Scar Tissue Under Eyelid: Causes, Treatment, and Prevention After Blepharoplasty

16.06.202111.07.2023 by alexxlab

What causes scar tissue under the eyelid after blepharoplasty. How can lumps and bumps be treated following eyelid surgery. What should patients know before undergoing blepharoplasty. How long does it take to see results after eyelid surgery.

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Understanding Blepharoplasty and Post-Surgical Complications

Blepharoplasty, commonly known as eyelid surgery, is a delicate procedure that can significantly enhance one’s appearance. However, like any surgical intervention, it comes with potential complications. One such complication is the formation of scar tissue under the eyelid, which can manifest as lumps or bumps along the incision line.

Why do these lumps appear? The primary reasons include:

Retention of scar tissue
Accumulation of lymphatic fluid
Focal swelling or fibrosis after surgery

The thin nature of eyelid skin makes these lumps more noticeable and easily felt. While their appearance can be concerning, it’s essential to understand that in many cases, this is a normal part of the healing process.

Essential Pre-Blepharoplasty Information for Patients

Before undergoing blepharoplasty, patients should be aware of several crucial factors that can impact their recovery and overall satisfaction with the procedure.

Temporary Dry Eyes

Can blepharoplasty cause dry eyes? Yes, many patients experience temporary dry eyes following the surgery. This occurs due to swelling, which creates pressure and disrupts the normal tear production process. The brain may trigger tear production, but these tears lack the necessary mucus and oil to keep the eyes adequately moist. Fortunately, this condition typically resolves as swelling subsides.

Formation of Small Bumps

Is it normal to have small bumps after blepharoplasty? Indeed, some patients may notice slight bumps during the healing process. These are often the result of scar tissue formation at the incision site. In most cases, these tissues soften over time, but occasionally they may thicken. If this occurs, your surgeon might recommend minimal steroid treatment to address the issue.

Gradual Results

How long does it take to see results after blepharoplasty? Patient experiences vary widely. Some may see improvements within a week, while others might contend with swelling and bruising for up to two weeks. It’s crucial to allow your body ample time to heal and for the underlying tissues and skin to adjust post-surgery.

Avoiding Repeated Surgeries

Should you consider another blepharoplasty if you’re unsatisfied with the results? It’s generally advisable to avoid immediate repeat surgeries. Multiple procedures can increase the risk of complications, including lower eyelid malposition. If further treatment is desired, alternative options like Fraxel laser or filler treatments may be more suitable.

The Healing Process: What to Expect After Blepharoplasty

The healing journey after blepharoplasty is unique for each patient. Understanding the typical timeline can help manage expectations and alleviate concerns.

How long does the healing process take? Generally, initial healing occurs within the first two weeks, but complete recovery can take several months. Here’s a general timeline:

Days 1-7: Swelling and bruising are most prominent
Days 7-14: Stitches are typically removed, and many patients return to normal activities
Weeks 2-4: Most visible swelling and bruising subsides
Months 1-3: Subtle swelling continues to resolve, and scars begin to fade
Months 3-6: Final results become apparent as tissues fully settle

It’s important to note that scar maturation can take up to a year, during which time the appearance of any lumps or bumps may continue to improve.

Managing Lumps and Bumps: Treatment Options

While many post-blepharoplasty lumps resolve on their own, there are several treatment options available for persistent cases.

Non-Invasive Treatments

What are some non-invasive ways to treat post-blepharoplasty lumps? Consider these options:

Gentle massage: This can help break down scar tissue and promote fluid drainage
Silicone gel or sheets: These products can help soften and flatten scars
Moisturizing creams: Regular moisturization can improve skin elasticity and appearance
Cold compresses: These can help reduce swelling and discomfort

Medical Interventions

When might medical intervention be necessary? If non-invasive treatments prove ineffective, your surgeon may recommend:

Steroid injections: These can help reduce inflammation and soften scar tissue
Laser therapy: This can improve the appearance of scars and promote collagen production
Surgical revision: In rare cases, additional surgery may be required to address persistent issues

Preventing Complications: Best Practices for Blepharoplasty Patients

While some complications are unavoidable, patients can take steps to minimize their risk and promote optimal healing.

