1.1.   Hypertophic scars

A hypertrophic scar is formed when the body reacts unusually to a wound that reaches the dermal layers of the skin. The occurrence of this is dependent on an individual’s wound healing tendency. In this case, the body’s healing response leads to the formation of scars that are slightly thick, elevated, and are usually red in color while sometimes being itchy and painful. A hypertrophic scar differs from other similar scars by way of its characteristic of not spreading beyond the parameters of the original wound with a tendency to stabilize and subside on its own in due course. The once elevated red scar tends to become flatter and paler with time.

 

Hypertrophic scars can often be confused with keloids because both tend to be thick, red, and raised. Hypertrophic scars differ from keloid scars because they remain within the boundaries of the original incision or wound, and they often improve on their own over time or with the help of steroid applications or injections.

1.1.   Keloid scar

Keloid is a type of a thick, irregular scar that rises above the skin level and extends beyond the wound boundaries. Studies have shown that Asians, African American, and Hispanic people are more susceptible to keloids. Keloids tend to form on the chest, shoulders, arms, earlobes, and cheeks. Keloid treatment is best administered with lasers to flatten the lesion, or via injections to cause the nodule to shrink. A combination is sometimes necessary.

 

Keloids are darker, red, thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision. Keloids occur when the body continues to produce excess collagen after a wound has healed. Keloids are most common over the breastbone, on the earlobes, and on the shoulders but can appear anywhere on the body. Occurring more often in dark-skinned people than in those who are fair, the tendency to develop keloids lessens with age.

Scar Retraction

When the healing process begins, the lesion can progress to contraction-retraction, which is considered the basic process where the edges are brought to the center by their tension lines, or it may contract generating a scar against cosmetics or functional objectives. The healing process is inherent to everyone, but there are various circumstances such as traumatic injuries, closures by second intention and burn scar that can contribute to the development of a scar
retraction. In the case of a burn scar the tissue is subjected to a state of chronic hypoxia. Now a day’s some of the possible treatments include laser
therapy external silicone patches, injectable glucocorticoids, superficial
radiotherapy, drug treatments such as interferon and colchicine (the still
mostly under review), and a surgical treatment conventionally referred as z or
w plasty, used to change the vertical axis of the scar and distribute better
and without anarchy the basic tensions generated by the scar. 

A process called
contraction occurs when burns or other injuries result in the loss of a large
area of skin that forms a scar that pulls the edges of the skin together. The
adjacent muscles and tendons can be affected causing restriction of normal
movement because of the contracture.

Correction of a
contracture usually involves removing the scarred area and replacing it with a
skin graft or a flap. In some cases, a Z-plasty revision or tissue expander may
be needed to release the scar and provide healthy unscarred tissue to the area.
Physical therapy is sometimes needed to restore function to an area that has
had a contracture for a long time.

Abdominal Scar revision

Scars following abdominal surgery can be very irregular and may disfigure the appearance of the abdomen. By employing cosmetic surgery techniques, scar revision surgery can be used to improve the appearance of the scar and restore the shape of the abdomen.

Hypertrophic scars

Hypertrophic scars can often be confused with keloids because both tend to be thick, red, and raised. Hypertrophic scars differ from keloid scars because they remain within the boundaries of the original incision or wound, and they often improve on their own over time or with the help of steroid applications or injections.

Poor scarring generally results from a genetic propensity to make bad scars, inexpert surgical planning, or post-operative healing problems. The rating of scars as good or bad is quite subjective. The way one patient may feel about a scar might be totally different than the way another patient would feel about an identical scar.