A scar is the visible mark on the skin left
by trauma – of which surgery is one,
very controlled example. A surprising proportion
of many plastic surgeon’s workloads
involves camouflaging, de-accentuating and
at times, radically revising surgical and
Something in the region of 70% of the process
in which the body produces a finished scar
is out of a surgeon’s control: factors
such as where the wound is made on the body;
the body’s genetic predispositions;
where ladies are in their menstrual cycle
when a wound is made; your nutritional state;
your age; your skin tone; whether or not
you smoke or passively inhale tobacco; whether
or not your wound becomes infected, or receives
a knock whilst it’s healing can have
major effects on the final result of a scar.
Only 30% of the final result is truly a
function of surgical expertise and technique.
That said, there is a great deal that your
surgeon can do to influence the 70% that
isn’t strictly down to the surgeon
and knowing how and when to do that can
make all the difference.
Scars which heal nicely are not usually
a source of concern for patients, so I’ll
concentrate on the rest which are, broadly
speaking, scars which stretch and widen
or scars which become raised and lumpy –
of which there are two sorts: hypertrophic
scars and keloid scars.
These can be the result of suboptimal surgical
technique, but can also result from the
wound being banged accidentally in the first
few weeks of healing; or from infection
during healing; or in the same way that
stretch marks occur, secondary to rapid
weight gain or pregnancy.
Most stretched scars can be surgically revised
and improved using plastic surgical expertise
and fundamental techniques.
These have in common an abnormal metabolism
of the protein molecule collagen which is
the main component of scars; but otherwise,
the genesis of hypertrophic scars and keloid
scars is very different. They appear similar
to the untrained eye, however, and the difference
confuses many doctors who don’t specialise
in dermatology or plastic surgery.
There are many treatment options for lumpy
scars but the important thing is to make
the correct diagnosis first and then tailor
the management of abnormal scars accordingly,
whilst paying careful attention individual
The afro-caribbean population in the UK
is especially susceptible to keloid scars
and as a result, over many years, I have
gained a considerable experience and expertise
in the surgical and non-surgical options
for treating these scars.
Treating patients with these scars can be
immensely satisfying because patients have
often given up hope and resigned themselves
to what is often both a painful and an unsightly
blemish, so I am always happy to consult
with people and colleagues on how best to
manage these scars.