Hypertrophic Scars

Scarring can occur following any damage, infection or inflammation to the skin. As part of the healing process, collagen (a type of connective tissue) is laid down within the skin during the proliferative phase of wound healing. Scars can be categorised based on the amount of collagen that is produced within the scar.

If excessive amounts of collagen are present, then the scar is said to be ‘hypertrophic’ and will typically have a raised, red and lumpy appearance. The dimensions of hypertrophic scars usually remain with the bounadaries of the original injury site. They are usually seen in younger individuals who have had precipitating injuries such as a burn.

Hypertrophic scars can take a number of months to fully develop but will then usually self-resolve through the process of scar maturation. Scar maturation is a gradual process that typically takes 1-2 years (although sometimes longer).

Hypertrophic scars can become troublesome if they are in a prominent location that makes people feel self-conscious, cause pain or itching, or are restricting movement (for example if they are overlying a joint).

Mr Ioannis Goutos is an experienced plastic surgeon with a special academic and clinical interest in the care and management of scars and burns. He has a passion for understanding and exploring all aspects of burn and scar care, including the psychodynamic principles which may affect a person’s life and functioning due to their scar.

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About this condition

There are a number of risk factors that increase the risk of developing hypertrophic scars. These include:

Poor initial wound healing due to complications such as infection.
A family history, or genetic predisposition to developing hypertrophic scarring
The original area of skin that is injured. Although they can occur anywhere on the body, hypertrophic scars tend to be more common on areas of increased tension, such as the back, chest,
shoulders or overlying joints such as the wrist.
The type of original injury causing the scar. Hypertrophic scars are more common following burn injuries, in particular deep dermal or full thickness burns

It is currently understood that in the formation of hypertrophic scars, specific types of cells involved in the wound healing process, called ‘fibroblasts’ and ‘myofibroblasts’, produce too much collagen (which is stiff). This means that the resultant scar is thicker, raised and stiff compared to a normal scar. The exact reason for this imbalance in scar formation is not yet fully understood.

Whilst the appearance of hypertrophic scars can improve with time, there are several procedures and treatment options that can help to flatten, soften and reduce the amount of colour or pigment in the scar. These are similar to the treatment options for keloid scars and include:

Topical therapies such as the use of silicone sheets or steroid plasters
Appropriate soft tissue and massage techniques
Steroid injections, which can be performed multiple times on the same scar. These mainly aim to flatten and soften the scar as well as improve symptoms such as pain or itching in the scar
Laser therapies that aim to both flatten and soften hypertrophic scars
Surgical removal of the scar and closure using appropriate techniques (e.g a wavy line pattern) to reduce the risk of the hypertrophic scar reforming.
Needling techniques

If you are worried about getting hypertrophic scars, or know that you are prone to developing them, there are a number of steps that can be taken to reduce the risk of poor scar healing and formation of bulky scars. The first steps to consider include proper wound aftercare following an injury or surgery:

Ensure that the wound stays clean by using appropriate dressing materials as directed by your specialist
Keep the skin well hydrated by using non-fragranced emollients and ensuring that you are also drinking enough water
Stop smoking to help improve the initial healing process of the wound
Once the wound has healed, avoid exposure of the scar to direct sunlight by wearing appropriate clothing and regularly applying sunscreens with a good SPF (at least 30)
Attend all follow up appointments and adhere to advice from the healthcare professionals assessing your wound and scars. These are good opportunities to ask any questions you have about good wound care.

Additionally, if you are planning to have surgery and know you are prone to getting hypertrophic scarring, it is important to discuss this with your surgeon before the operation. There are additional measures that can be taken during the surgery itself to try and reduce the risk of unsightly scar formation. These techniques include careful planning of the incision line(s) to respect the natural creases in the skin and closing the surgical wound using special tension-relieving techniques. There may also be additional adjuncts to be included in the post-operative care of the wound to improve the healing process and produce improved cosmetic results.

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Testimonials

Mr Goutos is delighted to share some of his patient and peer feedback on their experiences of his services.

    
 
 
       Posted on Google  
    Louise Steel 
 
 
 
  Mr Goutos performed keloidectomy surgery on both my earlobes, and I am so grateful to have been referred to him. From the first consultation,  through surgery, and now my 3-month follow-up, I have nothing but good words to say.
  