Pre-Surgery Preparations

How can patients prepare for a successful blepharoplasty? Consider these tips:

Choose a board-certified plastic surgeon with extensive experience in eyelid surgery
Disclose all medical conditions and medications to your surgeon
Stop smoking and avoid alcohol for at least two weeks before surgery
Arrange for help during the initial recovery period

Post-Surgery Care

What can patients do to ensure smooth recovery after blepharoplasty? Follow these guidelines:

Strictly adhere to your surgeon’s post-operative instructions
Use cold compresses as directed to reduce swelling
Avoid rubbing or touching the surgical area
Keep your head elevated while sleeping
Protect your eyes from sun exposure
Avoid strenuous activities for at least two weeks

The Importance of Professional Consultation

While online resources can provide valuable information, they are no substitute for professional medical advice. Patients should always consult their surgeon with any concerns or questions about their recovery.

When should you contact your surgeon? Seek immediate attention if you experience:

Severe pain or swelling
Unusual discharge or bleeding
Changes in vision
Signs of infection, such as fever or redness

Remember, your surgeon is your best resource for personalized care and guidance throughout your blepharoplasty journey.

Advanced Techniques in Blepharoplasty: Minimizing Scar Tissue Formation

As surgical techniques continue to evolve, new approaches aim to minimize scar tissue formation and improve overall outcomes for blepharoplasty patients.

Minimally Invasive Techniques

How are surgeons reducing the risk of scar tissue formation? Some advanced techniques include:

Transconjunctival blepharoplasty: This approach avoids external incisions, reducing visible scarring
Laser-assisted blepharoplasty: Precise laser incisions can result in less trauma and faster healing
Endoscopic techniques: These allow for smaller incisions and reduced tissue manipulation

Tissue-Sparing Approaches

What strategies do surgeons use to preserve healthy tissue? Consider these methods:

Fat repositioning instead of removal: This can prevent hollowing and maintain a youthful appearance
Selective fat removal: Surgeons target only excess fat, preserving essential volume
Muscle-sparing techniques: These approaches aim to maintain natural eyelid function

By employing these advanced techniques, surgeons can often achieve excellent results with minimal scarring and reduced risk of complications.

Long-Term Outcomes and Patient Satisfaction After Blepharoplasty

Understanding the long-term outcomes of blepharoplasty can help patients set realistic expectations and make informed decisions about the procedure.

Duration of Results

How long do the effects of blepharoplasty last? While individual experiences vary, most patients enjoy long-lasting results. The upper eyelids typically maintain their improved appearance for 5-7 years, while lower eyelid results can last even longer. However, the natural aging process continues, and some patients may seek touch-up procedures after several years.

Factors Affecting Long-Term Satisfaction

What contributes to patient satisfaction years after blepharoplasty? Key factors include:

Realistic expectations set before surgery
Skilled surgical technique
Proper post-operative care
Ongoing skin care and sun protection
Healthy lifestyle choices, including proper nutrition and avoiding smoking

Patients who maintain open communication with their surgeons and follow recommended care guidelines often report the highest levels of long-term satisfaction with their blepharoplasty results.

Combining Blepharoplasty with Other Facial Rejuvenation Procedures

Many patients choose to combine blepharoplasty with other facial rejuvenation procedures for more comprehensive results. This approach can often provide more harmonious and balanced outcomes.

Common Complementary Procedures

What procedures are often performed alongside blepharoplasty? Popular options include:

Facelift: Addresses sagging in the lower face and neck
Brow lift: Corrects drooping eyebrows and forehead wrinkles
Dermal fillers: Restore volume to hollow areas or smooth fine lines
Chemical peels or laser resurfacing: Improve overall skin texture and tone

Benefits of Combined Procedures

Why might patients consider combining procedures? Potential advantages include:

More comprehensive facial rejuvenation
Single recovery period for multiple procedures
Potential cost savings compared to separate surgeries
Harmonious results across facial features

When considering combined procedures, it’s crucial to work with an experienced surgeon who can develop a tailored treatment plan based on your individual needs and goals.

As we continue to explore the intricacies of blepharoplasty and its outcomes, it’s clear that this procedure offers significant benefits when performed by skilled professionals. By understanding the potential for complications like scar tissue formation and following proper pre- and post-operative care, patients can maximize their chances of achieving satisfying, long-lasting results. Remember, every surgical journey is unique, and open communication with your healthcare provider is key to navigating any challenges that may arise during the recovery process.

The Occurrence Of Lumps After Blepharoplasty And Techniques To Treat Those Lumps 2023

Tiny lumps or bumps on the skin can be noticed after any surgery during the healing process. A sensitive surgery such as an eyelid can invite such complexities easily as you have to move your eyelids constantly. Through this blog, we will try to uncover the grey areas that cause the issue and the way to treat them.

