What are scars?

Scars are the body's natural way of healing from an injury, and are an inevitable part of the healing process. Each scar is unique to the individual and the circumstance in which it is formed. The way they develop is also unpredictable.

Poor healing may contribute to scars that are obvious, unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be raised or recessed, different in color or texture from surrounding healthy tissue or particularly noticeable due to their size, shape or location.

Some people produce better scars than others, for example 'poor scars' such as hypertrophic or keloid scars stay visible and cause skin irritation for a number of months. When these 'visible' scars fade they tend to whiten and remain equally visible – unlike a 'good scar' which blends in well with the surrounding tissue.

What are the different types of scars?

There are four main types of scars:

  • Flat, pale scars are the most common form of scar. They may be red, dark and slightly raised soon after injury, but will become pale and fade naturally as the healing process progresses
  • Keloid scars are highly visible, exaggerated scars that are irregular in shape, raised well above the surface and continue to grow beyond the wound site. These are caused by over-healing, and can become itchy and painful. The risk of keloid scars is much higher in darker skin 
  • Hypertrophic scars are red and raised, similar to keloid scars but do not go beyond the injury. These may mature and regress over time
  • Contracture scars tighten the skin and may go deeper beneath the skin, affecting nerves and muscles. They normally pull down into the skin and have a sunken appearance.

How can scars be treated?

There are a number of effective treatments available for scar revision, especially if you have a scar that's painful, itchy or unsightly, or if it restricts your movement.

Scars can't be removed completely, but they can be made less visible, either through surgery or non-surgical means.

The most common treatments are:

We offer all of these at the Cadogan Clinic, often in combination with each other depending on the size, location and profile of the scar.

What are the benefits of scar treatment?

  • Removal or reduction of unsightly, raised scars
  • Decreased itchiness of scar site
  • Pain relief
  • Psychological improvement 
  • Swift, effective treatment (non surgical or surgical)

Why is it so important to see a highly qualified scar specialist?

The more complex the scar, the more important it is to see a specialist and receive professional medical advice.

Keloid and hypertrophic scars may also require a team of laser experts, aestheticians and dermatologists. At the Cadogan Clinic we create bespoke treatment plans for each scar in order to achieve the very best results, and often pull in more than one specialist to deliver the best result.

Frequently Asked Questions

It is still unknown what the exact cause of keloid scarring is.

They can develop after surgery, after major skin trauma, or even after very minor skin damage such as is caused by chickenpox, minor scratches or vaccination sites. Strangely, they may also develop even if there's no obvious damage to the skin at all.

Keloids typically occur in younger individuals, often between the ages of 10 – 30 years of age. The tendency to keloid scar does run in families.

The darker the skin, the more susceptible it is to keloid scarring. Studies show that whilst Caucasian skin has a 2% incidence of keloid scarring, this is as high as 12% among darker toned skin profiles

Keloids have a shiny and hairless appearance with a firm 'rubbery' feel. They usually occur on the upper chest and shoulders – particularly over the thin skin on the breastbone – and on the earlobes.

In people with dark skin they often occur in the beard area and on the scalp.

Keloid scars are not dangerous, but can be itchy and tender or even painful to touch.

The emotional impact of these scars, however, is often greater than the physical one as they can cause great distress, particularly in younger patients, and can seriously undermine self-confidence.

Keloids carry no cancer risk.

The sooner the better. Ideally the scar is being treated as soon as the wound site starts healing.

Some people produce better scars than others.

A 'good' scar fades significantly after appearing and blends in with the surrounding skin tone. A 'poor' scar, such as a keloid or hypertrophic scar, will stay visible and cause skin irritation for a number of months after formation. When these 'poor' scars fade they tend to whiten, flatten but, remain visible.

Good scars have the following characteristics:

+ Often caused by having the right genes. Some people simply scar better than others. Darker skin is more prone to make the worst scars, so too Celtic skin and those with red hair at the opposite extreme are also often poor scar makers
+ The scar is in the right direction in the lines of skin tension. Experienced trained surgeons will choose to position scars properly as for instance transversely across the abdomen rather than vertically downwards.
+ Located in naturally optimal areas, such as by avoiding the centre of the chest or tip of the shoulder
+ Scars may be hidden discretely below areas such as the breast, behind the ear, in the groin or in the armpit (axilla).
+ Influenced early by proper surgical care. Surgeons can influence the result by meticulous technique and using dissolving sutures or glue and removing other stitches early enough to avoid stitch marks.

