Unfortunately for many people a scar can be a debilitating phenomenon emotionally and physically. It is for these reasons that some insurance programs will cover scar revision for patients.

The formation of a scar depends as much upon the way your body heals. Likewise your individual healing process combined with the surgeon’s skill affects the success of a scar revision surgery outcome.

The factors that affect scarring are:
• the size and severity of the wound,
• its shape and direction
• the original color and thickness of your skin
• the blood supply to the injured area.

The merits as to the need for plastic surgery are a highly personal decision, and are different for each person.

Types of Scars
• Stretch Mark Removal
• Keloid scars
• Hypertrophic scars
• Contractures

Common Scar Revision Surgeries
• Z-plasty
• Flap surgery
• Skin grafting

Medical Insurance May Cover Cost of Scar Revision

Scar revision cost may include:
• Surgeon’s fee
• Hospital or surgical facility costs
• Anesthesia fees
• Prescriptions for medication
• Post-surgery garments
• Medical tests

Though many health insurance plans will not cover scar revision surgery for cosmetics alone. If the surgery if for complications related to the injury and the scar can be revised through the procedure it can be covered. Some policies also include coverage for scarring that is limiting body functionality. You must carefully review your health insurance policy.

It is impossible to remove a scar completely. However, plastic surgery can often do much to lessen the severity of a scar, making it less noticeable by applying or injecting steroids or through scar revision, a commonly used surgical procedure. Many people assume that as elective surgery it has to be an out of pocket expense. This is not necessarily true. Check with your medical insurance provider to see if this is the case; don’t assume. Many people improve their self image and quality of life through scar revision surgery.

Facts about Common Types of Scars

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Scarring is part of living

Accidents, surgery, skin disease, burns, acne, and infection are things that are common to the human experience. All of these often leave some type of scarring on a person to varying degrees. It is unlikely that and person living to the edge of five years is without some type of scarring. The skin is the largest organ system of the body and provides us with amazing protection that allows humans an advantage over other mammals on the planet. However it is greatly associated with our personal self image and sometimes scarring has adverse emotional effects.

Below are common types of scars that occur:

Flat, Pale Scars – are the most common type of scar.
They occur as a result of the body’s innate healing process. Initially, they may be red or dark and raised. After the wound heals they often become paler and flatter over time. The final appearance being in a flat, pale scar that can be nearly unoticeble. This process can take up to two years and there will always be some visible evidence of the original wound.

Hypertrophic Scars – Red or Dark and Raised
Hypertrophic scars are more common in the young and people with darker skin. Some people have an inherited tendency to this type of scarring. It is not possible to completely prevent hypertrophic scars. It is important to record this tendency as part of one’s medical history. Some scar therapies are available that may speed up the process of change from a hypertrophic scar to a flatter, paler one.

The body produces new collagen fibers at a rate which balances the breakdown of old collagen. Hypertrophic scars do this in abundance. These scars are red and thick and may be itchy or painful. They do not extend beyond the boundary of the original wound but may continue to thicken for up to 6 months. Sometimes they improve over the next one to two years. Some people complain because these types of scars can cause distress due to their appearance or the intensity of the itching. Depending on their location on the body they can restrict movement.

Keloid Scars – Red or Dark and Raised
As in hypertrophic scars, keloids are the result of an imbalance in the production of collagen in a healing wound. Unlike hypertrophic scars, keloids grow beyond the boundary of the original wound and can continue to grow indefinitely. They can also be itchy or painful and in a number of instance not improve in appearance over time.

Keloid scars can result from any type of injury to the skin, including scratches, injections, insect bites and tattoos. Anybody can get a keloid scar and they can occur anywhere on the body. However, the young and people with darker skin are more prone to this type of scarring and they are more common on certain parts of the body e.g. ears, chest, shoulders and back.

As with hypertrophic scarring, people who have developed one keloid scar are likely to be prone to this condition in the future and should alert their doctor or surgeon if they are likely to need injections or to have any form of surgery.

Sunken Scars – are recessed into the skin.

They may be due to the skin being attached to deeper structures (such as muscles) or to loss of underlying fat. They are usually the result of an injury.

Acne & Chicken Pox Scars
A common cause of sunken scarring is acne or chicken pox which can result in a pitted appearance. However, it is important to note that acne scarring is not always sunken in appearance and can even become keloid.

Stretched Scars
Stretched scars occur when the skin around a healing wound is put under tension during the healing process. This type of scarring may follow injury or surgery. Initially, the scar may appear normal but can widen and thin over a period of weeks or months. This can occur where the skin is close to a joint and is stretched during movement or may be due to poor healing due to general ill health or malnutrition.

