Scars (Hypertrophic & Keloid)

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 should be 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 chooses to do so. 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 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 facelifts.

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 treatment, LED light treatment 

Some patients may be advised to also undergo:

• PRP: healing factors (platelet-rich plasma) are taken from your own blood and injected 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 disease, 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 under-nourished (those lacking vitamins) lack the necessary elements to drive recovery.
• Avoid smoking. Smoking is always bad for healing and patients undergoing facelifts, breast reductions and lifts and abdominal reductions should stop smoking three weeks before surgery. If smokers are also overweight 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 sunblock. 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 to 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).

We know that 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 improve patient outcomes, and we are passionate about delivering them to the widest possible audience via our programme.