However, ensure that you do not self examine your condition and treat it yourself. Ask your plastic surgeon to take a look at you, in return, you will get expert advice keeping you away from harm’s way.

If you are looking for blepharoplasty Dubai, you have landed in the right place for all kinds of advice.

What happens exactly?

After blepharoplasty, a small grain-sized lump can sprout along the incision and it is quite normal. The focal swelling or fibrosis after surgery is the reason behind this occurrence. As the skin on the eyelids is very thin, the lumps can easily be felt or seen prominently.

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Before exploring the depth of reason. Let us take a look at four elements that you need to know about blepharoplasty.

4 Things you should know before blepharoplasty

These four things often cause discomfort to patients as they get confused while understanding the entire process.

Here is an easy way, take a look-

Eyes can get dry after the surgery

Often blepharoplasty Dubai patients report dry eyes right after the surgery. Dr. Tarek Aesthetics has studied that this is temporary. The fluid that makes the eyes watery is made with water, mucus, and oil with a fluid secreted by eyelid glands.

After the eyelid surgery, pressure is created from the swelling resulting in dry eyes. This leads to your brain getting triggered to produce tears, however, the tears created do not carry mucus or oil for keeping the eyes moist. The itchy and dry feeling will wear off as soon as the swelling reduces.

Small bumps can form on the incision

After the blepharoplasty, a few patients have complained about slight bumps during the healing. Normally, when the incision heals, scar tissues build resulting in a bulge. However, with time the tissues get softer in most cases, while it gets thicker for some. In case of this, recommend Dr. Tarek Aesthetics for minimum amounts of steroids to treat the tissues.

The results after surgery will not show in just a week

It is common to have swelling or bruising after blepharoplasty. Some patients luckily see results right after the switches are removed after six to seven days. However, different patients have different healing rates.

Few may be doing well in three to four days, while some might be dealing with bruising and swelling for as long as two weeks. So, consider all these circumstances before you judge your new look. Give time to your body for healing and the underlying tissues and skin to adjust to the surgery after the swelling and bruising.

Don’t go for another blepharoplasty

After undergoing eyelid surgery, if you still feel that the skin around your eyelids is still loose, do not jump into another surgery immediately. If you repeat blepharoplasty Dubai patients can increase the risks for complications.

You can also notice the lower eyelid is pulling down or out in case of repeated surgery. If you want to take another treatment, then consult your plastic surgeon about Fraxel laser, or filling it with Autologous or Restylane Fat. This will help in treating the area without the risk of pulling down the lower eyelid.

Blepharoplasty is indeed a complicated surgery. Those who choose to undergo this procedure should know everything that will help them through the surgery. These points sum up most of the areas that a patient should keep in mind.

Additionally, if you have undergone filling, or any other surgeries near your eyelid recently refrain from getting this surgery if you have not healed completely. Consult a surgeon before you undergo the surgery after you have healed.

Now let us find out why lumps occur and how they can be dealt with after blepharoplasty.

Reasons for a lump to show up

The common cause for lumps might be caused because of the retention of scar tissues or lymphatic fluid. Post-blepharoplasty the scar tissues get firm and slightly raised. Most of the eyelid surgery or blepharoplasty Dubai patients’ scars get worse then heals slowly.

It takes over 3 to 4 months for the scar to mature resulting in softening. Generally, without any intervention, the scars respond well to routine scar treatment such as silicone gel or moisturizing creams. If needed, a small dosage of cortisone can be injected into the scar in case the hard lumps need to be broken down into smaller ones.

The granuloma or lump might be the result of a reaction caused due to the sutures used in the surgery. When the body builds a scarred wall around the stitches mostly around the knot it is a suture reaction. The lumps can be easily felt due to the thin skin around the eyelid. A lump is formed when deep stitches are used to hold the eyelid tissues to the periosteum (bone).

This is a result of lower eyelid surgery. In a transconjunctival blepharoplasty, the incision is inside the eyelid. The lump could also be a reaction from ointment used during the surgery, leading to building foreign bodies. The treatment is easy with surgical excision, which can be done right in the office and with minimum pain.

How are these lumps classified?

There are different kinds of lumps that can occur after surgery. Let us discuss some of them.

Blood clotting (hematoma) or a cyst filled with fluid (seroma): This is healed with time.
Stye or chalazion: This develops after undergoing eyelid surgery. This can be treated by an ophthalmologist by removing the stye easily.
Nodule of fat: Occurs when you had injected fat during the surgery.
Bacterial infections: Scarcely found in patients, a painful, unresolved, and reddish lump. It can be a local infection or an abscess on the incision. The treatment for this is antibiotics and warm soaks. If the issue doesn’t get resolved, then the scar might need to be opened again for draining the area and resolving the problem.

