Hypertrophic Scar Treatment and Removal
Hypertrophic scars can form on the face as a result of severe acne. These are also typical in patients who may have had cuts or burns that were poorly healed. Hypertrophic scars are often mistaken for keloids and look similar but do not extend beyond the borders of the scar.
Acne lesions damage the surrounding tissue when they penetrate the skin deeply. Collagen is the body’s natural way of repairing damage. Overproduction of collagen leads to the formation of an elevated scar that may be red or highly pigmented. The back, chest, and even the face are the areas where these scars are most prevalent. Board-certified plastic surgeon Dr. Solomon Azouz offers the best hypertrophic scar treatment to his patients in Dallas.
What is a Scar Contracture?
Scar contracture occurs when the skin tightens excessively around a healed wound, often leading to restricted movement and deformity. This condition is commonly seen in cases of severe burn injuries, where the underlying tissues and surrounding skin pull together tightly throughout the healing process, resulting in a restricted and sometimes painful area. Some hypertrophic scars can develop scar contractures. Contractures can seriously impair the function of muscles and joints close to the scar, requiring surgery to return to their natural state of movement and appearance.
Candidates for Surgery and Treatments
Good candidates for the removal of hypertrophic scars are those who:
- Feel distressed on an emotional or psychological level as a result of the scars’ appearance
- Are in good overall shape and have reasonable expectations regarding the surgery’s results
- Have no uncontrolled medical disorders that could hinder healing, such as active skin infections
- Some may have scar contractures that restrict their mobility or cause them physical discomfort
The benefits of hypertrophic scar removal include:
- Enhanced confidence and self-esteem due to an improved cosmetic appearance
- Reduced discomfort, irritability, and pain brought on by hypertrophic scars
- Improved range of motion if there is scar contracture
- Long-lasting outcomes with appropriate maintenance
How to treat a hypertrophic scar?
There are many options for treating hypertrophic scars. During your consultation, board-certified plastic surgeon Dr. Azouz will determine the best treatment for hypertrophic scars depending on your physical exam and desired goals.
- Surgical Excision: Board-certified plastic surgeon Dr. Azouz gently removes the elevated scar tissue and meticulously closes the incision. In some cases, Dr. Azouz may use specific scar revision techniques, such as a Z-plasty or W-plasty, to help decrease scaring and tension.
- Laser Resurfacing: To resurface the skin, lessen the thickness of the scar, and enhance its texture and color, high-energy laser beams are used. For this, pulsed dye lasers and fractional CO2 lasers are frequently utilized.
- Steroids: To lessen inflammation and stop more collagen formation, corticosteroids are injected straight into the scar tissue. Over time, this may cause the hypertrophic scar to thin and become softer. In some cases, Dr. Azouz may prescribe a steroid cream for mild cases.
- Dermabrasion: By mechanically removing the outermost layers of skin, this procedure smoothes out scars and makes them mix in with the surrounding skin. It’s frequently applied to less severe, smaller hypertrophic scars.
- Silicone Gel and Silicone Sheeting: To further flatten the scar and lessen redness in the treated area after surgery, silicone gel or silicone sheets can be placed.
- Z-Plasty: This is a surgical method for loosening constricted scar tissue. Small triangular skin flaps are created during the surgery and later adjusted to expand the scar and enhance the final appearance and functionality. This technique shifts the scar to a less obvious spot while also relieving tension.
- Skin Grafting: Skin grafting could be required if a significant portion of the skin is damaged. This entails transplanting healthy skin to the location where the scar contracture has been loosened from another portion of the body (donor site). This aids in bandaging the wound and encourages recovery.
- Tissue Expansion: In this method, a tissue expander, which resembles a balloon, is inserted beneath the skin close to the scar. To stretch the skin, saline is gradually poured into the expander over time. The expander is taken out once there is sufficient new skin, and the scarred area is replaced with the new skin.
- Flap: Local or regional flaps may be used in more severe instances. This involves transferring a portion of healthy tissue to the damaged location, complete with its blood supply. This method aids in producing skin coverage that is both useful and more natural-looking.
Keloids grow outside the edges of the incision and can eventually grow to be considerably larger than hypertrophic scars, which are elevated and remain inside the original wound's bounds.
Depending on the kind of skin, hypertrophic acne scars can appear differently.
- Lighter Skin Tone: With appropriate care and time, scars can progressively disappear from their reddish or pinkish appearance.
- Darker Skin Tone: Hyperpigmented scars can have a darker hue and are more likely to cause prolonged inflammation, as well as a higher risk of post-inflammatory hyperpigmentation (PIH).
Underlying medical conditions may have an impact on scar healing and formation:
- Autoimmune Disorders: Disorders such as rheumatoid arthritis or lupus can interfere with the skin's natural healing mechanism, which may raise the possibility of hypertrophic scarring.
- Vascular Conditions: Circulation-related disorders may have an impact on how scars form and react to treatment.
- Hormonal Imbalances: Changes in hormone levels, such as those that occur during pregnancy or puberty, can have an impact on the formation of scars and collagen.
Yes, lifestyle alterations can play a role in scar therapy outcomes:
- Giving Up Smoking: Quitting smoking could speed up the healing of scars and lower their risk.
- Nutrition: The general health and healing processes of the skin are supported by a well-balanced diet high in vitamins and antioxidants.
What is the treatment for scar contracture?
If the scar develops a contracture, Dr. Azouz can remove the hypertrophic scar and release the contracture in the same procedure. To close the incision, various techniques can be used, including:
Anesthesia for hypertrophic scar removal
The specific type of anesthesia used during the excision of hypertrophic scars or scar contracture depends on the procedure. Some procedures can be conducted with a local anesthetic, which numbs the area around the scar. If surgery is recommended, Dr. Azouz uses local anesthesia with sedation to help keep the patient comfortable during surgery.
Risks of Surgery
While hypertrophic scar removal is generally safe, there are potential risks, including infection, temporary numbness, or bleeding. Dr. Azouz will discuss the risks before surgery along with the specific techniques that will be taken to reduce them.
Recovery After Surgery
The recovery depends on the specific procedure used to treat the hypertrophic scar and scar contracture. Typically, there may be some swelling that resolves with time. During your routine follow-up visits, Dr. Azouz will monitor your progress and give personalized recommendations to improve scarring. It is best to avoid direct sunlight and use sunscreen as the scar heals.
Cost of Hypertrophic Scar Treatment
The cost of hypertrophic scar removal varies based on factors such as the technique used, the complexity of the case, anesthesia, and facility fees. Dr. Azouz offers a thorough quote depending on your unique treatment plan during your consultation.
Schedule your Consultation with Dr. Azouz
Removing hypertrophic scars can greatly improve your appearance and ease your discomfort. Call the office at (972) 702-8888 or contact us online to schedule your appointment with Dr. Azouz today for options on the best treatment for hypertrophic scars.