Scars are formations of connective tissue that form on the skin after healing of wounds of traumatic or surgical origin. Scars stand out against the background of healthy skin; in addition, there are no hair follicles in the area of ​​scarring, and, accordingly, hair does not grow there.

Removal of scars and scars is a very popular procedure, since such a cosmetic, and in some cases functional, skin defect becomes a huge problem for its owner. First of all, it is a psychological problem, when a person is ashamed of his own body and face, feels like an outcast, and cannot lead a full life.

Removal of scars can be carried out in different ways; the choice of method depends on the characteristics and location, the presence or absence of functional impairment due to the defect, and of course, on the wishes of the patient himself.

Detailed information about scar removal at the KLAZKO clinic

Today it is possible to remove scars of different types:

• atrophic (sinking) - resembling retracted stripes in appearance (for example, stretch marks, post-acne scars);
• normotrophic - fairly thin and pale scars;
• hypertrophic (rising) - rough and dark in color, which is explained by the production of collagen that does not have time to dissolve, which eventually accumulates and leads to the formation of such a defect. Typically, in this case, surgical removal of scars by excision is required;
• keloids - having a purple or pink tint, rising above the surface of the skin. Such formations can itch and hurt. The most unpleasant thing is that they can also grow.

Scar plastic surgery is an operation aimed at excision of scar formations on the skin. This technique is one of the most effective when it comes to old, rough and large scars. Based on practice, removal of postoperative scars or formations of traumatic origin using surgical plastic surgery does not completely eliminate the defect on the skin, but makes it much less noticeable. So, as a result of the performed scar removal operation on the body, instead of a conspicuous large, rough scar, a thin, linear and barely noticeable seam remains, which over time can become almost invisible.

Doctors can also use contour plastic surgery of scars, which is used in the presence of atrophic scar tissue. In this case, special injections of a biodegradable gel are performed, which, by pushing out the scar, equalizes it with the surface of the skin.

How is surgical removal of scars on the face and body performed?

Scar excision can be performed under general or local anesthesia. During the operation, the doctor excises the scar formation and cuts out the scar in such a way that the edges of the wound can then be matched. Next, the surgeon applies a cosmetic suture, which is removed after 3-4 days. Scar plastic allows you to closely match the edges of the wound, while obtaining a thin, straight and, in many cases, almost invisible suture. Postoperative rehabilitation takes 2-4 days. To speed up healing and improve the aesthetics of the suture, the doctor may recommend taking a course of physical and cosmetic procedures.

Removal of scars by surgical method, if the formations are quite extensive, in addition to excision, also includes autotransplantation, that is, transplantation of a healthy flap of tissue from any part of the body to the site of the scar formation.
Klazko's doctors remove postoperative scars, scars resulting from burns, gunshot wounds, household and other injuries. Modern medicine makes it possible to completely eliminate or minimize such aesthetic defects as scars.

Surgical excision of scars (Scarplasty) in Klazko clinics is performed by experienced doctors, the estimated price of such an operation is from 7,000 thousand rubles per 1 square cm. The exact cost can only be announced after an examination by a doctor, who will analyze the structure, size and other features of the formation, and then inform about possible correction options.

Removal of scars and scars using laser technology

Laser exposure during treatment destroys collagen fibers, while stimulating the production of fibroblasts - cells that produce collagen. As a result, thanks to the intensive production of new collagen, the scar is smoothed out, gradually becoming equal to the surface of healthy skin.

Removing scars with a laser does not damage surrounding tissues, has no side effects, and does not require rehabilitation or sutures. This technology allows you to remove scar formations, including in delicate areas, for example, in the eyelid area.

Removing scars on the face and body with a laser, unlike surgical plastic surgery, requires several procedures, usually 4-5 sessions are needed to achieve a lasting, significant result.
The cost of laser scar removal in Klazko clinics starts from 490 rubles per square centimeter. The exact price can only be announced after the doctor conducts an examination and evaluates the condition and characteristics of the surface in need of correction.

To achieve maximum efficiency, scar removal is performed in combination with other procedures, for example, dermabrasion, mesotherapy, peeling. The doctor may also prescribe physical therapy and special muscle exercises.

