Scars are the result of skin repair following wounds, which may be related to accidents, disease or surgery. The more the skin is damaged,  the longer it will take to heal and the greater will be the risk of a noticeable scar. Scars appear red and thick initially, and then gradually fade. Scars that seem unsightly at three months may heal nicely by six months or one year. But one thing should be clearly noted that once the scar developed from full thickness damage to the skin, it could never be removed completely. The only possibility after a good management is to make is almost invisible or very thin & less visible, so that it can fade with surrounding skin crease or geometry of face.
There are many types of scars, many locations for scars and many causes for scars. Each scar has to be individually evaluated when treatment is being planned. The length of time scar has been present, the location of the scar, the appearance and whether it is causing irritation determine the treatment plan for individual scars.

THE WOUND OR BROKEN SKIN RESULTS IN BEST APPEARANCE WHEN REPAIRED ON 1ST DAY BY AN EXPERT PLASTIC SURGEON; THE RESULT MAY BE ALMOST INVISIBLE SCAR.

Below are Some poorly Managed Wound After Trauma leading to Bad Scarring Of Face

ACNE Scars 

ACNE scarring is the result of abnormal healing of the skin as a result of ACNE. This is the most common scar problem that presents to our practice in young population. The scars often cause the patient to be self-conscious and may impact on their self-esteem. The scars may be of different types from very deep to shallow. They may involve small or large areas of the face. The treatment depends on many factors and is highly individualized. Treatment of ACNE scars will result in reduction in the number of visible scars, a reduction in the depth of the scars and a greater uniformity of colour of the affected area. A 50% improvement in appearance of the scars is considered to be a good result.

Raised Scars (Hypertrophic Scar or keloid scar)

This is the second most common reason for presentation to our practice. Raised scars are the result of poor wound healing or ill-managed wound in the beginning. It may also be due to some internal factors like your skin type and familial tendency for formation of more scars after wounding. Some people produce raised scars in all their wounds, these patients are referred to as keloid formers and clearly they have internal factors at play. Other people develop raised scars because the skin may have been excessively traumatized or ill managed from the beginning, an infection during healing or when the wound edges may have been stitched by an inexperienced surgeon or quack under excessive tension.

Keloid Scar

THE WOUND OR BROKEN SKIN RESULTS IN BEST APPEARANCE WHEN REPAIRED ON 1ST DAY BY AN EXPERT PLASTIC SURGEON; THE RESULT MAY BE ALMOST INVISIBLE SCAR.

Hypertrophic Raised Scars 

Not all raised scars are keloid scars. In most of the cases, the raised hypertrophic scars are due to ill management from the beginning, due to burn & contractures or excessive tension on suture line. This is more common in dark skinned person. These types of scars can be avoided by proper management of wound or burn from the beginning by an experienced plastic surgeon. Once developed, this type of scar can be managed to a great extent to make it less visible.

Keloid Scars 

Not all raised scars are keloid scars. The features that make it a keloid scars are:

• It has been present for a long time -- more than one year
• It is hard
• The lump is much bigger than the original scar -- it may began as an insect bite or scratch
• It is itchy and irritating

Keloid scars having familial tendency and are more common is dark skinned people. Keloid scars are very difficult to treat, if not impossible. 

What treatment options are available for scars? 

There is a wide range of treatments available for scars, but remember, THE BEST MANAGEMENT OF SCAR IS ITS PREVENTION BY INITIAL REPAIR OF WOUNDD ON THE VERY 1ST DAY OF WOUNDING BY AN EXPERT & EXPERIANCED PLASTIC SURGEON; THE RESULT MAY BE ALMOST INVISIBLE SCAR.

• Surgery -- Surgical scar revision can improve the appearance of scars to a great extent, however, no scar can ever be completely removed. Surgical scar revision results in a less obvious mark. Each scar is different and each will require a different approach.
• Silicone-containing products  -- Available as gels, creams and bandages through pharmacies. They are helpful in reducing scar thickness and pain. 
• Steroid injections -- Using a very fine needle, steroid is injected directly into the keloid or hypertrophic scar. Used with raised scars causing them to shrink and flatten.
• Micro-dermabrasion or Full Dermabrasion -- Dermabrasion is a method that uses an electrical machine to remove the top layers of the skin to give a more even and smooth contour to the surface of the skin. It can result in improvement of certain scars like ACNE Scar or scars due to childhood smallpox or chicken pox. However, it cannot get rid of the scar entirely. 
• Resurfacing lasers  -- Also referred to as peeling lasers, are an excellent method of improving acne scars and chicken pox scars. High-energy lasers are used to remove tissue, which is making the scars more visible. Patients can return to work usually within two weeks. The skin may remain pink for several weeks or months. This treatment is used in the treatment of wrinkles and sun-damaged skin. (Dark skin of Indian population is not very suitable for resurfacing laser, as they can lead to hyperpigmentation or dark discoloration of skin even after trivial exposure to sun rays or U.V. rays)
• Non-resurfacing lasers -- These lasers are very useful for reducing scar redness. They may flatten raised scars and can also improve itching and burning sensations. Acne scars can be improved with this type of therapy without any need for time off work.
• Fillers -- There are a number of these injectable materials that are particularly helpful with depressed scars. They are injected under scars to lift them up and decrease their appearance. Fillers are also used in the treatment of wrinkles.
• Some specific techniques are used for the treatment of ACNE scarring are : 
• Subcision -- This technique is used in depressed ACNE scars. A needle is inserted under the scar to lift the scar up.
• Needling  -- This technique can be used in all ACNE scars. Needles are used to break the superficial skin layers, to stimulate a healing reaction resulting in a smoother appearance.
• Punch excisions  -- Deep small ACNE scars can be removed by cutting them out. The technique uses small knives called punches. Stitches are left in place for one week.
• Punch grafting  -- Punch grafts are small pieces of normal skin used to replace scarred skin. Small knives called punches are used to remove the scars. The area is then filled in with a matching piece of unscarred skin, usually taken from the skin behind the ear. The "plugs" are taped into place for five to seven days. Laser resurfacing one month later to achieve the smoothest result can follow a Punch grafting.

 

Some example cases where initial wound was primarily managed by Plastic Surgeon providing a good result

Some example cases of Scar Management

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