Apart from these tips on different kinds of lumps, it is necessary to keep in touch with your blepharoplasty Dubai surgeon.

Follow up with the plastic surgeon for guidance and treatment

The various reasons cause various issues, hence it is important for you to be in touch with your plastic surgeon after the blepharoplasty. The surgeon will be able to diagnose you and determine which kind of a lump you have grown and what will be the best treatment. Steady communication with your surgeon will help in answering questions that may come to your mind during the healing process.

The right time to get a blepharoplasty is now!

Modern and advanced technologies and techniques have made eyelid surgery easier, effective, and safer. Being said that modern surgery is more capable of delivering the best results that you desire and with minimum pain, downtime, and discomfort. An experienced plastic surgeon equipped with advanced technology can offer better results that are long-lasting. The anesthesia specialist will ensure that you are comfortable and safe in a modern clinic.

Consult an expert before the procedure

Before you go through the procedure ensure that you consult a professional who will be able to guide you thoroughly in addressing your concerns. As the autonomy and ability to heal are unique for each one of us, a detailed evaluation by an expert plastic surgeon can help you. Through this, you will be able to explore different options, and finally, choose the one that suits you best.

How will you find the best blepharoplasty Dubai surgeon?

There are certain things that you need to keep in mind, while you look for a surgeon.

What is their overall experience and how many successful surgeries they have completed?
What do their clients say about the services?
Do they have the right certifications for conducting medical cosmetic procedures?

If you keep these simple things in mind, then you will be able to find the best blepharoplasty Dubai surgeon.

Conclusion

We hope that this blog was enough for you to understand the reasons for lumps occurring after blepharoplasty. Please let us know how helpful this article was to you, and if you like it, share it with your friends. If you have any comments on this article, drop your valuable feedback for us in the comment section.

If you want to get such surgery, ensure that you go through the right processes and follow what the surgeon advises you. Dr. Tarek Aesthetics offers you a number of aesthetic solutions, along with blepharoplasty Dubai. We have experience in offering the right treatment with minimum or no complications.

Our patients have proudly recommended us to their close ones, for critical cosmetic surgeries. If you want to get more details give us a call at +971 56 960 5146 or email us at [email protected].

how to fix eyelid scarring and retraction after surgery for removal of bags

May182020

Surgery

In our last blog, we went over the causes of eyelid retraction after lower lid blepharoplasty, a procedure to remove bags and excess skin from under the eyes. However, we did not expand on the therapeutic alternatives to correct this unwanted complication. Thus, we have decided to dedicate this blog to the treatment of lower eyelid scarring and retraction, a feared and relatively common complication of blepharoplasty.

Repair of lower eyelid retraction is not easy.

The first thing to keep in mind when facing this complication is that there is no simple way to correct the problem. Eyelid scarring and retraction are usually due to the removal of too much skin when performing blepharoplasty. Therefore, the most straightforward approach to the correction of the problem is inserting a skin graft on the lower eyelids. The main concern with this option is that skin grafts on the lower eyelids don’t generally heal well. This is not what a patient who had cosmetic plastic surgery wants. It would not make sense to worsen the appearance of an individual who wanted to improve it in the first place. Therefore, the task of the eyelid reconstructive surgeon is to resolve the problem of retraction and scarring while also respecting the patient’s cosmetic expectations.

Midface lift with bone fixation for lower eyelid retraction

An excellent way to recruit skin from the cheek without having to use a skin graft is by doing a procedure called midface lift with bone fixation. The operation consists of liberating the attachments of the midface tissues from the cheekbone and elevating them in a superolateral vector. The tissues are then fixated to the bony rim on the lateral aspect of the eye. This procedure will raise the cheeks and allow the skin of the upper midface to work as a “graft.” This way, the surgeon avoids a skin graft, and the final result is natural and aesthetically pleasing.

Midface lift is a complex operation performed as an outpatient procedure under general anesthesia. In most cases, patients can expect recovery times of about one month. Bruising and swelling may be quite pronounced during the first two weeks. Nevertheless, this is an elegant operation with remarkable and long-lasting results.

