Dr. Stelnicki uses the most advanced and reliable methods for treating scars, keloids, and burns. Not every child is the same and not every scar or burn is the same. After the initial consultation, Dr. Stelnicki tailors the treatment plan to meet the unique needs of each patient.

The goal of treating a keloid is to produce the best results with as minimal scarring as possible, as well as taking the appropriate measures to prevent the keloid from recurring. Dr. Stelnicki has extensive experience in removing keloids while maintaining a low rate of recurrence.

Burns are unfortunate, accidental events that can be very emotionally traumatic and physically harmful. There are two separate aspects of treating burns. The first is the acute or immediate care of a burn after it happens. This typically involves an emergency room visit initially, and then with a follow up appointment to see a plastic surgeon for the next steps. The exception is very large and extensive burns that need to be addressed by a burn center. The objectives of burn treatment are to improve the function and appearance of burn scars. Because the treatment of a burn may take the course of several years, it is important to entrust your child to a doctor with a lot of experience and a caring attitude. Dr. Stelnicki educates families on their child's condition with a special focus on caring for the burn at home outside the office and the operating room.

Aside from the commonly experienced keloid and burn symptoms of pain and restriction of movement, they also may be disfiguring. If your child is being teased about a scar, whether it's due to a keloid or a burn, this is not uncommon. There are methods of treating it and improving its appearance. Treating scars and burns improves self-esteem and self-confidence.

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What is a keloid?

A keloid is a tumor of scar tissue. They may look and feel hard, wide, red, scaly, or raised.

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What causes a keloid?

Keloids form after ear piercing, tattoos, lacerations, burns, surgical incisions, or any type of trauma to the skin. They occur when the body stops producing normal scar tissue and instead produces too much fibrous and collagenous material without stopping. The exact reason for keloid formation is unknown.

Keloid scarring has a tendency to run in families (especially African and Asian families) and with people with darker pigmented skin. However, anyone is susceptible to a keloid.

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How is a keloid diagnosed?

A keloid may be diagnosed via physical examination or after it has been surgically removed and examined by a pathologist.

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What are signs and symptoms of a keloid?

Signs and symptoms of a keloid may include sensations of itchiness, pain, and burning. They also may restrict range of motion to the normal skin and underlying tissue.

Keloids may appear anywhere on the body.

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How are keloids treated?

There are many methods for treating keloids.

One method is an injection of a steroid medicine called Kenalog. This steroid stays locally at the site of injection (it is not systemic—it is not a medicine that goes throughout the body) and helps to dissolve the scar tissue within the keloid. The typical regimen for this treatment is having one injection per month for a total of three months.

Another modality to treating keloids is with surgical excision. The keloid is excised in the operating room under anesthesia in order to keep the patient still during the procedure. An incision is made at the location of the keloid, the keloid is removed, and the specimen is sent to the laboratory to be diagnosed by a pathologist. Removable stitches may be used to join the edges together and close the incision. At the time of the removal, an injection of the steroid medicine Kenalog is also given. Antibiotics are administered during the surgery in order to prevent infection.

Sometimes, a staged surgical excision (where the keloid is not initially removed all at once) is recommended in order to preserve the integrity of the structure of the affected body part and/or skin surrounding the scar. This is typically recommended if the scarring is very extensive.

Also, laser therapy is sometimes recommended to treat scars that are abnormally red or have an abnormal pigment.

Radiation therapy is sometimes indicated as an additional treatment in the case of a recurring keloid.

When it comes to keloids, the post-operative care with scar treatment recommendations is as important as the surgery to remove the keloid itself. Adjunct to the removal or injection of a keloid is a scar massage, scar bandages such as silicone sheeting, and monthly steroid injections.

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What is a scar massage?

A scar massage is essential to preventing a keloid scar from recurring. It is also used to treat an existing keloid or a keloid that is being treated by injections.

Scar massages are most effective when they are performed in a higher frequency of times throughout the day and not necessarily the length of time performed. When performing a scar massage, it is important to keep in mind the goal of the massage: to help break up the present scar tissue. The scar massage may be done with scar treatments such as Vitamin E oil or Mederma, or with silicone-based scar gels such as Kelocote or New Gel. These items are available for purchase at our office.

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What should be expected after the surgery?

Post-operatively, a dressing may be placed over the stitches. It is important that this dressing be kept clean, dry, and intact for the first 72 hours following surgery. Under the dressing, stitches may be present and are typically the type that needs to be removed. It is imperative to comply with post-operative recommendations because remaining stitches can instigate the keloid to return.