If you want to find out in more detail how plastic surgery of scars on the face and body is done, what are the indications and contraindications for the procedure, what is the estimated cost of performing it, call Klazko or ask a question you are interested in using the online form. The exact cost of scar removal, as well as the possibility and necessity of plastic surgery or laser treatment in your particular case, can only be known after a personal examination by a doctor.

You can find out the most complete information by phone or by asking a question on the website.

The Institute of Plastic Surgery and Cosmetology offers modern effective methods for correcting scar-deformed tissue on any part of the body, including scars after cesarean section. Plastic surgery of scar formations involves removing the deformed area of ​​tissue, followed by re-suturing. Of course, a new scar is formed in place of the old scar, but thanks to a special technique it turns out smoother and neater.

Indications and contraindications for scar plastic surgery

Scar plastic surgery can be performed if:

• at the site of surgical access or suturing after injury, hypertrophic scars have formed - protruding, bright in color;
• atrophic scars - retracted, forming a depression in the skin, often pale;
• keloid scars - such scars tend to grow and in some cases increase in volume up to several times compared to the original condition;
• The patient has post-traumatic scar deformities of the skin and mucous membranes.

Scar plastic surgery has virtually no contraindications, since it does not involve extensive tissue mobilization and, in fact, is not stress for the body. However, it is not recommended to perform scar plastic surgery in the presence of diseases of the cardiovascular and respiratory systems, or blood diseases.

Correction technique: surgical excision of scar tissue

Surgical removal of scars is the most radical way to get rid of them. This procedure is usually performed with local anesthesia, but general anesthesia can be used if the scar is too large and deep, and its excision requires a lot of time.

The surgeon excises the scar-deformed tissue and then applies cosmetic sutures, since only such sutures allow for the most aesthetic healing.

After the tissue has re-healed, laser skin resurfacing or any other method of hardware cosmetology can be used to consolidate and improve the result.

Rehabilitation

After excision of scars, it is painless and quick: during the operation, the tissue does not peel off, and the damage is very limited. Therefore, all you need for a quality recovery is to follow your doctor’s recommendations.

The human body, alas, does not have the ability to regenerate, which is inherent in some lower animals: we do not grow new organs or limbs to replace the lost ones. However, our tissues also have certain reparative, restorative resources: bones grow together, due to the increase in hepatocytes in size, the liver gains its original mass, and even the common idea that “nerve cells do not recover” is refuted by the results of modern research.

The skin must also have a pronounced ability to independently eliminate damage and “holes,” otherwise a person would die from the slightest scratch. Indeed, our scars, scars, traces of thermal or chemical burns are nothing more than evidence of the regenerative functions of the epidermis. The damaged area of ​​the skin or the edges of the wound are “healed” at one speed or another, and this happens through an emergency build-up of universal connective, scar tissue, which generally plays one of the key roles in the life of the body (and also, unfortunately, in the development of a number of autoimmune diseases and in the processes of pathological fibrosis, leading to a decrease in vascular patency, progressive functional failure of parenchymal tissues, etc.).

However, not only the physiological and functional aspects are important for humans, but also the cosmetic ones. Minor injuries are known to heal without any visible marks on the skin. Deeper and/or more extensive ones leave behind noticeable scar defects, which, if they occur on open areas of the skin, are sometimes disfiguring, as they say in aesthetic medicine, in nature.

2. Types of scars

There are several main types of scar defect.

A normotrophic scar does not protrude above the surface of adjacent healthy areas and is not deepened below their level. Such scars usually have a natural flesh-colored or slightly lighter color and are quite firm and elastic.

A hypo- or atrophic scar is lighter and thinner than healthy skin. The tissue in such an area seems to be “stretched”; the surface may protrude or be recessed. An example would be stretch marks on a woman’s stomach and/or chest, which remain after childbirth and cause a lot of aesthetic experiences.

A hypertrophic scar usually forms at the site of complicated (for example, infectious-inflammatory process) healing. Such a scar is noticeably highlighted in color and protrudes above the surface of the skin.

Finally, keloid scars are not only noticeable, but can also cause itching or pain. In the formation of such scars, individual characteristics of the processes of connective tissue production, as well as localization, large area and unfavorable conditions of the lesion play a role. Keloid scars are characterized by an intense pink or bluish tint, dense cartilage tissue, and an uneven and often shiny surface.

