Every time the skin is cut or damaged through its full thickness it will heal with a scar. The scar is the result of the body’s natural repair process. During the wound healing process, all scars become red, raised and lumpy before going through a period of colour changes a texture changes until they finally mature into thin white lines. For some people, and in certain parts of the body, this process of scar maturation takes only a few months whilst in others and in different parts of the body (e.g. the middle of the chest), the process can take up to 2 years before the scar finally matures. Occasionally, the scar can stay red for much longer. It is difficult to predict who is going to produce a bad scar, but in general, patients with black skin or with fair freckled skin and red hair are more likely to make hypertrophic scars (thick red scars that last longer than 18 months) and keloid scars (very thick scars which spread out from the original wound). These are notoriously difficult to treat.
Scars can look conspicuous for a number of reasons. For example, the scar may be irregular in shape; it may have pigment/ or dirt tattooed into it if the wound was not cleaned correctly; it may not have been sutured correctly; the wound may have got infected during the healing process; the scar may have stretched due to tension on the wound while it was healing; the direction of the scar may be out of line with the natural skin creases. In these cases it may be possible to perform a scar revision to produce a cosmetically better scar. Scar revisions are usually done under local anaesthesia. The old scar is excised and the wound sutured using plastic surgery techniques. Sometimes a specific technique called a Z-plasty is used to change the direction of an abnormal scar. Depending on the location of the scar revision, dissolving stitches or stitches that need to be removed may be used.