Stretch Marks
Stretch marks develop when the skin is stretched rapidly, for example during pregnancy or the adolescent growth spurt. Initially, stretch marks appear red but become paler over a number of years.

Caesarian Section Scar Revision

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About C section Scar

Some women may do to emergency or elect to have their birth surgically. This is called a Caesarian Section or most often referred to as a C-section. In this surgical procedure one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. This will leave a surgical scar that many woman wish to have revised after the decision not to have any more children. In emergencies often the scar is longitudinal running from just below the naval to the lower abdomen. In elective C section more often the scar is latitudinal just above the pubic bone on the lower abdomen.

The Video Below is a medical procedure and contains graphic images that may be unsuitable for children and some adults.

About C section Scars

  • This Cesarean section scar involves a midline longitudinal incision which allows a larger space to deliver the baby. It is not often performed today.
  • The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.
  • An emergency Cesarean section is a Cesarean performed once labour has commenced.
  • A crash Cesarean section is a Cesarean performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, the child or both.
  • A Cesarean hysterectomy consists of a Cesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
  • A repeat Cesarean section is done when a patient had a previous Cesarean section. Typically it is performed through the old scar.

    • Regardless of the type of C section performed and the resulting scar they can be treated in a similar way. Tummy tucks are often used to revise or obscure a C-section scar.

Facial Scars

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Facial Scar Duress

The impact of scarring and the disfigurement from it has a tremendous emotional impact on a person. It can be even greater for children who may lack the cognitive and language skills to communicate there distress. Males of all ages are often ingrained socially not to communicate distress over scarring even if it is impacting them in a negative way. Many people undergo unnecessary deformity because either they or their families have failed to deal with their concern over the effects of facial scarring or have failed to seek advice on what can be done to improve the appearance of facial scars.

Advancement in today’s cosmetic surgery provides more options. The treatment of facial scarring can be the most gratifying thing that a cosmetic surgeon does. Unlike other cosmetic procedures, incisions for revision cannot be hidden. The location of the scar determines the incision but it is the techniques in restructuring the scar that can greatly reduce its appearance and advance a patients self-image and emotional wellbeing.

Importance of Timing Scar Revision

Children and young adults are the disproportionately the victims of injury. Their skin tends to heal with more scarring because they heal more rapidly. Although these scars tend to fade with time, it still makes the treatment program more difficult. Furthermore, it makes it much more important to wait before initiating treatment since a scar that looks poor a month or so after injury may continue to greatly improve in appearance for many months. Ultimately, it may be so unnoticeable as to not require treatment.

Although the repair carried out at the time of injury does influence the amount of scarring that exists after healing, even the most careful repair may not provide a totally acceptable result. When treating the initial injury, one is never sure how tissues will heal. Lost tissue may have to be replaced with grafts. Wounds may have to be closed under tension. These are only some of the factors that tend to promote increased scarring.

The Nature of Scars

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Scars are the result of our natural biological process of wound healing. This repairing takes place in the skin and in other body tissues. The external scars of the skin most often comes to mind even though injured internal parts of the body can heal with scar tissue. Often a doctor can diagnose a condition based on some internal scarring of an organ such as the liver, lungs or kidneys.

Regenrative Animals do not scar

What Are Scars?

Scars are areas of fibrous tissue (fibrosis) that replaces normal skin or organ tissue after injury. This is why it is said that scarring is a normal part of the healing process. Every wound (e.g. after accident, disease, or surgery) has some degree of scarring. There are some exceptions to this in the animal world. These animals undergo regeneration, which do not form scars and the tissue will grow back exactly as before. Some examples are:

• Lizards who lose all or part of their tails can grow new ones. Most
lizards can regrow a tail within nine months.

• Planarians are flat worms. If cut into pieces, each piece can grow
into a new worm.

• Sea cucumbers have bodies that can grow to be three feet long. If
cut into pieces, each one can become a new sea cucumber.

• Sharks continually replace lost teeth. They can grow as many as
24,000 teeth in a lifetime.

• Spiders can regrow missing legs or parts of legs.

• Sponges can be divided. In that case, the cells of the sponge will
regrow and combine exactly as before.

• Starfish that lose arms can grow new ones; sometimes an entire
animal can grow from a single lost arm.

As mammals, humans just aren’t that fortunate. Scars are part of our existence for better or worse.

