Scar treatment encompasses a broad spectrum of surgical and non-surgical techniques aimed at improving the appearance and function of abnormal scars such as hypertrophic, keloid, contracture, or atrophic scars. Scarring is a complex biological process and the aesthetic outcome depends on numerous factors including location, skin tension, skin type, and individual predisposition. The plastic surgeon is the most qualified specialist to evaluate a scar and propose the most appropriate treatment, personalizing the approach based on specific characteristics.
There are several techniques for scar treatment, often used in combination for optimal results: • Surgical revision: excision of the abnormal scar and re-suturing with plastic surgery techniques that optimize orientation, tension, and wound closure • Fractional CO2 laser: stimulates collagen remodeling in superficial, acne, and post-surgical scars, improving texture and color • Corticosteroid injections: intralesional triamcinolone injections to reduce the thickness and redness of hypertrophic scars and keloids • Dermabrasion: mechanical resurfacing of the skin surface to even out irregular or raised scars • Z-plasty and W-plasty: surgical techniques that reorient the scar along the skin tension lines to make it less visible
• Red, raised, and itchy hypertrophic scars that have not spontaneously faded over time • Keloids, scars that extend beyond the original wound margins, often painful or itchy • Contracture scars that limit joint movement or distort surrounding tissues, common after burns or trauma • Deep acne scars that alter facial texture • Extensive burn scars with significant functional and aesthetic consequences • Unsightly or poorly positioned surgical scars that the patient wishes to improve
• Known keloid-forming tendency requires careful evaluation: some techniques like simple surgical revision could worsen the situation, while others (injections, laser, pressure therapy) may be effective • Active skin infections in the treatment area, which must be resolved before any intervention • Scars still in active maturation phase (less than 12 months from the event): waiting for stabilization before surgical intervention is preferable • Unrealistic expectations regarding complete scar disappearance
Duration varies considerably based on the technique used and scar extent: surgical revision of a linear scar takes 30-60 minutes, while treatment of extensive burn scars or complex scar contractures may require 1-3 hours. Non-surgical treatments (laser, injections) take 15-30 minutes per session. Recovery after surgical revision requires 1-2 weeks for suture removal, while the aesthetic result continues to mature for 6-12 months.
The type of anesthesia depends on the technique and treatment extent. For surgical revisions of small to medium scars, local anesthesia is used, which is sufficient to ensure a completely painless procedure. For extensive scars, contractures requiring skin flaps, or treatments in particularly sensitive areas, general anesthesia or sedation may be needed. Laser treatments and corticosteroid injections generally require only a topical anesthetic cream.
Scar treatment results are progressive and require patience. After surgical revision, the new scar goes through an initial phase of redness and thickening in the first 2-3 months, then gradually fades. The definitive result is appreciated after 6-12 months, when the scar reaches its final maturation: becoming lighter, flatter, and softer. For laser treatments and injections, improvement is progressive and generally requires a cycle of 3-6 sessions.
Scars cannot completely disappear: any wound that penetrates the dermis leaves a permanent mark. However, with modern plastic surgery techniques, very significant improvement can be achieved, making the scar thinner, lighter, softer, and less visible. The goal is to transform an obvious, unsightly scar into a fine line that blends into the natural skin folds. The combination of multiple techniques (surgery, laser, injections, pressure therapy with silicone sheets) offers the best overall results.
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