Over time, the cosmetic defect may gradually lose its severity. In particular, a hypertrophic scar fades over several years, smoothes out and transforms into a hypo- or even normotrophic one. However, in many cases it is pointless to wait (since even a normotrophic scar, say, on the face, still creates a cosmetic defect that may be unacceptable for a person) or it would take too long. In such situations, medical correction is necessary.

3. Scar removal methodology

Currently, both conservative and minimally invasive surgical methods for correcting scars are being actively developed. Active research is also underway into the prospects for the actual regenerative restoration of the skin and even individual organs.

Conservative methods include all kinds of applications, injections of hormone-containing drugs, silicone, hyaluronic acid (which is becoming increasingly important in aesthetic medicine), physiotherapy and massage procedures; Laser “resurfacing” of scar defects is also popular today.

In some cases, conservative methods can achieve significant improvement, but they do not completely eliminate the defect. On the other hand, the primary correction of keloid scars, especially those complicated by inflammatory processes, is almost always conservative or, rather, step-by-step: only after the inflammatory process has been sanitized and the keloid scar has been transformed into a less problematic type (hyper- or hypotrophic) does radical elimination of the defect become possible.

In any case, correction of scar changes on the skin will take time, sometimes significant, up to several months or even 1-1.5 years.

The most effective method was and remains microsurgical.

4. Procedure and terms of rehabilitation

Excision of connective tissue and reconnection of the skin edges of the damaged area is a technically simple procedure. The main difficulty, which requires jewelry technology and the skill of a microsurgeon, is not to leave another in place of one defect. The restored area should be elastic and, ideally, not different in color from healthy skin. This is achieved by the fact that the edges of the skin are connected not just “joint to joint”, but layer by layer, and the tension should weaken as it approaches the surface, and the operating room is closed after an inconspicuous cosmetic suture flush with the surrounding skin. After this, conservative maintenance therapy (pressure bandages, silicone gels, plates, etc.) is necessarily prescribed in order to gradually lighten and smooth out the scar. Improvement is observed immediately after the operation, but over time it is possible to finally “erase” traces of the former defect.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Author: , candidate of medical sciences, pathologist, teacher of the department of pathological anatomy and pathological physiology, for Operation.Info ©

Scar excision is a method of surgically removing scar tissue, followed by carefully joining the edges of the wound and applying a cosmetic suture. The operation is indicated for ordinary scars, keloids of any localization, deforming, constricting, disfiguring scars of the face and other parts of the body.

The problem of having rough, unaesthetic, constricting scars that create not only physical but also serious psychological discomfort is familiar to many. It is especially acute when scars are localized on open areas of the body, the face, where it is not always possible to hide them with clothing. Elimination of such defects can significantly improve the quality of life, give self-confidence and relieve psychological problems.

Scars that are large in area or are too long cannot always be completely excised. however, plastic surgeons can make them much less noticeable. In complex cases, eliminating the defect may require several operations, as well as the parallel use of conservative techniques, peelings, dermabrasion, etc., which together will give, if not the desired, then close to it result.

Scar formation is a process reflecting reparative regeneration. Where it is not enough to simply increase the cell mass, the tissues are juxtaposed by connective tissue fibers, which become denser and turn into a scar. The scar is considered to be fully formed approximately one year after the injury. it is quite strong, but in terms of stretchability and elasticity it is inferior to healthy skin, so it can tighten it, cause itching and deformation.

The healing process through scarring is considered favorable in terms of aesthetics if the scar is located flush with the surrounding skin, has a soft consistency and a pink color, which makes it less noticeable. Neat scars form after cuts, when the edges of the resulting wound are smooth and well aligned. In addition, the location of the scar relative to the natural lines matters: if it runs parallel to them, it will be less noticeable to others.