Sometimes, antibiotics are prescribed in order to prevent infection from occurring. In some cases, pain medication is also prescribed, but most procedures are adequately treated with over the counter Children's Tylenol. We advise no sports or swimming for two weeks after the procedure to aid in healing. The bandage and/or stitches may be removed (if it has not already come off on its own terms) or trimmed at the post-operative visits.

After a keloid excision, there may be some mild pain at the surgical site, itchiness, and numbness. Mild pain may take 1-2 weeks to subside, while itchiness and numbness may take several weeks to subside as the skin heals.

Complications are uncommon after excision of a keloid. But the most frequent complications after surgery include scarring. Scarring is inevitable anytime there is a cut or trauma of any kind to the skin. Some scars are barely if at all visible while some scars are disfigured, red, dark, and/or raised. Another frequently seen complication is recurrence of the keloid. It is of special importance to be proactive with preventing, caring, and treating scars. Scar treatment recommendations may include sunscreen, scar bandages such as silicone sheeting, scar creams or gels, and/or a scar massage.

The recommendations for scar care are extremely important to comply with as keloids have a tendency to recur. Part of the post-operative care includes once monthly injections for three months of the steroid medication Kenalog. These injections further help the keloid from recurring. When it comes to keloids, the post-operative care with scar treatment recommendations is as important as the surgery to remove the keloid.

Infection is another complication that may be seen after surgery. Signs and symptoms of infection include fever, swelling, pus drainage, pain, and redness. However, some of these signs and symptoms are normal to an extent. If there's any concern, our office should be contacted immediately. Infections resolve typically with medical treatment of oral and/or topical antibiotics.

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Why does a burn require treatment with a plastic surgeon?

The first reaction of the skin when a burn happens is blistering. At times this blistering requires debridement to promote growth of new healthy skin and wound care in order to provide a moist healing environment and infection prevention.

The second reaction that may occur is alteration of the skin by formation of scar tissue as the burn heals. Scar contractures may arise which limit range of motion of the skin. They may appear months after a burn happens, especially in children who are still growing. They may have a painful or burning sensation and can be very disfiguring. Scar contractures will require surgical excision (often multiple surgeries) to restore function of the skin as well as to improve the cosmetic appearance.

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How do scar contractures limit the function of the skin?

These scars that arise after burns can limit range of motion of the neck (making it difficult to turn the head), knees (making it difficult to bend the legs), feet (making it difficult to walk), eyelids (making it difficult to blink or close/open the eyelid), etc. On the scalp, they can also inhibit hair growth.

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What is involved in burn surgery?

Burn surgery mostly consists of releasing tight scars, removing abnormal scar tissue, and sometimes skin grafting using a variety of plastic surgery techniques. These surgeries are typically outpatient procedures done under general anesthesia.

Burn surgery is usually initiated several months after the burn wounds have healed.

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What should be expected after the surgery?

Post-operatively, a dressing may be placed over the stitches or staples or skin graft. It is important that this dressing be kept clean, dry, and intact for the first 72 hours following surgery. In some instances, a splint or cast may be prescribed to immobilize the affected body part. It is imperative to comply with post-operative recommendations for scar care in order to improve scarring after surgery.

Sometimes, antibiotics are prescribed in order to prevent infection from occurring. In some cases, pain medication is also prescribed, but most procedures are adequately treated with over the counter Children's Tylenol. We advise no sports or swimming for two weeks after the procedure to aid in healing. The bandage and/or stitches may be removed (if it has not already come off on its own terms) or trimmed at the post-operative visits.

After surgery, there may be some mild pain at the surgical site, itchiness, and numbness. Mild pain may take 1-2 weeks to subside, while itchiness and numbness may take several weeks to subside as the skin heals.

Complications are uncommon after burn surgery. But the most frequent complications after surgery include scarring. Scarring is inevitable anytime there is a cut or trauma of any kind to the skin. Some scars are barely if at all visible while some scars are disfigured, red, dark, and/or raised. It is of special importance to be proactive with preventing, caring, and treating scars. Scar treatment recommendations may include sunscreen, scar bandages such as silicone sheeting, scar creams or gels, cocoa butter, and/or a scar massage.

Infection is another complication that may be seen after surgery. Signs and symptoms of infection include fever, swelling, pus drainage, pain, and redness. However, some of these signs and symptoms are normal to an extent. If there's any concern, our office should be contacted immediately. Infections resolve typically with medical treatment of oral and/or topical antibiotics.

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