A scar is the residual visible part of a dermal lesion after the tissue has been repaired, following an incision during surgery or after an injury.
Cicatrization is an integral part of the healing process. Apart from very minor lesions, each injury (after an accident, illness or surgery) causes a more or less significant scar. The scar tissue is not identical to the tissue it replaces and is usually of inferior functional quality. For example, skin scars are more sensitive to ultraviolet radiation, sweat glands and hair follicles do not develop under the scar. However, some tissues (e.g. bone) can heal without structural or functional deterioration.
It is impossible to completely remove a scar, whether by surgery or by any other means (ointments, tattoos, peeling, laser…).
In most cases, only stabilized scars can be treated at the end of their natural evolution (6 months to 2 years). Indeed, the healing will take place mainly in three phases. The first phase begins a few days after the operation; the scar is generally beautiful and fine. Then, during the 1 to 2 post-operation months, it becomes redder, hard, puffy and itchy. This stage lasts on average 3 to 6 months. The scar then enters its final phase where it begins to whiten and soften. In the same way, the itching disappears. At the end of this more or less long and unpredictable process, the scar is indelible, white, flexible and insensitive.
Throughout its evolution, it is important to take care of your scar so that it becomes as discreet as possible: it must be protected from the sun (clothes, hat, protective sunscreen), moisturized with creams and massaged daily. In some cases, your surgeon may prescribe silicone plate or gel to reduce redness or puffiness.
Attempts at surgical correction are only legal in the following cases:
Retractile scars: very indignant and "curled up", not allowing themselves to be stretched, very unsightly and sometimes even limiting certain movements by creating "straps".
Ulcerated scars: their fragility leads to frequent superficial "scratches" that become permanent, deepen and worsen.
Hypertrophic or keloidal scars: inflammatory, painful, red, enlarged and especially swollen "in relief". Their treatment is very delicate and subject to frequent recurrences
Unsightly scars: wide, colored, irregular, offset, sunken, adherent…
Duration of hospital stay
Pure local anaesthesia or an analgesic product.
Average length of stay
1 to 3 days.
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An interview followed by an examination of the incriminated scar will have been carried out by the surgeon in order to specify the surgical possibility (s).
In the event of anaesthesia other than purely "local" anaesthesia, a pre-anaesthetic check-up may be prescribed and a pre-operative consultation with the anaesthetist is mandatory.
No medication containing aspirin should be taken within 10 days of the procedure.
Depending on the type of anesthesia, you may be asked to fast (no food or drink) 6 hours before the procedure.
No make-up, jewellery or piercing should be worn during the operation.
Type of anaesthesia:
Pure local anaesthesia where an analgesic product is injected to ensure the insensitivity of the area to be operated on. This is the most frequent case for basic Dermato-Surgery.
Vigil anaesthesia (local anaesthesia deepened by tranquilizers) during which you can stay awake but where you will be relaxed and from which some amnesia about the operation may result. It may be preferred for reasons of personal comfort or for the realization of certain complex flaws, especially on the face.
Classical general anaesthesia during which you sleep completely, in fact rarely useful in Dermatology and Surgery.
The choice between these different techniques will be the result of a discussion between you, the surgeon and the anesthesiologist.
Basic Dermato-surgery procedures, especially if they are performed under pure local anaesthesia, do not necessarily require hospitalisation and can, like dental treatment, be carried out in an office, provided all the necessary equipment is available.
If the procedure is scheduled in a clinic or hospital, it can usually be performed " externally ", i.e. with an entry just before the operation and an exit just after the operation or " ambulatory ", i.e. in "day hospitalisation" with a discharge on the same day after a few hours monitoring. Traditional hospitalization with a night to spend on site is exceptional for this type of surgery.
In the simplest cases, it is sufficient to excise the defective scar and close it with a perfect suture technique to hope to obtain a new, more discreet scar.
Often, it is necessary to use a special incision line to "break" the main axis of the initial scar, to redirect the scar as best as possible according to the skin's natural tension lines and thus reduce the tension exerted on the wound edges.
For very extensive scars, several techniques can be used alone or in combination:
Excision in several stages allowing the skin to relax between two operating times (the so-called "iterative excision" principle)
Skin graft taken from another region
Local plasty with displacement of a neighbouring flap of skin so that it covers the scarring area.
Skin expansion thanks to inflatable balloons placed under the surrounding healthy skin and allowing it to stretch as the swelling progresses (over several weeks) in order to use the excess skin obtained when the balloons are removed to cover the scarring area.
In any case, your surgeon will explain to you which solution is best suited to your personal case.
You may experience some discomfort with a feeling of tension on the scar, but real disabling pain is rare.
During the first few days, it is important to avoid "forcing" the scar. Caution should be exercised with regard to movements that would place too much stress on the operating area.
In the hours following the procedure, a small oozing of blood (red) or lymph (yellow) may slightly stain the bandage. Within the first 48 hours, the operated area may also sometimes show edema (swelling) and small bruises that are only transient.
Itching is also quite frequent during the healing phase. All these findings are not worrying and should be considered as "usual" consequences.
Stitches, when they are not absorbable, are removed between the 5th and 15th day.
The scar can then be massaged according to your surgeon's instructions.
Concerning exposure to the sun, as long as the scar is still dark, it is preferable to avoid any exposure and to use a "total sunscreen" type of protection.
A period of several months (sometimes up to one to two years) is necessary to assess the final appearance of the scar.
It must be understood that scarring remains a random phenomenon whose quality can in no way be guaranteed. The perfect technical expertise of a qualified plastic surgeon specifically trained for this type of operation makes it possible to put all the chances on ones side but does not eliminate this random aspect.
In the context of surgical correction of abnormal scars, it is essential to regularly monitor the evolution and appearance of the scar. This is the only way to ensure that possible scarring disorders are identified in time and that appropriate treatment is applied.
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