Scarring: When to Consult a Plastic Surgeon

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Kids will be kids. Sometimes that means falls from bicycles, bites from dogs or other injuries that result in scarring. While most scars can be treated by a family physician, some require the attention of a plastic surgeon to reduce their size and appearance.

HOW DO SCARS DEVELOP?

Scarring is a natural part of the healing process. The way a scar develops depends on many factors, including the severity of an injury, how your body heals, and particularly the scar's location. Tension or "pulling" tends to increase a scar's width, so scars located over areas where motion occurs - for example, knees, elbows and shoulders - tend to widen the most.

Many scars that appear big and unsightly at first will diminish over time, though they won't go away completely. Your physician can offer guidance on how to treat and care for scars, including when you should see a plastic surgeon.

WHEN SHOULD I CONSULT A PLASTIC SURGEON?

It's generally a good idea to visit with a plastic surgeon when a scar is tender and itchy, painful, growing, impairing movement, or affecting a child's self-esteem or confidence.

You should also consult a plastic surgeon if foreign material - for example, asphalt - is retained within a scar.

A plastic surgeon will examine your child and discuss the options for treating the scar, including the benefits and risks of treatment, as well as likely outcomes.

You should talk with the surgeon about your expectations - and those of your child - to make sure they're realistic. A procedure might improve a scar's appearance by changing the depth, size or color. But it won't erase the scar or return the skin to its original appearance.

WHAT TYPES OF SCARS DOES A PLASTIC SURGEON TREAT?

According to the American Society of Plastic Surgeons, several types of scars may be treated by a board-certified plastic surgeon, including:

Facial scars: Because of their location, these scars often require the skill of a plastic surgeon. A facial scar may be cut out and closed with small stitches. A scar that lies across a natural skin crease may be repositioned to make its appearance less obvious. A technique called dermabrasion also may be used to soften the appearance of a facial scar.

Keloids: These scars extend beyond the edges of a wound or incision. They're thick, protuberant and itchy - and often appear on the chest, shoulders and earlobes.

To treat keloids, a surgeon may inject a steroid medication to reduce itching and shrink the scar. Another approach is to cut out the scar tissue. Because keloids often recur, the surgeon might combine scar removal with steroid treatments or radiation therapy.

Hypertrophic scars: Like keloids, these scars are thick, red and raised. But hypertrophic scars remain within the boundaries of the wound or incision. Sometimes, hypertrophic scars improve on their own over time. A surgeon might help this process along with steroid applications or injections. Surgery also may improve the appearance of these scars.

Contractures: These scars form after the loss of a large area of skin - from a burn, for example. They cause the skin to tighten and can restrict movement. Improving appearance and mobility usually requires cutting out the scar and replacing it with a skin graft or flap.

WHAT CAN I DO TO MINIMIZE THE APPEARANCE OF MY CHILD'S SCAR?

Practice good scar care:

• Avoid sunlight, especially the first year. New scars easily sunburn, and sun damage may cause increased pigment deposition, thereby increasing the prominence of a scar's appearance. If in the sun, use sunblock and protective cover - for example, clothing or a bandage.
• Once the wound or incision has healed, massage the scar using a topical ointment and gentle circular motions. Your physician also may recommend silicone gel sheets.
• Several brands of makeup - for example, Glominerals®, Covermark® and Dermablend® - are available for covering scars.