Lower eyelid hard palate grafts

When the eyelid retraction is severe, and the scar tissue affects all three layers of the eyelid, a hard palate graft is necessary. During the midface lift, as mentioned above, the graft is harvested from the mucosa of the hard palate. After excising the scar tissue, the graft is then sutured to the inside of the eyelids. The primary function of the graft is to increase the vertical length of the eyelid as the surgeon tries to elevate it to its normal position.

Canthopexy and canthal suspension

When lower eyelid retraction is mild and associated with eyelid laxity, a canthopexy or canthal suspension may be enough to correct the retraction. These are pretty simple operations done under local anesthesia in a minor procedure room. A small incision is made in the corner of the eyes, and a suture is used to anchor the eyelid tissue to the lateral bony rim. It is a quick and elegant way to fix mild eyelid retraction. However, it cannot address moderate to severe scarring and retraction (see videos).

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+506 7032-5570

Abraham Gómez, MD

Hospital Clínica Bíblica, Omega Building, 2nd floor

Momentum Escazu, Medical center, 6th floor, #CM48

Loras Medical, Torre Las Loras, main floor

+506 7032-5570

Abraham Gómez, MD

Hospital Clínica Bíblica, Omega Building, 2nd floor

Momentum Escazu, Medical center, 6th floor, #CM48

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The process of rehabilitation of patients in the postoperative period is closely related to wound healing and the formation of a postoperative scar. In most patients with extensive injuries of various etiologies, pathological scars form at the site of the lesion, leading to dysfunction of the limbs, deformities of the body and face, and an increase in the level of disability.
One of the ways to reduce the trauma of the operations performed is to reduce the volume of the surgical wound through the introduction of minimally invasive (endoscopic, laparoscopic, thoracoscopic, etc.) operations and the use of sparing wound closure methods (including intradermal absorbable suture) (Fig. 1).

Currently, there is no clear separation of the terms “scar” and “scar tissue” [1]. At its core, a scar is a connective tissue formation that is formed in the process of wound healing, and scar tissue occurs in the last phase of the wound process – the phase of epithelization. The process of scar formation includes external (volume, localization, type of wound healing) and internal factors (reactivity of the body, structural features of the connective tissue, etc. ). The severity of the cicatricial process depends on the amount of damage: it is greater in case of deep damage with damage to the sweat and sebaceous glands, hair follicles [2].
In the process of wound healing, several phases are conditionally distinguished, replacing and often overlapping each other: the exudation and inflammation phase, the proliferation phase, and the reorganization phase [3].
In the 1st phase (exudation and inflammation), the blood coagulation system is activated and a platelet-fibrin clot is formed at the site of injury, which leads to bleeding arrest and the creation of a temporary matrix consisting of glycoproteins (collagen), proteoglycans and hyaluronic acid, which serves as the basis for connective tissue synthesis. Subsequently, against the background of fibrinolysis and destruction of platelets, numerous growth factors (transforming growth factor β, epidermal growth factor, insulin-like growth factor, platelet growth factor, etc.) are released and neutrophils are attracted, phagocytizing foreign particles and activating keratinocytes and macrophages.
In the 2nd phase (proliferation), the formation of young connective tissue, rich in blood vessels and cells, and the synthesis of collagen by fibroblasts occur. A feature of this phase is the predominance of embryonic collagen (type III) in the tissues of the postoperative scar, which is thin fibers and is characterized by elasticity and good extensibility. Subsequently, type III collagen is replaced by less elastic type I collagen. At the same time, myofibroblasts synthesize proteins actin and desmin, which improve the convergence of wound edges.
In the 3rd phase of wound healing (phase of reorganization), contractile proteins and various components of the extracellular matrix are synthesized by fibroblasts. Fibroblasts, mast cells and macrophages synthesize matrix metalloproteinases, which destroy the components of the extracellular matrix. Thus, in the reorganization phase, the balance between collagen synthesis and destruction is maintained, which leads to the formation of a normal scar.

Reliable reasons for the development of hypertrophic and keloid scars have not yet been identified. The formation of such scars is based on violations of the processes of collagen synthesis and degradation at various stages of scar formation, violations are due to the following reasons [4, 5]:
1) intensification of the synthesis of collagen fibers in the postoperative wound for a long time
time;
2) the influence of various growth factors (transforming growth factor β) on the development of hypertrophic scars by stimulating angiogenesis, collagen synthesis, fibroblast proliferation, inhibition of cytoplasmic matrix degradation [6];
3) increased activity of inhibitors of metalloproteinases, leading to the formation of excess collagen and fibronectin;
4) violations of the processes of apoptosis of fibroblasts of the postoperative wound against the background of suppression of the p53 protein, which is a regulator of the cell cycle.
Pathological scars can appear at any age, but most often they occur in young patients. This is due to the peculiarities of their skin – elasticity and extensibility due to the synthesis of a large amount of collagen, while in older patients the skin is more rigid.

