A scar is a normal part of the healing process following an injury, whether from physical trauma such as road traffic accidents or burns or from surgical procedures. While scars can serve as reminders of overcoming challenges, some may become bothersome due to their location, appearance, or size, making them aesthetically unpleasing. In more severe cases, scars can be functionally limiting, particularly when they affect areas like joints, hands, neck, or eyelids. When scars restrict movement in these areas, they are known as scar contractures and can be debilitating to incapacitating. Scars may also be associated with negative experiences, leading to psychological distress. It’s important to understand that various factors influence how one scars from a wound. Skin type, age, genetics, the cause of the initial wound, and the wound's location all play a role in the healing process. Unfortunately, darker skin tones tend to develop more conspicuous scars, and younger individuals are more prone to forming worse scars than much older adults. For those undergoing planned surgery, it is essential to discuss scar expectations with your surgeon beforehand. Although the final appearance of the scar can be difficult to predict, even with an experienced surgeon, this conversation can help prevent disappointment and prepare both the patient and doctor for early wound care and better scar outcomes. It’s also important to note that the scar-healing process varies among individuals and can take up to 18 months. Scars often appear more prominent and swollen in the early stages before eventually settling into a flat, mature scar. However, some scars may not mature as expected and can remain swollen, itchy, or even continue to enlarge over time, also medically known as hypertrophic or keloid scars, which can be more challenging to the patient. In the past, less attention was given to achieving fine scars, even among healthcare providers. The focus was primarily on treating the underlying condition and ensuring the wound healed. However, today’s patients have more diverse concerns, and once the surgical issue is resolved, the scar may become the new focus. There are various medical therapies available for scar management, including; gels, pressure garments, scar sheets, injections, etc. Laser therapy, now available in Rwanda, is a newer option that can improve certain types of scars when used appropriately. Some scars may require surgical revision if a surgeon determines they are unlikely to improve naturally or with non-surgical options. The first step in addressing a scar is acceptance and working closely with your healthcare provider to achieve the best possible outcome. However, it’s crucial to maintain realistic expectations, as it is rarely possible to eliminate a scar, even in the best settings with experienced hands. No universally accepted treatment applies to all scars. If one is dealing with a bothersome scar, it’s advisable to consult a certified plastic surgeon who can recommend the best scar management plan. Additionally, some individuals might struggle to accept their final scars despite utilizing all the appropriate management options available, especially if the scar is tied to unpleasant memories. In such cases, seeking mental health support from a psychotherapist may be beneficial. The author is a Reconstructive and Aesthetic Plastic Surgeon at the Rwanda Military Referral and Teaching Hospital Iangashugi@gmail.com
