Q: I just had surgery on my breasts, now I am left with two tell-tale scars. How do I make my surgical scars disappear?

 

How Does Scarring Happen?

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Scarring is a natural part of the healing process after an injury. Its appearance and its treatment depend on multiple factors. The depth and size of the wound or cut and the location of the injury matter. So do your age, genes, sex, and ethnicity. Some studies have shown that pulsed dye lasers and fractional resurfacing lasers started early after stitch removal can reduce the incidence and severity of hypertrophic scars.

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What Are The Types of Scars?

To understand how to treat the scars, we need to know the different types of scars.

Keloid scars

We know these as the unsightly bulging scars that protrude from a healed wound. Some people do have a propensity for keloids compared to others. Location is also another factor, with the chest being a common area for the occurrence of keloids. These scars are the result of an overly aggressive healing process. They extend beyond the original injury. Over time, a keloid scar may enlarge or stabilize. Treatments include surgery to remove the scar, steroid injections, or silicone sheets to flatten the scar. Smaller keloids can be treated using cryotherapy (freezing therapy using liquid nitrogen). You can also prevent keloid formation by using pressure treatment or gel pads with silicone when you are injured. Keloid scars are most common among people with dark skin.

Contracture scars

As the name suggests, these scars are the result of overlying tissues contracting as it heals. If your skin has been burned, you may have a contracture scar. These scars tighten skin, which can impair your ability to move. Contracture scars may also go deeper, affecting muscles and nerves.

Hypertrophic scars

These scars are essentially a milder form of keloid scars. While they can appear raised and red like keloids, they do not go beyond the boundary of the injury. Treatments include injections of steroids to reduce inflammation or silicone sheets, which flatten the scar.

Acne scars

The most common type of scarring especially in people who suffer from cystic acne. If you’ve had severe acne, you probably have the scars to prove it. There are many types of acne scars, ranging from deep pits to scars that are angular or wave-like in appearance. Treatment options depend on the types of acne scars you have.

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Pigmented scars

These are just discoloured patches of skin which result from post-inflammatory hyperpigmentation causes as the skin heals from an injury. The best way to minimize their severity is to protect your skin with sunscreen when you get a skin injury, and to minimize further trauma to the skin after an initial injury. That is why doctors often advise you to stop picking at your skin, this is good advice to ensure your skin heals with minimal discolouration. As with keloids, darker skinned individuals are more prone to pigmented scars. This can be a result of acne outbreak or after surgery.

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What Are Possible Treatments for Scars?

The most basic treatments involve topicals alone which are used frequently to lighten existing marks and discolouration. There is limited efficacy when it comes to topical therapies but when they are combined with lasers, they can produce significant results over time.

Ingredients that are most often used for hyperpigmented scars include skin lightening agents such as mequinol, arbutin, kojic acid. Some patients have also found success with retinols and vitamin c preparations. Patience is needed when using topicals to lighten marks. Combine with a sunscreen if your scars are on a sun exposed part of your skin.

There are several lasers which have proven to be very effective in preventing the progression of keloid scars as well as to improve their existing appearance. Pulsed dye lasers such as Vbeam reduce the erythematous nature of red scars, helping them to revert to a more normal skin coloured appearance. Fractional resurfacing lasers such as Fraxel have also been used to improve the texture of the scars. Both modalities have been used to treat post-surgical scars such as breast augmentation scars which are frequently associated with colour and textural changes.

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If your scars are raised as in keloidal or hypertrophic scars, then you can consider an intralesional injection of steroids, that has been shown to flatten the bulk of such scars. This can be done in conjunction with laser therapies for optimal scar resolution results.

On the other hand, if your scars are pitted or depressed, you can consider scar subcision which involves using a special needle to break up the fibrous scar tissues that tethers the overlying skin to the base of the scar, causing an indentation. In certain cases, fillers can be used to plump up the depression of the scars.

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If you have a severe scar that is limited in size, you can also consider surgical excision as a last resort. In this procedure, the surgeon excises the tissue with the scar, and re-stitches the skin to result in a better appearance. This treatment is only for scars that are not too big. Other surgical treatments include using a skin graft especially in people who’ve had burns. If you’ve got scarring that impairs function, surgery can help address the functional problems.

Some studies show that silicone sheets, pulsed dye lasers as well as fractional resurfacing lasers when instituted in the early phase of the scar recovery can result in a more optimal appearance of the resulting scar.

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