Scars will always form with any incision or injury that happens below the most superficial layers of skin. Your body then creates inflammation and collagen to help heal and strengthen the scar with time.

When there is little tension on the skin and there is no sun exposure or skin that has pigment in it that wants to hyper-pigment, then the scar may heal well.

If a poor, keloid, hypertrophic, hyper-pigmented, or traumatic tattooing scar results, then they can usually be improved by simple excision and re-closure in a setting of less swelling, trauma, or infection. Beware that the exact scarring that occurs does depend on each individuals propensity to scar and react to the new incision, tension, sutures, and/or infection.

Areas of more tension and stretch can widen more easily. This can occur over the shoulder, back, or knees. There is also a tendency to keloid scar in an area from the ear down to the shoulder and over to the sternum on the chest.

Plastic surgeons have techniques to alter the lines of the scars to minimize the line of tension or use small skin flaps to cover areas of the wound or scar. Occasionally, on keloid scars need more extensive treatments such as steroid injections or even a small dose of radiation to keep the keloid scar from recurring.

In general, insurance carriers will not cover any scar revision if it does not have symptoms. The insurance carriers will cover if there is a functional problem with the scar and its position.

Keloid scars may or may not be covered. They usually have more symptoms, but the exact coverage depends on the insurance company’s policies.

Time and patience may be the best option for many. There are very few well designed studies that can show if one treatment is more effective.  Silicone sheets, Scar-away, and pressure has been the primary treatment for more extensive scarring and burns. Over the counter, Mederma and Scarguard promote improvements. In the office, we sell Neocutis (Biocream) which promotes certain growth factors and different types of collagen to help the scarring. It is based on unborn fetus’s, operated on before 24 weeks of gestational age, for congenital abnormalities while in the womb, have no scars when they are born.  We use it for facial reparative cream for aging as well.

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