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TGIF!!! Today I am bringing you Part Two of this Scar series and we have Dr. Megan Jack, MD and Plastic Surgeon weighing in on the different types of scars. 

SKB: “So, what are the most common types of scars?”

DJ: “So, we talked about what a normal scar looks like, and there’s two main abnormal scars that we’ll see. One is going to be hypertrophic. Hypertrophic scars are where the scars are raised, they are usually pink or red and they’re usually within the borders or boundaries of the original surgical site. They don’t extend beyond the border of the original incision. Those scars are typically successfully treated just with non-surgical management I said previously- scar massage, topical treatments such as silicone, sunscreen, etc. Occasionally when they are not responding to that we will do some steroid injections and usually one or two treatments with that is going to really help flatten that out. You don’t want to overdo steroid injection because that comes with the risk of certain complications. So, occasionally we will do that if we need to.

An example of a Hypertrophic Scar on a post Cesarean patient

The second type are keloid scars. Keloid scars are basically a step above hypertrophic scars. It looks almost like there’s a tumor growing out of the scars that extends beyond the boundaries of the original incision or the surgical site. Keloid scars are not exclusive to but are more common in people who have darker Fitzpatrick skin types, and Asian skin also tends to have an increased risk  of keloids. Latin skin will sometimes have an increased risk, and rarely we still do see it in Caucasian or lighter skinned people as well. The main point is that those darker pigmented patients will have a higher risk for naturally forming keloids. They are more significant and they are much more difficult to treat and so it is important to prevent them. That means that if somebody has a history of keloid scars or a family history of keloid scars you really want to try and avoid any injury to the skin itself. You want to avoid piercings, tattoos, and basically try to avoid any sort of trauma to the skin. In people who have a personal history of keloid scars, you want to avoid any elective surgery as well. The last thing you want to do is have a nice procedure and fix yourself up and then end up with a big keloid. If we know right out of the gate that someone does have that history and they still want a procedure then usually we will start right away with steroid injections after the surgery. Treatment of keloids is fairly complex. There’s a lot of different options and ultimately that is a whole other topic that can include options like additional surgery, cryotherapy, steroid injections, or even radiation treatments in some cases!”

An example of a keloid scar on a patient after an ear piercing.

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