Can Scars on the Neck Be Revised Using Scar Revision?
Can Scars on the Neck Be Revised Using Scar Revision?
Doctor Answers 4
Options for Treatment of Neck Scars
As all scars are not the same, it is difficult to make blanket statements about how well a scar will respond without more information such as the color, thickness, location, whether it is elevated or depressed, etc. Some scars respond best to medical treatment such as injections and topical agents while others are best treated surgically and still others are most likely to improve with laser treatment. It is true that some anatomic regions such as the neck pose certain limitations when it comes to scar treatment but the appearance of most neck scars can be improved using 1 or more treatment options.
Scar revision can be good to improve wide or pigmented scars. You need a proper "in person" evaluation to see if your scar is ripe for improvement.
John Di Saia MD
Considerations And Treatment Options For Scar Revision
Scar treatment or revision is a very individualized procedure that depends upon the appearance, characteristics, size, and location of the scar. Scars are visible because of color and texture changes; different treatments may be required to address these different characteristics. The history surrounding the injury or surgery is also helpful in trying to determine why unsatisfactory scarring occurred; the approach may be different for a post-traumatic scar compared with a post-surgical scar.
Scars may be difficult and frustrating for both patients and physicians because individuals want them to disappear following treatment. Unfortunately, there are no medical or surgical treatments to remove scars completely. Surgical scar revision of any kind does involve certain risks. These risks include changes in pigmentation (hyperpigmentation or hypopigmentation), possible red coloration or occasionally fine visible capillaries within a scar, infection, and surface texture changes (hypertrophy or atrophy). It is important to consider these risks when evaluating a scar for possible treatment, and these should be explained in relationship to the scarring you have, your skin type, and the procedure(s) recommended.
Scar revision by excision involves an actual surgical procedure to cut out the scar and then close the skin, followed by months of care to try to optimize the healing and maturation of the closure. Often times we will recommend certain skin care products and sunscreens be used before and after scar revision surgery.
Scars located in regions of significant motion, or that experience tension, often become less desirable because of widening, and the atrophy or hypertrophy that accompanies it. Areas on the upper back, shoulders, and upper/mid chest often develop raised (hypertrophic) scars that may be pink or red in color. Areas near joints such as the shoulders, elbows, and knees often produce scars that are widened and thinned (atrophic) because of tension that exists across the scar line. Scars on the neck have the potential to heal nicely but may widen as a result of recurrent tension associated with neck movements.
Steroids, 5-fluorouracil, and colchicine have all been used to treat scar hypertrophy or keloids. These compounds can soften and flatten scars, and can improve symptoms such as itching or pain; they will not improve scar width.
If the scar is pink in color, Intense Pulsed Light (IPL™) may help to lighten that coloration; but it does nothing for the surface texture. We frequently use IPL to treat dilated capillaries and rosacea on the face with good results; but similar appearances in scars do not always respond as consistently. IPL can only be used on lighter skin types (I-III). Laser Genesis is another light-based treatment that may reduce scar redness, and sometimes even the thickness of a scar.
Laser resurfacing with a fractionated system such as the Fraxel laser or Pearl Fractional laser may be helpful as an additional modality to improve scars. Lasers are used more commonly to address textural issues and provide smoothing and blending. Depending upon the laser modality, resurfacing may be more risky in individuals who have dark skin colors. Laser resurfacing may provide better results if used while scar maturation is still occurring.
Patients with darker skin pigmentation may provide additional challenges. In the presence of increased skin pigmentation, scars or the surrounding tissue may be more likely to darken as well. Inflammation that occurs as a result of the initial injury and subsequent healing stimulates increased pigment production in the skin, a process known as post-inflammatory hyperpigmentation (PIH). In many instances once scar hyperpigmentation occurs, the only way to effectively remove the pigment from that scar is to excise the entire scar; and there are certain situations where that is impractical. Even treatments aimed at improving scar appearance can result in PIH. For this reason, sun avoidance and proper use of sunscreen remains critical in reducing the risk of PIH, even months after healing. Pre- and post-treatment with skin care products (bleachers, retinol, etc.) may help to reduce recurrent hyperpigmentation following scar treatments.
In general, most physicians will evaluate a scar and determine if some reasonable improvement can be obtained. Scar revision is better undertaken if there is good probability for at least moderate improvement. It is important that patients understand the risk and estimated outcomes so they can make a decision they will be happy with.
Best wishes. Ken Dembny