Following surgery or trauma, a significant portion of patients experience scar thickening, which is generally divided into two categories. The thicker scars are defined as hypertrophic. Though these scars are typically red, firm and raised, they “fit” within the previous boundaries of the surgical incision and do not grow outside of the original trauma area. The second category of scars, known as keloids, is a different form of thickened scar. They are often found in a familial pattern meaning a previous genetic predisposition may exist in the patient leading to keloid formation. Though similar in appearance to hypertrophic scars, keloid scars invade surrounding tissue resulting in an overgrowth of tissue that extends outside of the boundaries of the previous surgical incision or laceration.
Causes that may contribute to scar thickening are tension at the site of the incision, history of smoking, surgical technique and local trauma such as thermal injury. Most often, very finely closed incisions will still result in hypertrophic scars and this must be initially addressed with conservative management including taping, the use of silicone gel sheeting or liquid silicone gel applications. Historically, studies with patients presenting a keloid or chronic hypertrophic scar have shown that silicone gel sheeting application along with the use of steroids such as kenalog injections and local radiation can be helpful in diminishing or reversing scar thickness. Over-the counter medications, including Mederma® and Scarguard®, are also available for conservative scar management.
Most hypertrophic scars will mature for up to 2 years following surgery. In many cases, after the scar has matured, excision and re-closure of the scar may be necessary and in these secondary closures, the scar may not become thick because tension lines are different in the secondary revision procedure. Some patients will also benefit from procedures such as an Intense Pulse Light (IPL) or Fraxel laser resurfacing treatment to diminish scar visibility as well as decrease redness and vascularity. Fortunately, the formation of hypertrophic and keloid scars are rare. When they do occur, plastic surgeon Dr Golshani can modify their post-operative care to improve their outcome and long-term results.