What is a scar
Scar tissue forms as a result of tissue injury, an open wound, or during normal wound healing after suturing. A scar can heal as an inconspicuous linear scar, a broad scar, a depressed scar, or a raised scar. Raised, coarse scars are also called “hypertrophic scars.” In cases of very pronounced scar overgrowth, accompanied by itching and pain, the condition is referred to as “Keloid“.
Different types of scar
Healed scar in the shape of a line:
Normal wound healing, inconspicuous scar
Depressed scar (hypotrophic scar), Akne-Narben:
Trough-shaped scars are a depression in the skin with loss of the cushioning layer of fat. The causes are varied and can occur, for example, as a result of acne or cortisone injections with atrophy of the fatty tissue.
Painfully retracted scar:
In the case of painful scars, the cause is often a retraction of the skin onto the underlying muscles. The cushioning layer of fat between the skin and muscles is missing. This results in a painful retraction that can cause problems, especially during movement.
Coarse, thickened scar (hypertrophic scars):
Raised, broad and coarsely healed scar, which can also be painful.
Proliferating scar (Keloid):
This is a very severe scar proliferation beyond the edge of the wound, associated with itching and pain. Keloids tend to occur above the breastbone, on the shoulders and ears.
Information on scar treatment
Depending on the cause and type of scar, there are a variety of treatment options:
Healed scar in the shape of a line:
A normal skin care cream is sufficient here, possibly apply Bepanthen ointment twice a day (dexpanthenol, vitamin A).
Trough-shaped scar (hypotrophic scar), e.g. acne scars:
There are various treatment options:
- Surgical needling
- Autologous Fat Grafting
- Surgical removal and tension-free wound suturing
Painfully retracted scar:
Surgical correction:
- In this case, surgical correction with removal of the painful scar cord and relining of the scar with well-perfused fatty tissue is advisable.
- Alternatively, a scar cord can be loosened in a minimally invasive procedure using a special instrument through a small incision in the skin and relined with autologous fat.
Rough, thickened scar (hypertrophic scars):
- Dermojet treatment: An early cortisone injection (triamcinolone, Volon A) is recommended here to slow further growth and make the scar flatter. This injection is administered using a special high-pressure injection device (Dermojet) and is performed on an outpatient basis over several weeks (every 2–3 weeks), taking only a few minutes. Thanks to the combination with a local anesthetic in the Dermojet device, the treatment is well tolerated.
- In the Dermabrasio the uppermost layers of skin are removed using a special, high-frequency grinding device. This flattens the scar, but does not make it completely invisible.
Surgical correction is advisable in the event of problems and pain:
- Excision of the scar and tension-free closure of the wound
- For cord-like scars, e.g., in areas spanning joints such as the fingers, armpits, groin, knees, or neck, surgical correction by repositioning skin flaps (e.g., Z-plasty) or applying a skin graft is recommended (Vollhaut or Spalthaut)
Burn scars:
Depending on the location and type of scar (flat or cord-like), the following are possible options:
Two-dimensional scar:
- Silicone treatment and compression using e.g. compression garments, pressure pads
- Dermabrasion (Dermabrasio) and e.g. ReCell-Therapie
- Surgical needling of the scar in several surgical sessions, possibly in combination with Co2-Laser
- Insertion of a Expanders to stretch the adjacent healthy skin over a period of 3–6 months. Removal of the expander, excision of the extensive burn scar, and use of the stretched, healthy skin to close the wound.
- Removal of an extensive scar and application of a skin graft (full skin or split skin)
Strand-shaped scar:
- Excision of a scar strand and dissolution of the scar by moving skin areas (e.g. Z-plasty) or application of a skin graft (full skin or split skin)
Proliferating scar (keloid):
For keloids, if possible not surgery, as this can cause the scar to grow even more aggressively.
- It makes sense to inject cortisone (triamcinolone, Volon A) at an early stage in order to slow down further growth and flatten the scar. This injection is carried out using a special high-pressure injection device (Dermojet), is performed on an outpatient basis over several weeks (every 2-3 weeks) and takes a few minutes.
- The effect of this treatment can be further improved with silicone pressure pads and compression.
- If there is no response to dermojet treatment, surgical removal followed by radiotherapy (X-ray irradiation to slow down growth) may be considered after the patient has been informed in detail about the risk of recurrence and worsening of the condition.
- Alternatively, local icing of the tissue (cryotherapy) can be used.
General recommendation for scar treatment
For scar care, we recommend scar ointments such as Kelocote®, Scarban®, Contractubex®, or Bepanthen® Scar Gel. Alternatively, a self-adhesive silicone patch can be used. These are available at the pharmacy. After the sutures are removed, you should treat the scars twice daily with a scar gel until the scars become softer overall. The gel should be applied for at least 3 months to achieve good results. Depending on the patient’s age, a scar remains malleable for approximately 1–2 years. Scar treatment should therefore be carried out consistently.
Hospital stay and anesthesia
Scar treatment can be performed under local anesthesia of the surrounding tissue or under general anesthesia. A hospital stay for scar treatment (except for Expanderinsertion) is generally not required.