Indications and contraindications for surgical treatment of scars

The method that a plastic surgeon chooses to excise scars depends on the structure of the scars, their size and location. The following are subject to surgical treatment:

• Postoperative scars, which create a cosmetic defect due to discrepancy with natural lines, skin deformation, poor tissue suturing technique, inadequate comparison of skin edges during a previous operation. Most often they are located on the abdomen after abdominal interventions; in women, scars after a cesarean section may be noticeable, especially if the incision was vertical;
• Scars that appear during pathological regeneration - keloids, hypertrophic. The reason for their appearance is an inadequate regenerative process against the background of infection, necrotic processes, foreign objects entering the wound, too much tension on the sutures when treating wounds;
• Post-inflammatory atrophic scars due to previous skin diseases (acne, rosacea, chickenpox) - sunken, surrounded by thin skin;
• Scars due to injury- an unfavorable type, formed after wounds and burns, often massive, tightening the skin and disfiguring.

keloid scar

Keloid scars - a frequent companion of postoperative and post-traumatic healing, which is based on the impregnation of connective tissue with plasma proteins with the formation of a complex glycoprotein resembling cartilage tissue (hyalinosis). The danger of keloids is the possibility of their spreading beyond the original scar and recurrence. It takes about 2.5 years for such a scar to form. Keloids rise above the skin, are dense, pink-red in color, and often cause pain and severe itching.

Hypertrophic scars also protrude above the surface of the skin, but they are located strictly in the projection of the primary damage. It takes only a few weeks to form; hypertrophic growths are often localized in areas with mobile skin. This type of scarring responds quite well to both conservative and radical treatment, and in some cases even independent regression of the scar is possible.

Theoretically, absolutely any scar can be subjected to surgical excision, but the result of the operation may differ from the patient's expectations. Practice shows that only those who understand that it is unlikely to be able to completely get rid of a noticeable scar are satisfied with the cosmetic effect, because the purpose of excision of scars in difficult cases is not to completely remove them, but to make them less noticeable.

Before choosing a method of scar excision, the surgeon very carefully questions the patient about the nature of past operations, the presence of endocrine-metabolic pathology, and unfavorable heredity. Age is also important, since keloids are more likely to form in young people under 30 years of age.

Finally, the appearance of the scar itself puts the final point in choosing tactics. All characteristics are important, from the color, density, area and location of the scar to the condition of the surrounding tissues and the nature of the previous treatment.

Contraindications to surgical excision of scars are:

1. Severe hemostasis disorders (laser is a possible alternative to a scalpel);
2. Decompensated diseases of internal organs;
3. Mental illnesses;
4. Inflammatory changes at the site of the intended excision;
5. Age under 16 years (relative contraindication).

Preparation and principles of surgical treatment of scars

Preparation for scar excision surgery is similar to that for any other surgical intervention. The patient will need to undergo blood and urine tests, undergo fluorography, ECG, be examined for HIV, hepatitis, syphilis, and have a coagulogram.

After passing the examinations, examinations by a plastic surgeon and an anesthesiologist are scheduled. At least 2 weeks before surgery, stop taking blood thinners and non-steroidal anti-inflammatory drugs, and any dietary supplements with ascorbic acid and vitamin E are discontinued. Alcohol and, especially, smoking, which impairs regeneration and microcirculation, are contraindicated.

Patients at risk are prescribed antibiotic therapy for prophylactic purposes (for interventions in the armpit, perineum, after undergoing joint replacement, heart valve replacement in the next 2 years, after taking immunosuppressants and cytostatics).

Plastic surgeons have developed some general principles of scar excision surgery:

• Preliminary marking of both incision lines and anatomical landmarks with the patient standing or sitting, before the administration of local anesthetics;
• Preference is given to local anesthesia, and in the case of a pronounced network of blood vessels, adrenaline is added to the anesthetic, which has a vasoconstrictor effect;
• After marking and anesthesia, the surgical field must be treated with antiseptics;
• Careful comparison of the incision lines, no tightening of the sutures, the use of inert and self-absorbing threads, the application of vertical mattress and support sutures are the key to speedy regeneration;
• The use of fewer stitches to prevent an inflammatory response; they are left on the face for 7 days, on the body - up to 2 weeks.

Developed for surgical excision of scar tissue several types of operating equipment:

1. Tangential;
2. Fusiform;
3. Step-by-step methodology.

The choice of a specific type of scar excision is determined by the size, consistency, localization of the scar, its relationship with other parts of the body, the condition of the surrounding tissues, and the nature of the previous treatment. A big problem is complex scar adhesions after a necrotic process, due to lacerations, removal of a large area of ​​skin in the past, since the ability of the skin to stretch in these cases is greatly reduced. Surgical correction is carried out in close proximity to the scar, but does not touch the scar itself.

