This procedure is usually performed under local anaesthesia when it is felt that an existing scar can be improved because of particular circumstances or complications of healing in the first instance, or because the procedure is likely to be carried out in a better manner. Post-operative pain is usually minimal. Sutures (stitches) are usually removed in four to six days from the face and seven to ten days from other parts of the body. However, dissolving sutures are frequently used on the trunk and limbs to avoid post-operative stitch marks.
Stitch marks are much less likely to appear on the face as stitches are removed early. All new scars will initially be red. Fading occurs within six to twenty four months depending on the scars location and the patient’s skin type.
Scars caused by active acne are difficult to treat. On the face it is sometimes possible to cut out the deep scars or to lift them to normal skin level. Dermabrasion and chemical peels have been used to reduce the overall depth of scars and to tighten the skin. More recently laser resurfacing has been used for the same purpose and has become very popular. It should be stressed that these treatments do not remove the scars and at best, give a moderate improvement. None of these surgical procedures are suitable away from the face. Other procedures that can occasionally be helpful are facelifts to tighten the skin and simple excision of badly affected areas.
Deeper burns tend to heal with scars. Children are particularly badly affected and suffer thick red hypertrophic scars as a result of scalds. The main route of treatment is with pressure garments, but silicone applications can also be helpful. Surgery is used to replace very severe scars with skin grafts and to reduce tension in the scars by putting in extra skin extensions.
These are a difficult to resolve scars. The easiest to treat are earlobe keloids which sometimes appear after piercing and often simple excision is adequate. Elsewhere a course of steroid injections are the main treatment, rarely, excisions to try and reduce recurrence of keloids can be helpful.
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