Scar Assessment

If you showed me your scar and asked, “What can I do about this?”, I probably wouldn’t start by talking about treatment. I’d start with a thorough scar assessment.

For me, assessment is the cornerstone of scar treatment. I wouldn’t want to start treating a scar without first understanding the scar - and, just as importantly, understanding its impact on you.

You can tell a lot quickly by looking at and feeling a scar. Often I can get a good idea of what has happened and what treatment you have had just by looking. But a proper scar assessment takes time. Mine will usually take around an hour, and for someone with extensive scarring it can take considerably longer.

Why? Because I’m not just assessing the scar I can see and feel.

I want to understand what happened, how the scar developed, how old it is and where it is in the healing process, what treatment you’ve already had and anything in your medical history that might be relevant. Most importantly, I want to understand what bothers you about your scar. Is it how it looks? Is it painful, itchy, sensitive or tight? Does it affect how you move, what you can do or how you feel about yourself?

Then I’ll look at the scar, feel it and see what happens when you move. Is it soft or firm? Raised or flat? Does it move freely over the tissues underneath or is it stuck? Does it pull or restrict movement? Is it tender or sensitive?

I’m also looking beyond the scar. Is the scar actually causing the problem? Sometimes it is. Sometimes it is only part of it. And sometimes the thing someone hopes scar treatment will change isn’t really being caused by the scar at all.

And this is important: what I think is the biggest problem may not be what matters most to you. I see that time and again. The treatment plan needs to bring those two perspectives together.

So, if your first appointment feels like there is a lot of talking, looking, feeling and moving rather than immediately getting on with treatment, there is a reason. What you should leave with is something much more useful: an understanding of your scar, a plan and a sense of what we might expect and over what time frame.

I should be able to explain what I think can change, what probably won’t, what treatment might help, roughly how long it may take and what sort of improvement we can realistically hope for. Sometimes there are uncertainties, but we should still have a direction.

And sometimes that plan won’t just involve me. I may think that you would benefit from what I can offer, but also that you need input from one of my colleagues or another specialist. Good scar care is often about bringing the right people together.

And assessment doesn’t stop after that first appointment. I reassess every time I treat you. Your scar’s response tells us whether we are on the right track and helps decide what we do next. Scar treatment is also about timing: what is right for your scar now may be different from what is right later, and sometimes there are other things that need to happen first.

Without a good assessment, it’s surprisingly easy to head down the wrong treatment path — to focus on something that isn’t actually causing the problem, isn’t what matters most to you, or to start a treatment when the timing isn’t right or when something else would be better addressed first.

Sometimes the likely benefit of a treatment may not outweigh its downsides. A good assessment helps us work out not just what might help, but what to do first, what might come later and, sometimes, what may be better left alone.