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The skin is the tough supple membrane that covers the surface of the body. It is the largest organ of the body and is therefore a vital component in the overall health of the body. The upper layer of the skin is the first line of defense against environmental pathogens. Both the dermis and epidermis provide functions essential to overall health.

The skin is composed of five layers of cells.  It is the surface layer, which is comprised of squamous, scaly dead cells , that is actively involved in the process of exfoliation whereby the dead skin cells are shed and protect the underlying healthy tissue from damage as a result of abrasion.

Our skin is very sophisticated. It helps to keep us cool in hot weather and warm in cold weather and it also prevents us from dehydrating. Our skin is constantly shedding old cells and creating new ones, enabling it to repair itself if damaged. It is the repair process that can result in a scar.


A scar is an essential part of the natural healing process following an injury to the thick layer of skin (the dermis) or the outer layer of skin (the epidermis).  Damage to the outer layer of skin is healed by rebuilding the tissue, and in these instances, scarring is slight.

When we damage the thick layer of tissue beneath the skin, rebuilding is more complicated. Our bodies lay down collagen fibres (a protein which is naturally produced by the body) and this usually results in a noticeable scar.

The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon's skills.  Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar.  There are different types of scars, such as keloid, hypertrophic, and contractures.

After the wound has healed, the scar continues to alter as new collagen is formed and the blood vessels return to normal. This is the reason why most scars will fade and improve in appearance over the two years following an injury. However, there will always be some visible evidence of the injury and hair follicles and sweat glands do not grow back.

Keloid Scars
Keloids are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision. They are often red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.

Keloids can appear anywhere on the body, but they're most common over the breastbone, on the earlobes, and on the shoulders. They occur more often in dark-skinned people than in those who are fair. The tendency to develop keloids lessens with age.

Hypertrophic Scars
Hypertrophic scars are often confused with keloids, since both tend to be thick, red, and raised. Hypertrophic scars, however, remain within the boundaries of the original incision or wound.

Burns or other injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement.


The Scar Biz
How much the appearance of a scar bothers you is, of course, a personal matter.

The Scar Biz functions on the assumption that regardless of degree, the scar will bother you.

While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar by making it less obvious.  This is accomplished through the injection or application of certain steroid medications that provide the optimum healing environment for scar treatment.  Another option is a surgical procedures known as scar revisions.

Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar.

If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. This is generally an outpatient procedure, performed under local anesthesia. You should be back at work in a day or two, and the stitches will be removed in a few days.  No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, the surgeon may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, requiring repeated procedures every few years.

The keloid is certainly a stubborn breed of scar!

Hypertrophic Scars
Hypertrophic scars often improve on their own -- though it may take a year or more!  Your physician would be delighted to assist you quicken this process with the help of steroid applications or injections.

If a conservative approach doesn't appear to be effective, hypertrophic scars can often be improved surgically. The plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anesthesia, depending on the scar's location and what you and your surgeon decide. You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.

Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases a procedure known as Z-plasty may be used. And new techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.


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