Variant Formation of Scars

• Scar tissue is the same protein (collagen) as the tissue that it
replaces, but the fiber composition of the protein is different;
instead of a random basket weave formation of the collagen fibers
found in normal tissue
• Scar tissue is fibrosis and the collagen cross-links forms a
pronounced alignment in a single direction.

Scar Tissue has inferior functionality

• Scars in the skin are less resistant to ultraviolet radiation
• Sweat glands and hair follicles do not grow back within scar tissue
• A heart attack causes scar formation in the heart muscle, which
leads to loss of muscular power and possibly heart failure.
• Bones can be an exception they can heal without any structural or
functional deterioration.

Hair Transplant Scar Revision

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Hair Transplant Scar Revision Options

Hair transplant surgery can sometimes lead to unanticipated and esthetically displeasing linear scars at the donor sites. A creative medical approach combining scar revision and/FUE Hair Transplant can mitigate the appearance of a hair transplant scar. Permanent tattooing in a small degree can also obscure the scar bringing a level of satisfaction to the patient when wearing a short hair style exposing your natural scalp.

Hair Transplant Scalp Scar

Trichophytic Closure

This method allows hair to grow inside the scar and minimize the contrast between scar and surrounding areas of the scalp. Trichophytic closure is performed by preparing one side of the surgical wound to allow the hair follicles on the margin of the incision to produce hair that will grow through the scar. There are various ways hair restoration surgeons prepare the incision. The end result is to allow for hair to grow through the margins of the scar as healing takes place. The hair growing through the scar borders camouflages the typical straight linear appearance of a hair transplant scar. The scar is present but as in all successful scar revision it is rendered less visible.

FUE Hair Transplant Procedure

Follicular Unit Extraction (FUE) is a method of extracting individual hair follicles which leave little to no scarring at all. In revisioning a scar a hair transplant surgeon can harvest a modest number of grafts from the various areas on the back of the head in a manner that is virtually unnoticeable. Those grafts can then be transplanted into the scar area strategically. Upon healing and the regrowth process the scar is hidden more because of the hair growing from its margins. This procedure combined with Trichophytic Closure is one of the most effective ways of hair transplant scar revision.

Evolution of Scars – Part 2

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Why Do We Have Scars?

“Human wound healing appears to have been optimized for quick healing in dirty conditions,” Mark W. J. Ferguson, Ph.D., University of Manchester.

Part II
Before and After Facial Scar Revision of Young Woman
Anthropologists and science have yet to explain why humans develop larger and thicker scars than other animals. Our response to scars reaches back through the eons of human evolution. A physically weaker structure than most mammals; humans live longer than any other mammal it perhaps is our species wound healing that allows us to thrive. When we’re injured; cut or burned, the immune system is immediately activated to close the wound and heal it.

Surgeon N. Scott Adzick, M.D., researches and studies scarring at the Center for Fetal Diagnosis and Treatment at the Children’s Institute for Surgical Science in Philadelphia, he notes:

“If you’re a caveman or cave-woman running around, and you get bitten by a saber-toothed tiger, it makes sense to patch that wound together as quickly as possible in order to survive, as opposed to devoting the body’s energy and resources to healing perfectly”

The result is that our bodies’ rapid immune response to inflammation leads to the larger and thicker scabbing and scarring. Some social anthropologists theorize that scars served as sexual attractors. Heavily scarred early men would be more attractive because it indicated there bravery and strength in survival.

No matter the theory or culture scars are part of human life; if you know someone who is experiencing anxiety from scars. Today’s cosmetic medicine may have the answers.

Evolution & Psychology of Scars

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Part 1

How Scars Make Us Feel

Man with extensive facial scar
There is unlikely an adult human on the planet without a scar. Most scars are not of consequence to cause severe emotional or physiological issues. Wound research has proven that the age of the person, gender and location of the scar are factors on how it will affect a person. In addition how the scar occurred can make it more of a problem. Facial scars cause more duress and scars that may be disfiguring or near around intimate areas of the body. Society premium appearance contributes to the anxiety associated with scarring. Stereotypes in moving show scarred people to be unpleasant, sadistic and mean.

However in some cultures consider scars desirable and are intentional and deliberate. Some tribes identify their clan and families by scar markings this was very common in Nigeria though the custom is no fading. Traumatic scarring is often very different. I greatly distress the person suffering from the scar and detract from their quality of life. Some anthropological studies indicate that facial symmetry seems to be innate attraction within humans; clearly facial scarring moves a person further away from what maybe a pre-programmed ideal. People who have adverse reaction to the scars can experience embarrassment and loss of self-image. Over long term this can lead to isolation, anger and self-loathing. In worse case scenarios psychological conditions that need to be treated can develop.

