Hypertrophic Scar Revision - Extra Information

Extra Scar Information

A scar is a fibroblastic replacement of normal healthy skin tissue. The tissue forms by force of resolution rather than natural ageing and regeneration.

The type of scarring and degree of the scar is determined by many factors including the size of the initial wound and the amount of time between the trauma and complete healing of the site.
Other common factors include location and tension on the wound and infection. Commonly with piercing scars we see prolonged healing due to many factors and quite often the circumstance surrounding the piercing were never going to allow for healing. Commonly we see piercings with low quality, externally threaded jewellery with high nickel exposure creating sensitivity and skin conditions like dermatitis, incorrect jewellery shape and sizing for location and or anatomy, incorrect placement of piercing for anatomy or angle going against tissue and incorrect aftercare treatment being advised.

Piercings are true brakes in the skin and are required to be treated as such. They also consist of a foreign item being permanently placed in the skin making biocompatibility highly important along with surface finish.

It is most common to see scar formation in cartilage areas of the body due to the layering of the tissue in these areas creating a longer healing time frame than that of a soft tissue area or an area of better blood supply.

Having an enlarged scar form in a cartilage piercing does not make you prone to keloids and in a lot of cases these scars classified as keloids actually started as hypertrophic scars that have been left untreated or not treated correctly and have not had correction made regarding jewellery quality and suitability. Full thickness wounds always scar. Some people find their scars are less visible than others, but either way, a piercing is a true break in the skin and will result in a scar. The size is dictated by other events.
This combination leads to a continued state of aggravation and stimulation in the overactive cells, essentially it is like creating a chronic wound because it is never allowed to heal properly.

Sometime people get to the point they are ready to give up and remove the piercing however once the growth has hit a certain size and has been left for an extended amount of time it will no longer decrease on its own as it would have in earlier stages. 

We also have the impact of toxicity from cheaper metals leave trace elements to the tissue the after removal continue an irritation to the skin and the added complication of infections that may have happened during the piercings time in the body and after.

It is highly important for us to assess your scar and see what type of tissue you have in order to know how and if we can treat the scar or provided further information on alternative treatments options. 

For most people with cartilage scars the issue is cosmetic and they have never had scar tissue complication previously. This makes for a good candidate. If a person has experienced enlarged scars or true keloids on soft tissue locations, then there is a chance we may not be able to assist solely or if at all. If the keloid required intervention and we feel there is a risk, we will always advise of this as we will need to team up with your regular physician for further monitoring and prevention of re-development. It is always easier to prevent than treat however if the risks of treatment outweigh the benefit of intervention than we cannot offer the service. don’t let that get you down though, everyone thinks they have the worst scars that are impossible to treat and in all my years I have only ever had to say no to possibly one person.    

Normal skin tissue has a matrix of collagen sheets, compared to scars which have organized unidirectional collagen bundles. This leads to prominent or raised tissue unlike normal undamaged skin tissue. In some cases, scars require treatment in an attempt to control the stages and growth it is forming.
Typically, significant scar formation is separated into two categories: Hypertrophic and keloid.

After your treatment we monitor your scar formation and apply a precautionary stage one treatment option to the scar. Being that these scars are more so the result of a negative piercing the chances of recurrence are lower than a standard soft wound that formed the same scar.

Hypertrophic scars are defined as a scar that form an excessive amount of tissue production at the site of the injury, which remain within the boundaries of the initial wound. These can also be subdivided into linear or widespread hypertrophic scars. In most people these scars soften over time without the need for treatment to control the scar. If control is required products like medical silicone dressings are a first stage intervention for these scars. Scars once healed and during healing can undergo further treatments to decrease scar size. We have multiple treatments we offer in the Studio for scar revision. The over stimulation of a hypertrophic scar can give the impression of a keloid scar and form a similar style mass however in most cases this over stimulation is never actually the formation of a true keloid. The two types of scars while very similar to each other in many ways have a few differences in how they look and it’s these difference that allow us to predict the likelihood of a scar reforming and the expected results we can achieve.

Keloids have a tendency of not softening much at all and not reducing much in size which can make people feel very sensitive regarding the growth size and be insecure about its noticeability. 

Keloid scars involve excessive scarring that extends beyond the boundaries of the initial wound and the impregnation of surrounding healthy tissue. This is one of the most important points we assess during your consultation, it is inevitably the impregnation of healthy tissue that will determine how easily the removal process will go. There are some differences to the formation of the scar and the time line in which they form, including the types of collagen fibres that form in the scar itself.
Scars can be graded and categorized by their appearance and by individual factors including the size, the scars height or depression, thickness, pigment, vascularity, flexibility, individuals pain, itching and discomfort. It is these characteristics that can turn a once classified hypertrophic scar into a keloid scar. There are many different methods used for categorization too. 
Please see images for indication on pre-consultation self-assessment and to further understand why we classify some types of keloids as not true keloids even though they now present the required traits of a true keloid scar and how this point is what makes it more effectively treated than a true keloid.