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Contents

    Scar problems

    Scars are not only an aesthetic problem. Near the joint, scars limit mobility. Near the eye, scars interfere with the closing of the eye or cause a watery eye. Around the mouth, scars distort the facial expression.

    This creates a scar:

    The aim of a good skin suture is a tension-free, gentle and exact adaptation of the wound edges so that the wound heals as inconspicuously and quickly as possible. Therefore, wounds are ideally sutured with very fine threads and under optical magnification.

    1. 1st week: During these days, scabs form.
    2. Week 2: Final scar tissue develops, the wound contracts.
    3. Week 3: The scar tissue begins to lighten and flatten slowly. The scar has reached 20% of its final firmness.

    Scar healing takes 6 to 12 months. In the first few months, scars are reddened, possibly painful or itchy and sometimes slightly raised above the skin level.

    As a rule, after a year scars are pale, soft, painless and flat.

    What can I contribute to favourable scar healing?

    • UV rays (sun or solarium) can lead to a permanent dark discoloration of the scar. Protect your scar with sun protection factor 50 or UV-impermeable clothing, especially in the first year.
    • The healing of wounds and scars is negatively influenced by the following factors: smoking, excessive exercise or germ colonisation.
    • In the third postoperative week, scar healing can be supported by multiple daily massages. How? It is best to apply for a few minutes in circles as well as lengthwise and crosswise to the course of the scar and with greasing creams as e.g. Bepanthen® Ointment / Linola® Fat.
    • Silicone plasters prevent the formation of bulges and soften the scar (e.g. Cica-Care by Smith and Nephew or Medipatch Gel Z® by asclepios Medizintechnik e.K.). For this purpose, the silicone patch should be worn continuously for one year.
    • Compression treatment with special compression underwear also supports favourable scar healing. Compression underwear must also be worn continuously for the entire duration of the scar healing process, i.e. one year.

    How scars heal best

    Scars are not only an aesthetic problem, they can also restrict functionality.

    What is a keloid scar?

    Growing, itchy, reddish or dark scars are called scar growths. Scar growths are known as keloids. The main characteristic of a keloid is that it grows beyond the borders of the injured tissue after the wound has already been closed. Keloids occur preferentially on the ears, shoulders and upper chest.

    What’s a hypertrophic scar?

    Hypertrophic scars are thick raised scars that do not grow beyond the border of the scar. However, the healing phase lasts up to one year.

    What is a scar contracture?

    Injuries to the skin that lead to the loss of tissue, such as burns, can cause a firm and contracted scar. This is called contracture. For surgical treatment, removal of the contracture and covering of the defect with a skin flap plastic or a graft is necessary.

    Which procedures do we offer for scar correction?

    • Surgical scar correction
    • Z-plastics
    • W- plastics
    • Injection of scars with autologous fat
    • Microneedling against scars
    • Injection of scars with cortisone

    The result of the scar correction depends on the type, size and course as well as on the individual wound healing, postoperative protection and scar care.

    What is the difference between keloids and hypertrophic scars?

    Wulstige Narbe (hypertrophe Narbe)Wuchernde Narbe (Keloid)
    AppearanceErhaben, auf die Wunde begrenztWuchernd über die Wundränder hinaus
    Healing tendencyBildet sich zurückKeine Rückbildungstendenz
    Scarring siteKeine PrädilektionsstellenVor allem an Ohren, Brustbein
    HealingSpontane RückbildungKeine Rückbildung
    Family inclinationKein RezidivgefahrHohe Rezidivgefahr
    Scar shrinkageMögliche KontrakturKeine Kontraktur
    Treatment methodsExzision, Kortisoninfiltration, Druck, SilikonExzision, Kortisoninfiltration, Druck, Silikon, Bestrahlung, 5-Fluorouracil
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    Which treatment methods do we offer for keloids?

    The selection of the right treatment together with you is the decisive step to success. We carry out the following treatments frequently and with good experience:

    • Removal of the keloid
    • Injection of keloid with cortisone
    • Injection of keloid with 5-fluorouracil

    Because keloids occur again and again, combined procedures such as surgical removal with injection or radiation are very advantageous. Pressure dressings with silicone foils delay the recurrence.

    Scar correction

    Since up to one year after wound closure the scars spontaneously become paler, flatter, softer and the pain less, surgical scar corrections should not be carried out earlier. In the case of medical indications, e.g. functional limitations, the treatment costs are usually covered by the health insurance.

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    The author

    Dr. med. Stéphane Stahl

    “We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”

    Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.

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