Scar Revision

Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar. While it is easy to understand that we cannot control the variables that lead to scar production, it is still very common to be bothered by the appearance of scars. No scar can ever be completely removed, but, through scar revision, surgeons can work to improve the overall appearance of any scar.

The Scars

There are several different types of scars and each is treated differently depending on their location and severity. The following are several common scar types:

Keloid Scars – These scars are thick, puckered, itchy clusters of scar tissue that most often grow beyond the edges of the wound or incision. They are often very dark in color and occur when the body continues to produce collagen even after the skin has healed. Keloid scars can occur anywhere on the body but are most often found on the shoulders, breastbone and earlobes.
Hypertrophic Scars – These scars are often confused with Keloid scars because they are thick and red, but Hypertrophic scars do not grow outside of the incision area.
Contractures – These scars are formed when burns or injuries result in large areas of skin. When the skin heals, the edges are pulled together and can sometimes result in limited muscle and tendon movement.
Facial Scars – These scars occur on the face. Most often they are considered cosmetic even though they are most often Hypertrophic.

The Procedures

There are several scar revision procedures that can reduce the overall appearance of scars on the body. Certain procedures are used more often depending on the type of scar. The following procedures are most often used for scar revision:

Skin Grafting – This procedure involves transferring healthy skin to the affected area from a different part of the body. This new skin is used to replace the scarred skin. Grafts are most often successful, but sometimes the skin does not take. In order for it to take, new blood vessels and scar tissue must form in the injured area. If the skin doesn’t take, it will die.
Flap Surgery – This procedure is a more involved form of skin grafting. Flap surgery transfers skin along with underlying blood vessels, nerve endings, fat and sometimes even muscle from a healthy part of the body to an injured part. The new vessels are reattached to the vessels under the injured area in order to reinstate microcirculation.
Tissue Expansion – This procedure can be used anywhere on the body. It involves stretching healthy skin that is in direct correlation with the scarred area. Once the skin is stretched it can be used to replace the damaged skin. Scars will remain from the expansion surgery, but will be much less noticeable than the originally scarred area.
Laser Skin Resurfacing – This procedure uses laser light to penetrate into the outermost layers of the skin. The lasers remove these top layers of skin which allows for the growth of new, smoother skin.
Z-Plasty – This procedure repositions scars so that they more closely conform to the natural lines and creases of the skin. In this procedure, the old scar is removed, and then new incisions are made on each side to create small triangle flaps of skin. These flaps are sewn together to cover the wound at differing angles. This allows the wound to heal more cleanly.
Steroid Injections - Injecting a steroid medication directly into scar tissue can greatly reduce redness, itching, and burning. In some cases, this might even shrink the scar. Often times, steroids are used in conjunction with other scar revision procedures.

Risks

Like any surgical procedure, there are risks associated with scar revision. The following are the most common risks that patients might develop:

swelling
no scar reduction
bleeding
infection
reaction to anesthetic or medication
numbness or change in feeling

The largest risk that patients face is that the scar revision procedure will leave an even larger scar than the original. Consulting with your doctor will help you determine which procedure is right for the treatment of your scar.

Results

Once patients undergo scar revision surgery, it is very important to follow their doctors post surgery suggestions. This will allow for the patients wounds to heal as well as possible. It is imperative for patients to understand that their scar will never completely go away. Scar revision simply involves procedures that can minimize visible scarring.

Your scar will most likely still look terrible right after your surgery but don’t panic. Most scars will take several months to properly heal and fade. Taking extra precautions will allow your scars to heal more rapidly. Patience and extraordinary wound care will lead to a much less visible scar, which in turn can boost your self confidence and allow you to live a better, happier life.