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Scar Revision Time?

Ask questions and get answers about how to heal and reduce the appearance of your scars, scar creams, scar silicone sheets, and scar reduction techniques.

Scar Revision Time?

Postby aplusmg » Sat Apr 13, 2013 2:53 pm

So I had my 2nd circumferential TT about 4 months ago. I have keloids & hypertrophic scarring. How long do u think I should wait until scar revision? Any experiences out there? What does it entail
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Re: Scar Revision Time?

Postby lexifoxy » Thu May 23, 2013 11:30 am

This blog covers skin scars only but does not include burn scars or scars related to breast implants.

Virtually everyone who lives long enough will have a skin scar from elective surgery or an injury. There has been a barrage of cosmetic surgery procedure modifications to decrease total incision length in the hope of creating less scarring. The healing of these disruptions in the skin surface follows a specific process. After the injury or cut there is bleeding. Once this stops an inflammatory process starts to get the cells needed for healing into the wound. New blood vessels grow into the area bringing in the energy needed to complete the healing process. You see this as a red color of the scar and the skin immediately next to the scar that blanches white with finger pressure. Within a week or two the healing is sufficiently strong that the wound should not reopen and any sutures that were placed can be removed. Even though the wound is healed it then must mature over the next 6 to 9 months depending on the type of injury, affected body part, age of individual etc. before the redness goes away and the increased blood flow is no longer needed. Once the scar has fully matured it usually does not blanch with finger pressure. Any problems in this process such as an infection, failure to suture a wound closed, certain vitamin deficiencies etc. prolong the healing time and in doing so result in worse more visible scarring. The skin of younger individuals makes strong repairs and tends to over heal, resulting in larger, thicker scars than on older skin. Skin over the jawbone is tighter than skin on the cheek and will tend to increase a scar's prominence. All scars are more amenable to treatment early in their life span before they mature. It is easier to prevent a bad scar from forming by control/manipulation in the early phases of wound healing than to treat one that has already formed.

Typically, a scar will become increasingly prominent at first. The tissue increases in height, firmness, and redness (vascularity) and then gradually fades. Many disfiguring marks which seem unsightly at three months may heal quite satisfactorily if given more time. The desired end result is a flat (not indented or raised), soft, pale, less than 1mm wide scar. We can call that the normal scar. The non-normal scar is more visible due to a number of factors, including its difference in topography (surface contour or depth and height relative to adjacent skin), color, thickness, pliability or texture versus the surrounding normal skin. Scar length, width or direction can also contribute to visibility. A scar that crosses natural expression lines (Langer's lines) or wrinkles will be visually striking because it will not follow a natural pattern for example a scar that obliquely crosses the natural skin fold between the corners of the mouth and the nose is much more visible than one that lies along this fold. If the skin scar adheres to deeper structures such as muscle or bone the skin may bunch up with movement as it is tethered to deeper structures and that also contributes to visibility. In fact some scars may only become visible on animation or movement. Some scars are accompanied by a loss of skin with or without a corresponding loss of deeper tissues (a tissue deficit). In worse cases the patients complain of scar itching, pain, breakdown to a raw surface with minor trauma (an unstable scar) and even recurrent infections in addition to scar visibility. I take all of these factors into account before treating a patient with scars and then develop a treatment plan specific to the patient's situation.

White scars are visible because they have lost all of their pigmentation. Excimer laser or dermal needling (a tattoo like needling of the skin without tattoo pigment) can be used to stimulate pigment cells to migrate into these types of scars from adjacent non-scarred skin. A more expensive approach would abrading the surface of the scar and spraying pigment cells harvested from elsewhere on the body onto the surface of the wound. The cheapest approach in such cases is camouflage make up.

TYPES OF SCARS
The non-normal or non-desireable scars can be classified as significant skin loss/deficit, flat and wide, hypertrophic and keloid.
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