Tangential excision method useful in the presence of single narrow scar changes that have raised or uneven edges above the skin. During the operation of tangential removal of scar tissue, the latter is cut off with a scalpel or blade, as if compared with the level of the surrounding tissue. When cutting tangentially, it is important not to damage the underlying dermis.

Spindle removal (elliptical) It is carried out for a wide variety of scars - from very small to quite large, as well as wide, rising above the skin or sinking. After removal, thin scars remain in their place, coinciding with the direction of natural lines and folds and therefore invisible.

The goal of the spindle-shaped technique is the total removal of scar changes, regardless of width and thickness. The incision is made spindle-shaped at an angle of about 30 degrees, while the underlying tissue is also dissected to ensure that the edges are aligned without tension on the skin and subcutaneous layer. The method is used for post-traumatic, postoperative scars, scars after cesarean section.

The spindle-shaped technique can be used when the scar penetrates deep into the dermis, while additional sutures are needed to securely connect the tissues - deep self-absorbing interrupted, mattress in the dermis, running vertically, then nodal or cosmetic, which does not leave its signs after skin regeneration.

Keloids and hypertrophic scars deserve special attention. Excision of keloid scars presents many difficulties due to the high density of the scar and the possibility of relapse of the pathology. It is not recommended to cut off a keloid where there is strong skin tension, since this approach is fraught with recurrence of scarring. In addition, healthy tissue in the scar area can be used as a graft after removal of the keloid, so before surgery, all inflammatory processes should be cured, epithelial cysts and fistula tracts should be removed. To prevent subsequent inflammation, superficial sutures are applied that do not affect the dermis.

Step-by-step scar removal It is carried out when it cannot be removed without injury to nearby tissues due to its large size or deep penetration into the dermis. This method is used to excise keloid scars, post-burn and post-traumatic injuries.

The technique of its implementation includes the usual removal of the scar with the only difference that it occurs in parts. At each stage, the surgeon cuts through the tissue and moves the skin, closing the resulting wound. There may be several such removals, but if the scar is too large, then as an alternative, surgeons can perform skin augmentation to reduce the number of operations.

In addition to those listed, there are other types of scar plastic surgery. For example, Z-, W-plasty, cosmetic suture. Z-plastic is needed to change the direction and configuration of a long scar, which breaks symmetry, deforms the tissue, tightens it, and it is also used for webbed scars.

With Z-plasty, the surgeon moves the skin in the form of triangles so that the scar is located along its natural lines. With this technique, you can increase or decrease the length of the scar, hide it with hair, remove membranes, and restore symmetry to the face.

The technique of the operation includes several stages:

• At an angle of 60 degrees to the scar, markings are applied in the form of lines, the length of which is approximately equal to that of the scar, thus obtaining something like the letter Z;
• The scar is removed, incisions are made according to the markings, and then the flaps of skin are shifted to again obtain a Z, but in a different direction;
• Cosmetic suture application.

Z-plasty

The described plastic surgery can be performed on several scar areas, which will reduce skin tension, and the newly obtained scars will be less noticeable due to their location in the natural skin lines. This technique also has contraindications, in particular keloids, the removal of which in this way will make the cosmetic defect even more noticeable.

W-plasty

W-plastic scars has indications similar to the previous treatment option, that is, long, symmetry-breaking, deforming, tightening scars, but it has one characteristic advantage: The resulting scar will not be longer than the original one. This plastic surgery is performed faster than the previous method, but the effect may be worse due to the fact that it is visually easier to guess in which direction the new scar will go.

Indications for W-excision are long scars that are located at right angles to the natural lines, as well as scars on the face (jaw, cheeks, forehead), tightening scar changes. An obstacle to the use of the method may be insufficient elasticity of the skin, which makes it difficult to accurately compare the edges of the wound.

The W-method technique consists of carefully marking out which will reveal triangular shaped skin flaps after the original scar has been removed. Next, the surgeon excises the scar and connects the marked “triangles”, avoiding tissue tension.

