Depending on the size and type of scar to be treated, it may be possible to treat your scar revision in different ways. The procedures usually take about 30-60 minutes (approx). It may be possible to improve the appearance of red, itchy and/or unsightly scars either by steroid injection, silicone gel tape or surgical excision. Steroid injection can be performed under Local Anaesthetic and may require a few injections over time to improve the appearance. Silicone gel tape is applied to the scar and worn for virtually 24 hours a day. It is removed for washing/bathing and each piece lasts a few weeks. Surgical excision can be performed under Local Anaesthetic. Sutures will need to be removed (if not dissolving) and a pressure garment may be required. If a large scar, serial excision may be required. The scar will need moisturising (with a bland moisturiser) and massaging to help with the final result. Skin coloured surgical tape is applied for a minimum of 2 weeks to help support the scar. Sun block should be worn for 18-24 months over the affected area as it will be prone to burning.
KELIOD AND HYPERTROPHIC SCARS.
Hypertrophic scars and keloids are difficult to improve and remain a therapeutic challenge. Every time the skin is cut or injured it will heal with a scar. Some people make better scars than others. In general patients with black and pigmented skin will tend to produce poor scars including keloids and hypertrophic scars .Certain areas of the body are known to produce keloid scars than others.
The worst areas are the chest, shoulders and over bony prominences, but fortunately the face and neck produce good scars .Scars which lie in the lines of skin tension are better than ones that run across them. Prevention is the foremost in keloid therapy. Avoid performing unwanted cosmetic surgeries in patients known to form keloids. Suture all surgical wounds with minimal tension. Incisions should not cross joints and avoid making chest incisions, and make sure that incisions follow skin creases whenever possible. Treatments include Intralesional Steroid injections, occlusive dressings, and compression therapy,. Intralesional steroid injections have been the mainstay of treatment.Intralesional steroids reduce excessive scarring by reducing collagen synthesis. The most commonly used steroid injection is Triamcinolone acetonide (TAC) in concentrations of 10-40 mg/ml, given intralesionally into the scar with 25- to 27-gauge needles at 6-week intervals. Other measures include occlusive silicon sheets on top of these scars. They are used for periods of 3- 6 months. Compression therapy with pressure garments is also very effective. Compression treatments also include button compression, pressure earrings, elastic adhesive bandages, compression wraps, and support bandages. Compression therapy involves pressure, which has thinning effect on skin.
Intense Pulse Light ( IPL) laser when used along with intra lesional steroids can produce a marked improvement in the scar texture , colour improvement and reduction in scar height.