Scar Revision

What is scar revision?

Scar revision surgery will attempt to minimize a scar so that it is less conspicuous and blends in with the surrounding skin tone and texture.

Scars are visible signs that remain after a wound has healed. They are the unavoidable results of injury or surgery, and their development can be unpredictable. Poor healing may contribute to scars that are obvious, unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be noticeable due to their size, shape or location; they can also be raised or depressed, and may differ in color or texture from the surrounding healthy tissue.

Your treatment options may vary based on the type and degree of scarring and can include:

  • Simple topical treatments
  • Minimally invasive procedures
  • Surgical revision with advanced techniques in wound closure

Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased.

What is a scar?

Scar revision is plastic surgery performed to improve the condition or appearance of a scar anywhere on your body. The different types of scars include:

Discoloration or surface irregularities and other more subtle scars can be cosmetically improved by surgery or other treatments recommended by your plastic surgeon. These types of scars do not impair function or cause physical discomfort and include acne scars as well as scars resulting from minor injury and prior surgical incisions.

Surface Irregularities

Hypertropic scars are thick clusters of scar tissue that develop directly at a wound site. They are often raised, red and/or uncomfortable and may become wider over time. They can be hyperpigmented (darker in color) or hypopigmented (lighter in color).

Hypertropic Scars

Keloids are larger than hypertropic scars. They can be painful or itchy, and may also pucker. They extend beyond the edges of an original wound or incision. Keloids can occur anywhere on your body, but they develop more commonly where there is little underlying fatty tissue, such as on the face, neck, ears, chest or shoulders.

Keloids

Contractures are scars that restrict movement due to skin and underlying tissue that pull together during healing. They can occur when there is a large amount of tissue loss, such as after a burn. Contractures also can form where a wound crosses a joint, restricting movement of the fingers, elbows, knees or neck.

Contractures

The type of scar you have will determine the appropriate techniques your plastic surgeon will use to improve your scar.


Case Study

Prior to scar revision surgery, you may be asked to:

  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Stop smoking well in advance of surgery
  • Avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

  • What to do on the day of surgery
  • The use of anesthesia during your procedure
  • Post-operative care and follow-up

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedures. The choices include local anesthesia, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The treatment

The degree of improvement that can be achieved with scar revision will depend on the severity of your scarring, and the type, size and location of the scar. In some cases, a single technique may provide significant improvement. However, your plastic surgeon may recommend a combination of scar revision techniques to achieve the best results.

Topical treatments, such as gels, tapes or external compression, can help in wound closure and healing, or to reduce the ability of skin to produce irregular pigment. These products may be used to treat existing surface scars and discoloration, and to aid in the healing of scar revision procedures.

Injectable treatments may also be used. Dermal filler can be used to fill depressed or concave scars. Depending on the injectable substance used and your particular scar conditions, results may last from three months to several years. Therapy must be repeated to maintain results. Another form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size and texture of raised scar tissue.

Surface treatments are most often used for cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of either mechanically removing the top layers of skin or changing the nature of tissue. These treatment options include:

  • Dermabrasion is a mechanical polishing of the skin.
  • Laser or light therapy causes changes to the surface of the skin that allow new, healthy skin to form at the scar site.
  • Chemical peel solutions penetrate the skin's surface to soften irregularities in texture and color.
  • Skin bleaching agents are medications applied topically to lighten the skin.

Step 3 – Sometimes for deeper scars an incision is needed to surgically remove the old scar

Step 4 – Closing the incisions

Some scars require layered closure. Layered closure is often used where excision extends to tissue below the skin surface or in areas with a high degree of movement. The first step, or layer, requires sub-dermal closure (below the skin surface) with absorbable or non-removable sutures. Layers of closure continue to build, concluding with closure of the remaining surface wound.

Advanced techniques in scar revision include complex flap closures and W-plasty or Z-plasty techniques. Flap closures may reposition a scar so that it is less conspicuous or improve flexibility where contracture has restricted mobility.

Pharmaceutical tissue substitutes may be used if ample healthy tissue is not present for closure of a scar excision. This is more likely with revision of severe burn scars.

Tissue expansion can be a substitute for skin grafts. In this procedure, an inflatable balloon called a tissue expander is placed under the skin near the scar site. Over time, the balloon is slowly filled with sterile solution to expand the area of healthy skin. Once the skin has been stretched sufficiently, the expander and the scar is removed and the stretched skin is moved to replace the scar tissue. This process can involve multiple surgical stages or procedures in order to achieve the final results.

Specialist

The success and safety of your scar revision procedure depends very much on your complete candidness during your consultation. You'll be asked a number of questions about your health, desires and lifestyle.

During your scar revision consultation be prepared to discuss:

  • Why you want the surgery, your expectations and desired outcome
  • Medical conditions, drug allergies and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries

Your surgeon will also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Examine your scar in detail
  • Take photographs for your medical record
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes and any risks or potential complications

Disclaimer

The decision to have scar revision surgery is extremely personal and you'll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.

You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo, the alternatives and the most likely risks and potential complications.

Scar revision risks include:

  • Bleeding
  • Infection
  • Delayed healing
  • Anesthesia risks
  • Change in skin sensation
  • Damage to deeper structures including nerves, blood vessels, muscles and lungs can occur and may be temporary or permanent
  • Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
  • Skin contour irregularities
  • Skin discoloration and swelling
  • Skin sensitivity
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Pain, which may persist
  • The potential need for additional surgical procedures or staged procedures

 

Frequently Asked Questions About This Procedure

What is Scar Revision?

The surgical treatment of scars is a procedure frequently performed by plastic surgeons. Scars are the unavoidable result of injuries, disease, or surgery. It is impossible to totally remove the presence of a scar, yet plastic surgery may improve the appearance and texture of scars. There are many different techniques of scar revision surgery.

Who is a good candidate for Scar Revision ?

The best candidates for Scar revsion is if the appearance or texture of the scar can be improved. 

Where is the scar from Scar Revision ?

The scar from this procedure will usually be in the same location as previous scar.  There may be times when the scar will be lengthened or altered to improve upon the scar.

What are the possible risks of Scar Revision?

Potential risks include bleeding, infection, seroma, pain, scarring, numbness, asymmetry, need for additional surgery. Dr. Sood will discuss these risks further during your consultation.

What is the typical recovery time for a Scar Revision?

This procedure can usually be done as an outpatient. You will be sent home on pain medicine and antibiotics. Recovery time will depend on extent of scar revision.

When do I return for a follow up visit?

You will need to be seen within a week after surgery. From there Dr. Sood will determine when you need to follow up.

How long before I can return to work?

Most patients are able to return to work within a few days, depending on the extent of scar revision.

How long before I can return to normal activity?

Most activities of daily living can be resumed within a couple of days. It is important to get up and move around within a day of surgery to help decrease the chance of developing a blood clot. Strenuous activities should be avoided for about 1-2 weeks or until Dr. Sood has given you clearance.

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