Currently, the following classification of scars is accepted [2].
I. Physiological (normotrophic) scars.
II. Pathological scars:
1. Atrophic scars:
• stab,
• rectangular,
• rounded,
• striae.
2. Hypertrophic scars.
3. Keloid scars:
A. By etiology:
• true keloid scars,
• false keloid scars.
B. By morphology:
• fibroblastic (active),
• fibrotic (stable).
Normotrophic scars develop as a result of the physiological process of wound healing.
The development of atrophic scars occurs at the site of ulcerative defects, pyogenic infiltrates, infectious granulomas, in foci of chronic inflammation. The main difference between atrophic scars is the absence of cells and blood vessels, dermal atrophy, and severe fibrosis [7]. Stretch marks are also characterized by rupture of elastic fibers along with a deficiency of collagen and elastin.
Hypertrophic scars are characterized by a fairly dense texture, they rise above the surface of the skin, but do not go beyond the damage. Histological examination reveals the growth of collagen fibers, an increase in the number of fibroblasts, and the presence of a developed vascular network [8].
A keloid scar is a neoplasm of immature connective tissue that extends beyond the damage zone and is characterized by the presence of a large number of fibroblasts and obliterated vessels, bundles of collagen fibers forming nodal structures [9].
Currently, the division of keloid scars into true (occurring spontaneously) and false (arising at the site of microtrauma) has undergone some changes, since it has been proven that true keloid scars also occur against the background of microtraumatization of the postoperative wound.

