Hypertrophic Scars & Keloids

Scar is a cutaneous development in the skin, culminated by biological wound healing processes. Hypertrophic scars and keloids can be described as variations of typical wound healing and these have been recognized as abnormal responses to trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection.

Hypertrophic scars grow within the borders of the original wound and eventually grow smaller, but keloids grow beyond the original wound borders and in general are raised more than 4 millimeters above the skin. Some keloid and hypertrophic scar patients have a familial history of pathological scarring, which suggests that these scars can be driven by genetic factors. Patients with darker skin are more likely than patients with lighter skin to develop pathological scars especially keloids.

Hypertrophic scars and Keloids aren’t dangerous or life-threatening. They can be itchy and painful, but more often are simply a cosmetic issue. In the proliferative and remodelling phases, the scar may contract, causing tension on the surrounding skin and joints, and leading to deformity and reduction in joint range of motion. Large scars can cause severe interference with the function of extremities. Some people seek treatment to minimize the appearance of the scar. There isn’t an officially established treatment regimen for hypertrophic scars, but a variety of treatments can help get rid of the scar more quickly. Cortisone or steroid injections are the first-line treatment for keloids. Many advanced aesthetic and reconstructive cosmetic surgery techniques can be employed to improve the appearance of a scar or reduce its size. The best result in treating hypertrophic scars or keloids is with a combination of scar revision surgery and steroid injections.

Scar revision surgery can minimize the appearance of a scar and help it blend with the surrounding skin. A surgeon may reduce the size of a scar; reposition a scar to a less visible area; or smooth the contours of the skin and other soft tissues to correct sunken or dimpled scars, which usually occur when the wound that caused the scar was deep and broad. A surgeon may use aesthetic techniques to move a scar to a less visible place. Other cosmetic techniques include injecting a small amount of fat which surgeons typically remove from another part of your body, such as the thigh or belly to fill in any sunken areas caused by an open wound that healed by itself or by a wide zone of injury. A surgeon may also remove a large hypertrophic scar rather than revise it. Removing a scar enables a surgeon to reclose the incision using specialized cosmetic techniques, resulting in a thinner, less noticeable scar. 

For scars that cover large areas of skin, a surgeon may use a reconstructive technique, such as skin expansion, to allow for replacement of the burn scar with normal skin.  Skin grafts, excision, dermabrasion, or laser surgery are other methods in cosmetic surgery to treat deeper scars. Certain types of injections, such as collagen or other “fillers,” may be useful for some types of pitted scarring, although these are not usually permanent solutions.