 
      Posted on Google  
    Luke Ward 
 
 
 
  This man is an extremely intelligent, professional gentleman. He will set realistic expectations from the beginning and will not ‘beat around the bush’ so-to speak. From the initial consultation to post-surgery, it has been a rollercoaster ride. However the high level of expertise & professionalism Mr Goutos maintained has been impeccable.

All I can say to any other individual considering treatment with Mr Goutos, is that you are in incredibly safe hands. And on top of this, he has a great sense of humour.

I wish nothing but the best for this man, and the best results for his future patients.
  
 
      Posted on Google  
    Mauricio Lucas 
 
 
 
  Outstanding Doctor - Exceptional Expertise

I recently had the pleasure of consulting and also going through surgery. Dr. Goutos removed a large class of keloids from my back and chest, and without a doubt, I can confidently say that he is the best doctor I have ever had the privilege of seeing. From the moment I entered his practice, I was immediately struck by his professionalism, knowledge, and exceptional bedside manner.

Dr. Goutos possesses an extraordinary level of expertise in his field, and his technical skills are truly remarkable. His ability to diagnose and treat medical conditions is unparalleled, and I have personally witnessed his remarkable success in improving the health and well-being of countless patients.

What sets Dr. Goutos apart is his genuine care and concern for his patients. He takes the time to listen attentively, ensuring that he understands every aspect of the medical issue at hand. He communicates clearly and effectively, explaining complex medical concepts in a way that is easy to comprehend, which greatly helps in alleviating any concerns or fears.

One aspect that impressed me greatly was Dr. Goutos' commitment to staying updated with the latest advancements in his field. He incorporates cutting-edge techniques and treatments into his practice, ensuring that his patients receive the highest standard of care available. This dedication to continuous learning and improvement is a testament to his unwavering dedication to his profession.

Additionally, the support staff at Dr.Goutos' practice deserves recognition for their exceptional service. They are friendly, compassionate, and highly efficient, ensuring that appointments run smoothly and patients feel comfortable throughout the entire process.

Overall, I cannot emphasize enough how fortunate I feel to have found Dr.Goutos' exceptional skills, genuine care, and unwavering commitment to his patients make him a truly outstanding specialist. I wholeheartedly recommend him to anyone seeking top-notch medical care.
  
 
      Posted on Google  
    Kashmala Khan 
 
 
 
  Mr. Goutos and his team did an amazing job reversing a scar I had on my forehead. This was a very old scar and had bothered for many years. The laser treatment and fat transfer procedure has changed my life and given me so much confidence. I would definitely recommend him, he is a fantastic and very skilled surgeon. Thank you so much!
  
 
      Posted on Google  
    Javier 
 
 
 
  Mr Goutos and his team removed some lipomas from my arms. The initial consultation right through to the aftercare was professional, sensitive and genuine. Mr Goutos put me at ease right from the start, discussing my history and background and then discussing the various options for the incisions and sutures. The incisions were quick, efficient and professional. I felt completely at ease knowing I was in expert hands. The incisions were extremely neat and have closed and scared really well. I had a number of questions after the operation and one of the sutures became infected. Mr Goutos was quick to make an appointment for me, see me and deal with the infection and offered for me to see him again if the infection didn’t calm down. He was genuinely empathetic to my needs and took time to check each scare, explain things and assure me along the way. He didn’t at any point, make me feel I was asking silly questions or too many.

I highly recommend Mr Goutos for his exceptional incisions and suturing as well as his professional conduct, caring approach and after care. The whole experience was smooth and easy and I am very grateful for what he has done for me.
  
 
      Posted on Google  
    Ieva Lihovida-Yarlett 
 
 
 
  We came to see Dr Goutos a few month ago to remove invasive spider nevus on my 9 year old sons nose . After a lovely consultation with Dr Goutos , he suggested to do several laser treatment sessions. After a few sessions we already noticed a massive improvement. On the final laser treatment session the spider nevus  was completely gone. Thank you to the Dr Goutos for tackling the problem so rapidly and with great results!
  
 
      Posted on Google  
    Amy Munson 
 
 
 
  We took our 4yr old daughter to Mr Goutos following an accident which resulted in a small burn scar on her cheek. Mr Goutos gave us various options and we went for laser treatment. After 4 appointments the scar has gone!
The care that Mr Goutos gave us was exceptional and so good with children. He made us feel very comfortable and confident in his ability. I would recommend him to anyone if they were looking for a doctor in that particular field.  Can't thank him enough.
  
 
  
  
 
 
   Google rating score: 4.7 of 5, based on 26 reviews