Drugs used to treat patients with pathological scars belong to different pharmacological groups and have application points at each stage of scar development [7].
A. Corticosteroid preparations
Corticosteroid drugs are the mainstay in the treatment of patients with keloid scars. Their action is based on the inhibition of the synthesis of inflammatory mediators and fibroblast proliferation, which leads to a decrease in the level of glycosaminoglycans and collagen in the wound [7]. The drugs in this group include:
• Hydrocortisone , used by injection and topically [12];
• Triamcinolone acetate , injected into the affected area at intervals of 4-6 weeks;
• Betamethasone dipropionate is used as a topical formulation. A feature of the action of this drug is a decrease in the relief of scar tissue due to changes in the kinetics of fibroblasts and resorption of connective tissue [12].
When using corticosteroid drugs, complications such as skin atrophy, telangiectasia, and pigmentation disorders may develop.
B. Enzyme preparations
Enzyme preparations used in the treatment of patients with pathological scars include collagenases and hyaluronidases, which hydrolyze collagen and glycosaminoglycans in scar tissue with further restoration of the normal composition and structure of the extracellular matrix [7].
The specific substrate of hyaluronidase are glycosaminoglycans – “cementing” substance of the connective tissue. As a result of hydrolysis, the viscosity of glycosaminoglycans decreases, the ability to bind water and metal ions. As a result, the permeability of tissues increases, their trophism improves, edema decreases, and the elasticity of scar-modified areas increases. The effect is most pronounced in the initial stages of the pathological process. A problem with many enzyme preparations is their inactivation upon administration. The indicated disadvantage is deprived of the drug Longidase ^®, which is a conjugate of hyaluronidase with a high molecular weight carrier, due to which the clinical effect of the drug is higher than that of the native enzyme. Conjugation increases the resistance of hyaluronidase to the action of temperature and inhibitors, increases efficiency, leads to prolongation of action, while maintaining the pharmacological properties of the carrier, which has chelating, antioxidant, anti-inflammatory activity. Due to its polytropic properties, Longidase ^® suppresses the reverse reaction aimed at the synthesis of connective tissue components, has an antifibrotic effect, and reduces the severity of the inflammatory reaction. It is well tolerated by patients [7, 13].
To prevent the formation of a hypertrophic scar after surgical operations or in the case of an already formed hypertrophic scar, Longidase is administered intra-scar or subcutaneously near the site of the lesion 1 time in 3 days, with a course of up to 15 injections at a dosage of 3000-4500 IU. Depending on the size and duration of scar formation, it is possible to alternate subcutaneous and intramuscular administration of the drug once every 5 days at a dosage of 3000 IU, with a course of up to 20 injections [13].
Conducted clinical studies demonstrate a significant effect of the drug, which consists in reducing the density of the scar and restoring skin elasticity, in patients with hypertrophic and keloid cicatricial changes with different localization and duration of the pathological process [14, 15].
Currently, a cream containing a stabilized hyaluronidase, Imoferase ^® , has appeared, which can be used by patients themselves at home to continue treatment or care [16]. The cream is applied 2 times a day (preliminary preparation of the skin is not required), it is easily absorbed and does not leave marks on clothes. The clinical efficacy of the drug has been demonstrated by the team of authors of the MGMSU named after M.V. Evdokimov. 1622 patients were examined in 46 Russian medical centers aged 18 to 45 years, with post-traumatic (698 people, 43. 03%), post-burn (98 people, 6.04%) and iatrogenic (826 people, 50.93%) scars. In 372 (22.93%) people, normotrophic types of cicatricial changes in the skin were recorded, in 1250 (77.07%) – hypertrophic ones. As a result of the use of Imoferase ^® cream for 8 weeks. there were statistically significant reductions in the intensity of dyspigmentation by 56.05%, the intensity of blood filling of scar tissue by 38.86%; scar height by 68.47%. Adverse events requiring the abolition or reduction of the frequency of application of the cream were not recorded [17].
In a study conducted in 2016 at the Scientific and Practical Center for Expert Evaluation of the Quality and Safety of Food and Cosmetics “CosmoProdTest”, with the participation of 35 volunteers with hypertrophic scars, the following results were obtained: the thickness of the scar decreased (by 2.1 times) and uncomfortable subjective sensations in the area of the scar (according to the POSAS scale, the symptom “pain” decreased by 1. 9 times, “itching” – by 1.5 times).
Researchers from the Khanty-Mansiysk Clinical Dermatovenerologic Dispensary concluded that Imoferase 9 cream0222 ® is highly effective in topical application, by photophoresis, ultraphonophoresis in patients with hypertrophic scars of various etiologies (30 people took part in the study).
In 2016 at the GKB im. F.I. Inozemtseva (Moscow) were treated in the early stages after injury (up to 3 months) of 30 patients who suffered burns of the II–III degree. Thanks to the use of Imoferase ^® cream, 80% of patients did not develop pathological post-burn scars, and with formed post-burn scars, scar tissue regressed by 1.7 points on the VSS scale.
As for the tolerability of the drug, within the framework of the study in CosmoProdTest, the use of the cream in 25 people with reactive (sensitive) skin did not have an irritating, allergenic and sensitizing effect.
B. Immunomodulators
The use of immunomodulators is a relatively new method of treating patients with pathological scars.
• Interferon -α2b, injected into the suture line after excision of a pathological scar, prevents its recurrence by inhibiting the synthesis of collagen types Ι and ΙΙΙ, which are the main structural components of scar tissue [18];
• Meglumine acridone acetate is an interferon inducer and affects the T-cell link of immunity [7]. The drug has an inhibitory effect on the synthesis of pro-inflammatory cytokines and reduces the level of chronic inflammation in the scar, which stimulates the growth of keloid tissue [7].
D. Vitamin therapy
The use of vitamins locally or by intradermal injection is a new direction in the treatment of patients with pathological scars.
• Retinol ( vitamin A ), accelerates wound healing, inhibits the growth of pathological scar tissue, increases the proliferation of epidermal cells and inhibits the proliferation of fibroblasts. The use of vitamin A leads to inhibition of the growth of keloid fibroblasts and reduces the level of collagen [19];
• Tocopherol ( vitamin E ), an active antioxidant that inhibits lipid peroxidation, stabilizes lysosomal membranes of endotheliocytes, which reduces the degree of endothelial dysfunction [20].
D. Flavonoid Compounds
This group of drugs includes various phytoextracts (quercetin , kaempferol, protocatechin , etc.), which are applied topically as part of various dressings. The effect of flavonoid compounds on the development of scar tissue is explained by their antioxidant properties, the ability to inhibit the process of lipid peroxidation and lipid peroxidation of membrane phospholipids, which affects the activity of endotheliocyte membranes [21]. Inhibition of the production of collagen and fibronectin is also noted due to the inhibition of specific genes involved in the work of some growth factors [11].
E. Amino acids
Currently, the effectiveness of glycine in the treatment of patients with pathological postoperative scars has been most studied. This amino acid is involved in the formation of new cells, has a hydrating ability. The use of glycine locally allows you to maintain the protective function of the epidermis, and its penetration into the dermis improves microcirculation, slows down the degradation of connective tissue. Studies have shown that its use in high doses allows for the prevention of keloid formation due to the endothelioprotective effect of the drug [19].
G. Combined preparations for the treatment of patients with pathological scars
Multicomponent preparations for the treatment of patients with pathological scars are more effective than monocomponent preparations, since they affect different parts of the scar formation process.

