Every surgical procedure, however big or small, will have a scar – period.
There are NO “scar-less” procedures.
Every cut on the skin will result in some kind of a scar. The aim with every surgical procedure, of course, is to produce a scar that over time becomes faint and, if possible, hidden in a naturally occurring skin crease.
Every effort is put in place when closing a wound to avoid an adverse scar. These include gentle tissue handling, precise wound approximation, and placing multiple layers of sutures to hold tension off the wound. Post-surgery measures such as taping, moisturising, sun protection, and silicone therapy also play important roles in scar management. Scars are always going to be slightly red and “lumpy” in the first few weeks after surgery. Massaging the scar after this initial healing period can help to reduce swelling and to soften the scar line.
There are rare occasions when an unfavourable scar occurs. These are known as hypertrophic or keloid scars. Both are scars that are bigger and more prominent than what’s expected. The difference between the two is that a hypertrophic scar is prominent but remains stable in size, whereas a keloid scar continues to increase in size, much like a tumorous growth. There are no firm explanation as to why these types of abnormal scarring occur in some people and not in others. It is often not predictable, and can occur weeks to months after the surgery. Certain skin types and races – in particular, races with darker skin pigmentation – are at higher risk of getting a more prominent scar. A personal or family history of bad scarring also puts a patient into a higher risk category.
When adverse scarring occurs, it must be actively treated in order to halt the abnormal scarring process and to prevent it from getting worse. Current ways of treating adverse scars include silicone therapy, steroid injection, radiotherapy, and surgical excision. As tempting as it may seem to simply cut out the offending scar, surgery is often reserved as a last resort. It must be remembered that re-operating in an area that’s already had a bad scar carries a predictably high risk of getting another bad scar, which sometimes can be worse than the original scar. It is generally more prudent to attempt more conservative measures first. Treatment for adverse scars requires tremendous patience, for both doctor an patient. Results may not be evident immediately, and repeated treatments may be necessary to attain satisfactory outcomes.
The vast majority of wounds will, over time, heal up without any concerns whatsoever. It is the rare and often unpredictable occasion when an adverse scar occurs which necessitates the mention of scarring as a possible risk factor for all surgeries that involve knife to skin.