BENGALURU: Time and again, scars have been part of the social commentary for a wide variety of reasons. They have been variously described as symbols of valour, silent witnesses to misery, or the relics of plain misfortune. In the present era, however, a scar is often regarded as undesirable – a blemish which requires treatment. Plastic surgeons deal with a wide variety of scars – post-surgical, traumatic, post-infective or even as sequelae of other interventions.
The treatment modalities vary as much as the types of scars. Vast majority of patients with scars are worried about the outcome. They are a logical outcome of a healing process, following damage to the skin. If the superficial layer is damaged, healing occurs by regeneration, leaving almost no scar. However, if the deep layer is damaged, it happens by repair, which means a scar is inevitable.
Most scars heal uneventfully leading to a fine linear scar. However, in some cases, overhealing happens which results in keloid or hypertrophic scars. Patients come to plastic surgeons to remove the scar completely, which is next to impossible.
They are often frustrated because of their appearance, repeated questions by others like, “What happened?”, or “Why are you not getting it removed?” Some of the scars are sinister in appearance leading to difficulty in employment. Most of the patients need reassurance and generally every scar will improve in about 1-2 years. Scars need time to mature before planning a scar revision.
Treatment of scars can be by non-invasive techniques like medications, massage, silicone gel sheet application, pressure garments, and lasers. All scars are not managed well by lasers. Careful selection of patients is mandatory to achieve good results. Scar revision by surgical techniques like excision, Zplasty, fat augmentation and microdermabrasion can be employed in suitable patients after careful assessments which provide predictable results.
It is a misconception that plastic surgeons do scar-less surgery. It has to be emphasised that by placing the scars in relaxed skin tension lines, or hidden areas, the appearance can be minimised. However, it must be remembered that a scar is a logical outcome of any injury or surgery. Nobody can do a scar-less surgery. However, plastic surgeons can do a ‘less scar’ surgery. (The writer is consultant -- plastic, reconstructive & cosmetic surgery, Manipal Hospital Old Airport Road)