Keloid Scars  

Keloids are thick, puckered, itchy clusters of scars that grow beyond the edges of the wound or incision. They are often red or darker than the surrounding skin. Keloids appear when the body continues to produce collagen long after the initial wound healing has taken place. 

Keloids can appear anywhere on the body but are more common over the breastbone, earlobes and shoulders. Black persons, who heal very rapidly, and have a much thicker skin than Caucasians are the most Keloid prone. The tendency to develop Keloids lessens with age. 

Treatment:
Injections of steroid material directly into the scar tissue reduces redness, itching and sometimes shrinks the scar. Also, scar tissue can be cut out and the wound closed with one or two layers of stitches. Skin grafts are occasionally used if another Keloid develops after the revision surgery but the donor site for the graft risks Keloids as well. 

No matter what approach is taken, Keloids have a stubborn tendency to recur, sometimes even larger than before. In these cases the surgeon may combine the scar removal with direct steroid application during surgery or radiation therapy. Pressure garments worn over the area for as long as a year are commonly prescribed by the physician in sever, recurring Keloids. 

Hypertrophic Scars

These scars are often confused with Keloids since both appear to be thick, red or dark brown and raised. The difference is that hypertrophic scars remain within the boundaries of the original incision or wound. They often improve on their own in a year or two.

Treatment:  
Surgical removal of the excess scar tissue will involve repositioning the scar so that it re-heals in a less visible manner.. Steroid injections at the time of surgery and at intervals for up to two years help to prevent the thick scar from reforming. 

Contractures

Burns or injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction. This contraction could affect the muscles and tendons restricting normal movement. 

Treatment:
Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or flap. Z-Plasty may be used in some cases. Z-Plasty is a surgical technique used to reposition a scar so that it more closely conforms to natural lines and creases of the skin where it will be less noticeable. This procedure also frees up the tension on the skin and relieves the lack of movement in the area. 
       
In Z-Plasty, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a “Z” pattern. The wound is then closed with very fine stitches. 

In Flap Surgery, skin, along with underlying fat, blood vessels and sometimes muscle, is moved from a healthy part of the body to the injured site. In some flap surgery the blood supply remains attached to one end of the donor site; in others, the blood vessels in the flap are reattached to the new site using micro vascular surgery. 

In the case of highly visible facial scars, most that are not hypertrophic can simply be cut out after the initial wound is healed and re-stitched with fine stitches resulting in a finer, smaller scar that fades with time. If the scar lies along natural creases or lines in the face, Z-Plasty is often employed in the scar revision surgery. 

Many physicians follow up these revision techniques with dermabrasion to smooth the skin, especially in the case of Keloids or hypertrophic scars but I have never seen a case where dermabrasion completely removed a scar. 

Microdermabrasian

This is one of the main reasons to purchase a microdermbrador. Over time, continuous treatments do result in a planing down of hypertrophic scar tissue. But this is only opening the door to further treatment. 

Light Treatment

 There is a new craze out that claims that certain wavelengths of light can not only remove signs of ageing but can also remove scars. The advertising this is of pseudo-scientific terminology and impressive grafts, but everything seems a bit too anecdotal. One could argue that laser skin revision (laser also being a form of light) can assist in scar revision. However, that is medical and still in the clinical trials stage. (Although it does look promising.) 

Electronic energy treatments

The incredible repolarizing powers of pulsing electromagnetic waves can be programmed like a computer for very quick post surgical wound healing. A therapist can perform this immediately after the physician has completed scar revision procedures. Better yet, electromagnetic waves appear to regulate normal cell proliferation, which is vital to keloid revision.  

Alkalizing the tissues

There are water-soluble compounds available that raise the pH of the skin to around 12 on the pH scale. Alkalizing the skin correctly softens the tissue via desquamation, often creating a mild irritation that forms a light scab. When the scab falls off, the scar appears flatter. 

Enzyme skin tightening treatments

Scars on aging skin tend to look deeper or more predominant as the skin loosens with age, particularly in the case of acne scars. Tightening the skin with enzyme treatments gives a temporary but progressive “lift” to the tissues which also smoothes out the appearance of scars as the skin becomes firmer.  

Acidic oils

There are some oils on the market from both the marine world and the botanical world that actually soften and flatten scars and reduce dark pigmentation. No one is really 100% sure why these types of oils work (I have my theories of course) but many wonderful results have been observed over the years, principally with the Rosa Mesquita Oil from Chile and many of its cousins. These oils have to be applied at least three times a day directly on the scar tissue and they must be fractionated enough to enter the tissues;