Reconstructive Surgery

Scar

What is a scar?

The different types of scars include:

  • Discoloration, 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.
  • Hypertrophic scars are thick clusters of scar tissue that develop directly at a wound site. They are often raised, red and/or uncomfortable, and they may become wider over time. They can be hyperpigmented (darker in color) or hypopigmented (lighter in color)
  • Keloids are larger than hypertrophic 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.
  • 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.
    The type of scar you have will determine the appropriate techniques your plastic surgeon will use to improve your scar.

What is scar revision surgery?

Scar revision is plastic surgery performed to improve the condition or appearance of a scar anywhere on your body.

Scar revision surgery is meant to minimize the scar so that it is more consistent with your surrounding skin tone and texture.

Scars are visible signs that remain after a wound has healed. They are 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 raised or recessed, different in color or texture from surrounding healthy tissue or particularly noticeable due to their size, shape or location.

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.


Scar revision candidates

Scar revision is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Scar revision can be performed on people of any age and is a good option for you if:

  • You are bothered by a scar anywhere on your body
  • You are physically healthy
  • You do not smoke
  • You have a positive outlook and realistic goals for your scar revision surgery
  • You do not have active acne or other skin diseases in the area to be treated

Scar revision consultation

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.

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 may 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

Preparing for scar revision surgery

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

What happens during scar revision surgery?

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 are often 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. One form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size, and texture of raised scar tissue.

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. The 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 the closure of the remaining surface wound.

Advanced techniques in scar revision include complex flap closure to reposition a scar so that it is less conspicuous, or improve flexibility where contracture has restricted mobility.


Scar revision recovery
Progress and healing

The initial healing phase of a surgical scar revision may include localized swelling, discoloration or discomfort and may take 1 to 2 weeks. Healing will continue for several weeks and as the new scar heals it will slowly refine and fade.

The results will be long-lasting

The final results of your scar revision surgery will be long-lasting, however, it may take several months for your final results to become apparent and in some cases, it may take a year for the new scar to fully heal and fade.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee, in some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Scar revision surgery risks and safety information

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.

Some of the risks include:

  • Bleeding (hematoma)
  • 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
  • Possibility of revisional surgery or staged procedures

Where will my surgery be performed?

Scar revision surgery may be performed in your plastic surgeon’s surgical facility or a hospital. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

When your procedure is finished, bandages or dressings may be applied to keep the surgical site clean.

You will be given specific instructions that may include: How to care for yourself following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, and when to follow-up with your plastic surgeon.


When you go home

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment?

Be careful

Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

Follow all postoperative instructions carefully, including cleansing and at-home treatment regimens, and avoid sun exposure. Your cooperation will influence the outcome of your surgery.


Before & After Photos

scar-2
scar-1
scar-before-after