A scar is a visible mark that forms following an injury or surgical procedure. Injuries that extend deep enough to damage the dermis, the second layer of the skin, will generally result in scar formation. There are several misconceptions about how scars develop, their appearance, how age affects healing, and the role of plastic surgery in scar management. Five common misconceptions are discussed below.
Myth 1: Plastic surgery can be performed without leaving a scar.
* Fact 1: Any surgical incision generally results in a scar. Plastic surgeons consider scar location, incision direction, wound closure techniques, and aftercare to help minimise scar visibility. The final appearance of a scar varies depending on individual healing and other factors.
Myth 2: Plastic surgery can completely remove scars.
* Fact 2: Plastic surgery cannot completely eliminate scars. However, certain procedures may improve a scar’s appearance by reducing its visibility or changing its position, shape, or direction. The degree of improvement varies depending on the scar and individual healing characteristics.
Myth 3: Children heal well and do not develop scars.
* Fact 3: Scar formation varies with age, skin characteristics, injury type, and individual healing responses. Children can develop noticeable scars despite their generally faster healing process. Scar appearance also varies among adults, and age alone does not determine how well a scar heals.
Myth 4: A plastic surgeon can create a fine, almost invisible scar in every patient.
* Fact 4: Scar appearance is influenced by several factors, including skin characteristics, individual healing responses, surgical technique, age, and incision direction in relation to natural skin tension lines (RSTL). The Fitzpatrick skin classification describes six skin types, and differences in skin pigmentation can influence scar colour and visibility. However, scar formation varies considerably between individuals, even when the same surgical procedure is performed using similar techniques. Therefore, the final appearance of a scar cannot be predicted with certainty.
Myth 5: Scars can be completely removed by laser treatment.
* Fact 5: Laser and intense pulsed light (IPL) treatments may help improve the appearance of certain scars by reducing their visibility, pigmentation, or texture. However, these treatments cannot completely eliminate scars, and results vary depending on the type of scar and individual skin characteristics.
Most fresh scars undergo changes during the healing process. They may become more noticeable during the first few months before gradually improving. Scar maturation can take approximately 1–2 years, although the timeline varies between individuals.
In some people, scars may continue to become thicker, raised, discoloured, or itchy during healing. This may indicate abnormal scar formation. A raised scar that remains within the boundaries of the original wound is known as a hypertrophic scar. Such scars may become noticeable within the first few months after an injury or surgical procedure.
A family history of raised or hypertrophic scars may indicate an increased tendency to develop similar scars. Skin pigmentation and individual healing characteristics may also influence scar formation. However, scar development varies from person to person and cannot be predicted by ethnicity or skin colour alone.
Hypertrophic scars may require a combination of treatments, depending on their size, location, and characteristics. Options may include laser therapy, IPL, compression garments, silicone sheets, or steroid injections. Treatment should be planned and supervised by a qualified plastic surgeon. In some cases, scar revision surgery may be considered to remove or improve the existing scar. This may be followed by additional treatments, depending on the patient’s individual needs.
No, keloid is a more severe condition. See below.
A keloid is a type of raised scar that develops when scar tissue grows beyond the boundaries of the original wound, sometimes following a minor skin injury or without an obvious trigger. Unlike ordinary scars, keloids can extend into the surrounding skin and continue to grow over time.
Keloids may cause itching, tenderness, or pain. In some cases, irritation or infection may occur, particularly if the skin becomes damaged. Some keloids can also develop small openings or pits where ingrown hairs may contribute to inflammation or infection. When sensitive, they may cause discomfort through contact with clothing or seat belts.
Common sites: The front of the chest, shoulders, back, and ears.
Keloid treatment can be challenging, and results vary depending on the scar and individual response to treatment. Several approaches may help manage symptoms and improve the appearance of the scar. Intralesional steroid injections are commonly used as one of the treatment options. Although these injections may cause discomfort, careful administration techniques and appropriate measures can help improve patient comfort. Dr. Mohan Rangaswamy takes particular care during the procedure to minimise discomfort. The number of sessions required depends on the size of the keloid, its response to treatment, and the individual’s clinical needs.
Other treatment options, such as pressure therapy, laser treatment, and silicone sheets or tapes, may also be considered depending on the characteristics of the keloid and the patient’s response to treatment. Dr. Mohan Rangaswamy and his team can explain the available options and provide guidance throughout the treatment process.
Insurance coverage for keloid treatment varies between providers and individual policies. Some insurers may classify certain treatments as cosmetic and exclude them from coverage. However, keloids can cause symptoms such as pain, itching, and irritation, which may affect daily activities. Patients are advised to check their policy details and confirm coverage with their insurer before proceeding.
Answer: Keloids that develop after piercings usually do not disappear on their own. They are raised scars caused by excess collagen production during the healing process. Although they may persist without treatment, options such as steroid injections, cryotherapy, and laser therapy may help reduce their size and improve their appearance. A consultation with a qualified plastic surgeon can help determine the most appropriate treatment based on the keloid’s size, location, and characteristics.
