Healing a scar & scar treatment
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.
- 1st week: During these days, scabs form.
- Week 2: Final scar tissue develops, the wound contracts.
- 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.
Description: Mathematically speaking, the course of scar healing can be compared to an asymptotic curve. This means that in the first weeks and months very much changes. Collagen is produced to close the wound as quickly as possible. As a result, the collagen is remodeled so that it is ideally aligned according to the tension conditions of the skin. The rebuild takes much longer. At first, the scar may be red, raised, hardened and may itch. After nine to twelve months, the scar eventually becomes pale, flat and soft. After one year, a scar has reached its highest tensile strength. However, a scar does not reach the tensile strength of the original tissue.
Die Wund- und Narbenheilung vollzieht sich in vier verschiedenen Etappen. Im ersten Schritt wird die Blutgerinnung der Wunde aktiviert. Die zweite Phase kommt es zur Einwanderung weißer Blutkörperchen, die den Körper vor dem Eindringen von Keimen schützen. In der dritten Phase überwiegt die Bildung von Kollagen durch Bindegewebszellen. Im letzten Abschnitt der Narbenheildung wird das Kollagen umgebaut und entsprechend der Spannungskräften der Haut ausgerichtet. Die letzte Phase dauert bei jungen Menschen etwa ein Jahr.
1.) Blood coagulation (Day 1)
2.) Inflammatory reaction (day 2-3)
3.) Cell proliferation (day 3-7)
4.) Conversion phase (from day 8)
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) | |
| Appearance | Erhaben, auf die Wunde begrenzt | Wuchernd über die Wundränder hinaus |
| Healing tendency | Bildet sich zurück | Keine Rückbildungstendenz |
| Scarring site | Keine Prädilektionsstellen | Vor allem an Ohren, Brustbein |
| Healing | Spontane Rückbildung | Keine Rückbildung |
| Family inclination | Kein Rezidivgefahr | Hohe Rezidivgefahr |
| Scar shrinkage | Mögliche Kontraktur | Keine Kontraktur |
| Treatment methods | Exzision, Kortisoninfiltration, Druck, Silikon | Exzision, Kortisoninfiltration, Druck, Silikon, Bestrahlung, 5-Fluorouracil |
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.
You may be interested in
The author
“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.