Scar correction is a procedure in aesthetic medicine and is used to remove or disguise bothersome and painful scars. A scar is defined as connective tissue lacking cells and blood vessels that serves as a replacement for the previous, localized tissue after profound injury.
Indications (areas of application)
Scar correction is primarily an aesthetic procedure and serves here the psychosocial well-being of the patient. However, it is particularly useful when it is not a purely cosmetic procedure, such as in the case of scar contracture over a joint. Such a scar contracture can considerably restrict the patient’s mobility (e.g. in the area of the hands) and should be treated. Painful scars are also an indication for scar correction.
Before treatment
Before scar correction, an intensive medical history discussion should be conducted that includes the medical history and motivation for the procedure. The procedure, any side effects, and the consequences of the surgery should be discussed in detail. Note: The requirements of the explanation are stricter than usual, since courts in the field of aesthetic surgery demand a “relentless” explanation. Furthermore, you should not take acetylsalicylic acid (ASA), sleeping pills or alcohol for a period of seven to ten days before the procedure. Both acetylsalicylic acid and other painkillers delay blood clotting and can lead to unwanted bleeding.Smokers should severely limit their nicotine consumption as early as four weeks before the procedure so as not to jeopardize wound healing.
The surgical procedures
The treatment procedure to be selected depends on the nature of the scar. The clinical description of a scar includes width, length, thickness, contour, consistency, elasticity, sensitivity, pigmentation, and the orientation of the scar in relation to the skin lines. A distinction is made between active (pathologic tissue that is metabolically active and continues to grow, for example) and dormant scars.
- Active scars: keloids (bulging scars; excessive scarring that extends beyond the original wound), hypertrophic scars.
- Dormant scars: planar scar plates, scarred contour defects, dehiscent scars (scars that burst or become larger due to increased skin tension), scars that are cemented to deeper structures, scar contractures (e.g., over joints), function-impairing scars
Active scars are primarily treated with conservative therapy. Surgical therapy is performed when no improvement can be achieved or when it comes to dormant scars. Conservative therapy is also used as an adjunct to surgical therapy and includes the following elements:
- Intralesonal injection of corticosteroids (triamcinolone acetonide, TAC; has anti-inflammatory (anti-inflammatory) effects and may inhibit/inhibit fibroblast synthesis) [see below Cicatrix (scars)].
- Cryosurgery – targeted icing of scar tissue with subsequent necrosis (tissue death) of the lesion.
- local silicone films
- For prophylaxis of de novo development (new formation) of hypertrophic scars or keloids (bulge scars) in high-risk patients.
- After surgical therapy
- Compression of the scar by pressure dressings (usually in combination with silicone sheets).
Today, the combination of cryotherapy and intralesional corticosteroids (TAC) is often considered the treatment of choice. Icing loosens the scar tissue, making it easier to inject the corticosteroid. Surgical scar correction is based primarily on the shape and quality of the scar. The incision should be made along the skin tension lines to improve healing and make the scar less visible. It is an aesthetic plastic surgery that usually cannot completely remove the scar. Nevertheless, significantly improved results can be achieved. The following surgical procedures make scar correction possible:
- Dermabrasion – an abrasion of the epidermis (top layer of skin) to correct extensive scarring.
- Z-plasty – a triangular skin flap is placed at a 45° angle to the scar line to match the natural skin tension lines. The scar is now Z-shaped and less noticeable
- Complete excision – excision of the scar tissue followed by readaptation (direct attachment of the wound edges by suturing) or displacement plasty (a skin flap from an adjacent region is used to close the wound).
- Flapplasty – a skin flap with an existing blood supply is sutured over the lesion to close it
- Skin grafting
Surgical scar correction of smaller defects is usually performed on an outpatient basis. For treatment of larger scars (for example, flapplasty), an inpatient stay of several days should be expected. Smaller corrections take place under local anesthesia, but general anesthesia is also possible.
After the treatment
Immediately postoperatively, the wound is dressed with a bandage. The stitches of the skin suture are removed after sufficient wound healing (about one week). Pain can be managed with medication. Especially in the postoperative care of scar contractures over joints, physiotherapy is often required to restore full range of motion.
Benefits
Scars are not just unaesthetic skin lesions. They can be painful and, in the case of contracture, significantly limit joint mobility. For this reason, scar correction is a useful medical procedure that can positively affect both self-confidence and well-being.