The Cadogan Clinic has introduced the Bilhi genetic test that can determine from a saliva sample whether you might be a 'poor' scar former. This is particularly useful ahead of surgery, since a positive result can influence the decision to go ahead with surgery, and where to place scars if one does. It can also mean our comprehensive Scar Management programme can be applied proactively, immediately after surgery.

We are the only clinic in the UK where this is available.

Scar quality is extremely important to us and to our patients. To mitigate the risk or impact of scars, we take a proactive scar management approach to all of surgical activity done on site.

All patients undergoing surgical procedures with us are eligible for this treatment, but this will be of particular interest to patients who could potentially have larger scars in areas of the body where they could be an issue. In particular after breast surgery, abdominal reduction and face lifts.

Our care programme includes:

+ Bespoke, tailored advice from our post-operative wound care nursing team
+ 24 – hr access to our on call nursing team to answer any questions
+ Access to core follow up treatments such as; Silicone gel or sheets, ICON Fractional laser treatmentLED light treatment 
+ Some patients may be advised to also undergo:

PRP: healing factors (platelet rich plasma) are taken from your own blood and injected them under the scar to promote healing and tissue rejuvenation.
Micro-needling or 'collagen induction therapy'. This involves using fine needles to create hundreds of tiny, invisible puncture wounds in the top layer of skin. These micro injuries are virtually painless and stimulate the body's natural wound healing processes resulting in increased collagen and elastin production, tissue regeneration and skin repair
Steroid Injections: A highly effective treatment for lowering and taking inflammation out of established active scars and for those at risk of developing keloids.
Irradiation for keloids: a treatment via superficial radiotherapy to prevent keloids from forming post surgery. In the case of existing keloids, they can be excised and the new wound treated with irradiation to prevent a new one from forming.
Repair cream (Ticalfate, Cicaplast): a useful adjunct, but given for patient comfort rather than efficacy.

Whilst we cannot guarantee a perfect scar, we can guarantee that our scar management programme will give your body the very best chance to heal and recover properly.

Although scarring is largely a function of the trauma involved in creating it in the first place, for those patients undergoing elective surgery the following activity is recommended.

+ Take a pre-emptive BILHI genetic scarring test. This will give your surgical team the best idea of your genetic disposition toward poor scarring, and the team can plan accordingly
+ If you suffer from a chronic diseas, ensure that you are in the very best possible condition ahead of surgery. Infection rates and healing speed and quality can be directly impacted
+ Ensure you are properly nourished: overly nourished (obese) patients suffer more infections whilst underly nuourished (those lacking vitamins) lack the necessary elements to drive recovery
+ Avoid smoking. Smoking is always bad for healing and patients undergoing face lifts, breast reductions and lifts and abdominal reductions should stop smoking three weeks before surgery. If smokers are also over weight then the risk is greatly increased.
+ Avoid the sun – scars are sun sensitive. Post surgery it is important to stay out of the sun for a period of time, and use factor 50 sunblcok. Patients with olive or darker skin need particularly to avoid sunshine
+ Avoid exercise initially – exercise will cause tension in the wound and should be reduced in the first two weeks

Skilled surgeons can influence the quality of the scar by choosing the optimum position and orientation of the scar during surgery.

For instance, a vertical scar in front of the ear will be a good scar, while a transverse scar across the cheek will be a poor scar. Our Surgeons aim to keep the scar as short as possible and to repair the wound with appropriate stitches. Any conventional stitch through the skin will need to be removed early to avoid stitch marks. In many areas of the body the Surgeon will choose use dissolving suture materials under the skin, thus avoiding stitch marks altogether.

Any signs of slow healing or infection are treated promptly by our expert team. Prolonged redness or raised keloid scars are treated early, as well as patients with olive or darker skin may develop extra pigmentation around the scar, called post-inflammatory inflammation (PID).
Why are we so passionate about scar management at the Cadogan Clinic?

At the Cadogan Clinic we are passionate about scar management. This is because with due care and consideration, a far superior outcome can be achieved on a patient by patient basis, if the right process is adopted from the outset of treatment and the right treatments applied.

We have the skills in-house to dramatically improved patient outcomes, and we are passionate about delivering them to the widest possible audience via our programme.

At the Cadogan Clinic we are passionate about scar management. This is because with due care and consideration, a far superior outcome can be achieved on a patient by patient basis, if the right process is adopted from the outset of treatment and the right treatments applied.

We have the skills in-house to dramatically improved patient outcomes, and we are passionate about delivering them to the widest possible audience via our programme.


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