Video: surgical removal of a keloid scar

Postoperative period and recovery

Postoperative management of the patient plays no less important role than the operation itself and its type. After excision of the scar, a pressure bandage is applied to the wound to compress the vessels and stop bleeding, which is removed the next day. For as long as possible, you need to protect the new scar from sunlight, any damage, or tension on the edges. Over the course of a week, bandages with regenerating agents are prescribed for the face and two for the body. After one and a half to two months, the patient can be referred for laser treatment or dermabrasion.

After any surgical scar excision technique, additional treatment with laser, peeling, and dermabrasion is possible, which help smooth the skin and make the scar less noticeable.

Complications after excision, scars arise when the surgical technique is violated, excessive haste, incorrect choice of suture material, the patient’s individual predilection for them due to the pathology of the internal organs. Inflammatory processes, suppuration, and the formation of hematomas are possible, which may require another operation.

To prevent future scarring and obtain the most beneficial results from scar correction, it is important to mark the incision lines as accurately as possible, carefully align the edges of the new incision, and not tighten the sutures too tightly. In addition, patients should know that in the case of scarring, time plays the opposite role: it is never too late to eliminate scars, but premature treatment and haste can lead to hypertrophy, keloid formation and skin deformation.

The choice of surgical excision method depends on the characteristics of the scar - its size, density, position and direction relative to other landmarks on the body, the condition of the surrounding skin, as well as the type and duration of previous treatment.

“Difficult” scars formed after healing of scalp wounds, necrosis, and extensive excisions require special attention, because in such cases, the extensibility of the skin is significantly reduced. Surgery should be performed close to the original scar, but outside its boundaries.

Tangential excision

Indications. Tangential excision is indicated for the treatment of small, single and narrow scars with raised or irregular edges.

Execution technique. The scar is excised with a scalpel or flexible blade directed parallel to the skin until it is even with the surrounding tissue. At the same time, they try to avoid capturing the deep layers of the dermis. When using a scalpel, in order not to cut too deeply, you can mark the boundaries of the raised scar. The border between the scar and intact skin can be smoothed using electrosurgical instruments, but they are not recommended for excision of keloid scars. The postoperative wound heals by secondary intention.

Fusiform excision

This technique is also called elliptical excision. It leaves behind a thin linear scar, invisible among the natural lines on the body.

Indications. Fusiform excision can be used for a wide variety of scars - from small (up to 2 cm) along the natural lines to medium and large ones, although in this case several excisions may be required 6-8 weeks apart. This method can treat wide, raised or depressed scars.

Execution technique. The purpose of the operation is to completely excise the scar, regardless of its size and depth. As the name of the method suggests, the scar is excised with a spindle-shaped incision with an angle of 30° or slightly less. To achieve free closure of the edges of the wound, without excessive tension and good healing, subcutaneous dissection of the soft tissue is necessary.

Deep scars. Fusiform excision can also be used for extensive deep scars, but this requires the application of additional supporting sutures. The first layer is an interrupted suture with a simple absorbable thread. Good rapprochement of tissues at the level of the dermis is ensured by a submersible vertical mattress suture, followed by a simple interrupted or cosmetic intradermal suture. The intradermal suture does not leave marks on the skin, even if it is not removed for more than a week.

Keloid and hypertrophic scars. You should not excise keloid scars located in areas with high tissue tension, because such scars very often recur (50-80% of cases). Before surgery, it is necessary to eliminate all inflammatory foci, incl. epithelial cysts, fistulas and other limited lesions of hair follicles. The intact epidermis and dermis overlying such lesions can be used as a donor flap to close the defect after excision of the underlying keloid tissue. In this case, in order to avoid subsequent inflammation, only epidermal, but not subcutaneous sutures can be used.

Staged excision

Indications. This method is especially useful in cases where the size and density of the scar and surrounding skin make it impossible to excise and close the wound without damaging adjacent tissue.

Execution technique. The usual scar excision is carried out, but in parts. In this case, each time a subcutaneous dissection of the soft tissue is performed and the skin is moved to close the resulting wound. How many of these excisions are needed depends on the size and location of the scar, as well as the elasticity of the surrounding skin. If there are more than two, then it may be worth using the skin extension method. This allows you to reduce the number of interventions.