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Scars by Mr Ioannis Goutos



Scarring is the natural end result of the healing process following injury to the skin, including lacerations, burns, infection, acne and surgery. When there is a break or insult to the skin, the skin itself is able to employ a biological process which helps to repair the damaged tissue and restore integrity to tissues. This occurs in multiple stages and the final stage is referred to as ‘remodelling’; it is during this phase that the established scar tissue matures. The aim of the scar is to bridge any separation in the skin to prevent infection and restore the skin’s natural properties. Scar tissue is created by a variety of special cells within the skin, including fibroblasts, which lay down connective tissue, including collagen, that form a bridge-like structure for new skin cells to grow around.

Unfortunately, this process does not always form a scar that is congruent with the surrounding skin and this can become problematic. Depending on the amount of collagen and pigment laid down, the resultant scar may appear:

  • Bulky or raised
  • Dimpled or depressed from the surrounding skin
  • Stretched
  • Tight and stiff in texture
  • Darker or lighter in colour than the original skin tone

Sometimes scar tissue can cause long term symptoms of discomfort, pain and itch.  Scars that are particularly tight or tough can also cause problems with movement if located overlying a joint (e.g. elbow or knee).

Some people will have a tendency to develop troublesome scarring. For example, those with darker skin tones or strong family history are more likely to develop hypertrophic or keloid scarring in response to skin injury. Individuals who are known to have connective tissue disorders, such as Ehlers-Danlos syndrome, are at higher risk of atrophic (depressed) scarring. People who suffer from certain skin problems, such as extensive acne, are also at risk of developing adverse scarring, if the primary skin condition is not well managed in the first instance.

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About this condition

In addition to the physical factors around scars, there are a number of psychological, social and functional considerations for individuals who have experienced adverse scarring. It is known within the medical community that unfavourable scarring can be associated with poor self-esteem, mental health problems as well as functional limitations. It is beneficial to address scarring from all of these aspects in order to confer the most treatment benefit to each individual.

There are a number of treatments available for problem scarring, including the use of medicated tapes or plasters, injections, laser therapies, needling and surgical options. There is also a range of good moisturisers and camouflage products that can be of benefit. In those who are at a higher risk of developing adverse scarring, it can be beneficial to avoid any non-essential cosmetic or surgical procedures, which may cause scarring in the first place. In the case of necessary surgery, additional steps can be taken by an experienced and skilled surgeon to increase the chances of favourable scarring. These include tension-relieving suturing methods and employing additional post-procedure adjuncts to promote aesthetic healing, such as steroid tapes or needling.

Mr Ioannis Goutos is a London-trained and based plastic surgeon with a particular expertise in the assessment and surgical and non-surgical management of scars and burn injuries. He places special emphasis on the functional and psychodynamic aspects of scarring, to better give each individual fully holistic care. He is well known within the academic community as a leading expert on managing scars and burns, and has work published and presented both nationally and internationally.

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Goutos London - Scarring


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