These treatments are based on various physical effects on the pathological scar and include:
A. Products containing silicone (plates, patches, gels) [7]
The effect of silicone plates and patches on keloids is due to their uniform pressure on the scar, which leads to a decrease in the volume of the extracellular matrix and to the correct, ordered arrangement of collagen fibers in the wound. The use of silicone plates allows you to constantly keep the surface of the scar moist, protect it from drying out and traumatization. Constant hydration of the scar tissue helps to restore the water balance of the epidermis and normalize the activity of fibroblasts, which prevents excessive growth of the connective tissue, and exposure to a negatively charged static electric field of silicone can lead to regression of the keloid process [12].
B. X-ray therapy
The use of X-ray therapy is due to the effect of ionizing radiation on the connective tissue, which leads to edema and destruction of both fibroblasts and collagen fibers [22]. A feature of the method is that irradiation affects only the epidermis and superficial layers of the dermis (including the scar), while the load on the underlying tissues is minimal. Contraindications for prescribing X-ray therapy include:
• kidney disease,
• decompensation of circulatory disorders,
• the presence of dermatitis.
The total radiation dose is 15–20 Gy. To prevent the development of a keloid scar, it is possible to irradiate the wound once on the day the sutures are removed.
B. Exposure to low temperatures (cryolysis)
Cryotherapy on a pathological scar (with liquid nitrogen) leads to damage to the vessels of the microvasculature and cell death as a result of the formation of microcrystals inside the cells. The disadvantage of the method is pain and frequent development of hypo- and depigmentations, which in some cases may be irreversible [1].
D. Laser therapy
The use of laser therapy in patients with pathological scars is based on the ability of collagen to contract against the background of local heating (when using a carbon dioxide laser) or to be destroyed during photothermolysis (when using pulsed dye lasers) [1]. The use of lasers leads to a decrease in the size of the scar and its softening. However, when using only laser exposure to a pathological scar, a fairly high percentage of relapses is noted. Therefore, the photophoresis method is of interest, when a drug is first applied to the scar, and then laser irradiation is performed using a contact-stable, quasi-scanning, or contact-labile method. Use low-energy infrared laser radiation (pulse power is 2-8 W / pulse) with a pulse repetition rate of 80 or 1500 Hz. It should be noted that Longidase 9 preparations0222 ® and Imopherase ^® can be used for photophoresis. Longidase is dissolved in water for injection, procedures are carried out daily or every other day with a course of up to 15 procedures. Repeated courses are shown after 2 months. This physiotherapeutic method is most effective for fresh scars from 2 weeks to 2 months ago [15].
E. The use of ultrasonic vibrations in the framework of the method of ultraphonophoresis
The technique is carried out using the combined use of a drug (for example, Longidase or Imoferase) and ultrasonic vibrations in continuous or pulsed mode with a frequency of 880 kHz – 1 MHz. Before use, Longidase is diluted in 1 ml of liquid (sodium chloride solution 0.9%, water for injection, novocaine solution, etc.) and applied to the scar, then, without a time interval, ultrasound is applied using the contact method, the intensity is 0. 2 W / cm2 when the process is localized on the face, and 0 when localized on other parts of the body. .4–0.8 W/cm2. The total duration of the procedure does not exceed 15 minutes, the procedures are carried out daily or every other day with a course of up to 20 procedures. A second course of ultraphonophoresis is allowed no earlier than after 3 months. It is important to note that this method, in combination with intra-cicatrical and subcutaneous (near the site of the lesion) administration of Longidaza, is effective for the treatment of cicatricial changes even more than 1 year old [15].
It should be noted that the effectiveness of the use of therapeutic and physiotherapeutic agents depends on the period of scar formation – the older it is, the less effective the treatment. This is due to the predominance of scar tissue and a decrease in the number of vessels in the connective tissue formation, which disrupts its trophism.

Surgical excision of keloid scars is used extremely rarely, because a traumatic effect on the scar almost always leads to a recurrence of the keloid. The method is based on the removal of scar tissue and the creation of optimal conditions for healing by primary intention: comparison of homogeneous tissues and wound edges, cleansing the wound, suturing the wound with an atraumatic absorbable thread. Surgical treatment must necessarily be accompanied by other methods of prevention and treatment of pathological scars [1].