Today’s modern surgical techniques in the field of cosmetic surgery now provides many options in scar revision. Birth Marks, skin anomalies as well as scars can be treated with much success.

Read Part II of the Evolution of Scars

Scarring and Breast Cancer

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Scarring and Breast Cancer

Healing and Coping with Physical and Emotional Scars

Breast cancer is often treated by minor or major surgical intervention; from a lumpectomy to radical mastectomy life changing surgery takes place. This means that the treatment of breast cancer surgery that unavoidably leaves scarring as part of the process. The concern for loss of life is for many women often underscore by the fear of disfigurement and loss of feminine ideal and beauty. However this is not inevitable.

Breast Cancer Scarring Is Not Only To The Body

The journey to healing from breast cancer surgery always leaves the challenge of mitigation scarring from the minor to major depending upon the surgical treatment required to restore the patient’s health. Even radiation therapy can leave lasting marks. These scars can range from localized, temporary burns that resemble sunburn or a hardened, rigid-type known as radiation fibrosis. Chemotherapy can potentially leave some scarring. The chemotherapeutic medicine is often delivered through an intravenous line or catheter, and since these catheters are inserted during minor surgical procedures that pierce the skin. In some cases a patient’s ability to heal has seriously been compromised; these minor procedures can cause scarring at the site. In extreme instances sites may have to be rotated because of the patient’s inability to heal well and the subsequent scarring.

Factors that Affect Scarring

The breadth and or amount of scarring from breast cancer treatments depends on several factors:
• the type of surgery performed
• each patient’s individual capacity to form scar tissue.
•
Lumpectomy & Mastectomy Scarring
Sixty percent of patients prefer for lumpectomies, surgery that spares the breast and much of the surrounding tissue while removing the cancerous tumor or cells. Still scarring can be a problem. These surgeries range from the removal of a very small amount of breast tissue for testing; to having a full quarter of the breast taken to eradicate the cancer. The result is quite often an asymmetry in the shape of the breast that is emotionally disconcerting to the patient. This feeling is part of the emotional despair experienced by the forty percent of patients who undergo a modified radical mastectomy or the radical surgical removal of the entire breast. These invasive surgical procedures result in a long, slit-like scar that runs from the breastbone to up under the pit of the arm.

For both the lumpectomy and the mastectomy, breast reconstruction is optional, but one of the ways to achieve this actually results in at least one more scar. A flap of tissue can be taken from the women’s abdomen or other area of the body, depending on the amount needed to restore the form of the breast, this results in additional scarring at the site from where the tissue was taken from.

Scars, Body Image, and Intimacy

“Some women choose mastectomy with reconstruction, because they feel there will be a better cosmetic outcome,” says Debbie Saslow, PhD, director of breast and gynecologic cancer at the American Cancer Society in Atlanta. “Some women have a really strong reaction to the scarring – it affects their body image and their sex lives – and other women can almost ignore it.”

The overt presence of scars that are difficult to disguise when a mastectomy patients disrobe can be troublesome for the patient. Many patients who initially decide against breast reconstruction opt for it ater which makes for a more difficult surgery. Patients are not only self conscious about the scars; they fear having to explain them in intimate relationships. This underscores the importance of having a fully holistic team prior to surgery. A consult with counselors and plastic surgeons should be utilized to address the concerns and fears prior to surgery. Discussing with other breast cancer patients who have undergone the surgery is helpful. Those who have and have not opted for breast reconstruction is advisable.

Healing and Reducing Scars

Some of the best ways to limit scarring are:
• by preventing infection immediately after surgery
• lightly stretching and massing the scar area daily during the first year, when most healing occurs
• medical consult with surgeon specializing in scar revision
• ensuring proper surgical site drainage which is inevitable
• keeping the wound clean
• following physicians orders in bandaging the wound
• transverse friction massage by a therapist

The implications of scarring aren’t only in appearance. There can also be pain associated with tightness and pulling. This can be moderate to severe in patients. Various professional modalities and therapies can be used to guide and assist the patient in their wound healing. Some are deep and soft-tissue massage, physical therapy if the muscular structures of the chest and shoulders have been involved to any degree. Alternative therapies such as yoga, which involves deep breathing and full-body stretches, as well as, acupuncture can be used to assist in the recovery of patients who have undergone surgery from breast cancer.