Question:
Excision Tattoo Removal problem?
After two attempts, our doctor is again removing keyloids following
cosmetic eye surgery. Now he's going to do it for a third time! Is
there a better way to rid oneself from these keyloids sans surgery?
Will they ever go away or is this a botched eye (tighten) job?
They tend to recur after excision, as you have discovered.
Ask your doctor if steroid injections could help. They may cause more
trouble, however, so if he doesn't want to do it, don't.
Answer:
- I believe so.
Had you formed keloids from previous injuries or operations in the
past before your eye surgery?
- An essential part of the body's natural healing process, scars are the
result of the skins' repair of wounds caused by accident, disease, or
surgical incision (hair transplants). The more the skin is damaged and
the longer it takes to heal, the greater the chance of a noticeable
scar. That is why picking at healing wounds only make them scar worse.
Typically, a scar will become increasingly prominent at first, then
gradually
fade; many disfiguring marks which seem unsightly at three months may
heal quite satisfactorily if given more time.
Scars can be classified as hypertrophic (seen as a ridge within the
confines of the original wound), keloid (large sometimes dumbell shaped
scars that grow out of the confines of the original wound) or widened
& depressed.
A scar's visibility will depend on a number of factors, including its
difference in topography or color from the surrounding normal skin i.e.
color, texture, depth, length, width or direction.
If the skin scar adheres to deeper structures such as muscle or bone the
skin may bunch up with animation or movement as it is tethered to deeper
structures.
How the scar forms will also be affected by an individual's age and by
its location on the body or
face. Younger skin, for instance, makes strong repairs and tends to over
heal, resulting in larger, thicker scars than on older skin. Skin
over the jawbone is tighter than skin on the cheek and will tend to
increase a scar's
prominence. If it is depressed, it will make skin seem shaded, and
if it is higher than surrounding skin, it will cast a shadow. A scar
that
crosses natural expression lines or wrinkles will be visually striking
because it will
not follow a natural pattern, and a scar that is wider than a wrinkle
will stand
out because it is not a naturally occurring line.
Any one, or a combination, of these factors may result in a scar that,
although healthy, may be improved functionally or cosmetically by
treatment.
The techniques I have found to make scars less noticeable are changing
scar direction so it lies within a normal skin crease or fold, debulking
procedures, scar taping, scar massage, local steroid injection, medical
grade skin tatoos, dermabrasion, collagen
injections, chemical peels, cryosurgery, application of a pressure
dressing or silastic sheeting,
laser treatments & separation of the skin scar from deeper structures.
Which technique or combination of techniques to apply
for the best result requires a qualified trained physician. Keloids in
general require debulking, steroid injections & pressure garments or
earrings. They require long term follow up with the treating physician
as they are not cureable only controlable. Keloids do not respond to
silicone
sheeting. Keloids less than 1cm respond well to steroid injections &
pressure earrings alone. Virtually all keloids that are cut out
will return if steroids & pressure are not applied after surgery.
Hypertrophic scars are sometimes treated in the same fashion
but are more amenable to laser treatments, silastic sheeting & pressure
garments. I would need to examine the area in question in order to
give you a specific recommendation.
There are certain areas such as a good quality scar on the face or neck
of an adult male where a tattoo to simulate early beard growth is the
best technique. The problem is that most tattoo artists are great when
it
comes to drawing anchors etc. but not very good at simulating natural
skin color or
beard growth. I have had this done myself on my neck and am satisfied
with the result.
If you do not mind hiding a scar with a graphic tattoo then this method
will do. However, the ultimate goal seldom achieved is to hide a scar
so that it is not visible to the unaided eye & the area in question
looks as though nothing untoward has occurred.
The few points I might add is that although a repaired laceration or
incision heals so that it won't come apart within 14 days it takes
months to mature. The cells present along
the scar have not fully matured. During the maturation phase which can
last up to
8 or 10 months the cells making up the scar are still active. This can
be clearly seen as a red scar that blanches white with finger pressure.
During this phase the scar is malleable & sensitive to external
treatments
such as laser as well as local skin surface tensile forces. These forces
can be
distracting causing the scar to widen or parallel to the length or
height of the scar causing scar thickening. There can even be a
combination of forces. These forces are greatest in areas where the
skin is not lax i.e. it is difficult to pinch a significant amount of
skin.
Just try this on your chin, knee cap area with the knee bent or scalp
vs.back of the hand or neck. To diminish these forces I place elective
incisions along lines of least tension & have patients follow a
skin taping or silicone sheet regimen for all incisions/laceration
repairs.
I have had many good results with this management. Thus, you can see
that how an incision line is treated for the months
following surgery has greater impact on the final look of a scar than
the initial stitching procedure. Simple excision of a scar usually does
not work. Removal of skin increases tension around the scar & results in
a high recurrence rate of unsightly scars. Keloids are not cureable they
can only be managed by debulking & then treatment with pressure,
steroids etc..
Once the scar has fully matured it usually does not blanch with finger
pressure. Sunscreen should be consistently used to protect the scar from
sun exposure until it has fully matured in order to prevent the scar
from becoming permanently hyperpigmented.
The problem with the facial area in men is they try to grow a beard
to hide the scar. The scar then widens & one is left with a bald area.
The better treatment is a close shave & taping. I had one patient with
a scar over the jaw line that would alternatively turn red & then
pale as the patient moved his jaw -speaking, eating, facial expressions.
