Scar Revision

Scars—whether they’re caused by accidents or by surgery—are unpredictable. The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon’s skills.

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. How much the appearance of a scar bothers you is, of course, a personal matter.

While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions.
If you’re considering scar revision, this will give you a basic understanding of the most common types of scars, the procedures used to treat them, and the results you can expect. It can’t answer all of your questions because lot depends on your individual circumstances. Please be sure to ask our doctor if there is anything about the procedure you don’t understand.

2.1) Keloid Scars
Keloids are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision. They are often red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.
Keloids can appear anywhere on the body, but they’re most common over the breastbone, on the earlobes, and on the shoulders. They occur more often in dark-skinned people than in those who are fair. The tendency to develop keloids lessens with age.

Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar.
If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. This is generally a procedure, performed under local anesthesia. You should be back at work in a day or two, and the stitches will be removed in a few days. A skin graft is occasionally used, although the site from which the graft was taken may then develop a keloid.
No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, the surgeon may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, requiring repeated procedures every few years.

2.2) Hypertrophic Scars
Hypertrophic scars are often confused with keloids, since both tend to be thick, red, and raised. Hypertrophic scars, however, remain within the boundaries of the original incision or wound. They often improve on their own or with the help of steroid applications or injections.
If a conservative approach doesn’t appear to be effective, hypertrophic scars can often be improved surgically. The plastic surgeon will remove excess scar tissue and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anesthesia, depending on the scar’s location and what you and your surgeon decide. You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.

2.3) Contractures
Burns or other injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement.
Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases a procedure known as Z-plasty may be used. And new techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.

2.4) Facial Scars
Because of its location, a facial scar is frequently considered a cosmetic problem, whether or not it is hypertrophic. There are different components in scar that makes it look bad:
1. color mis-match with the surround skin ( darker or lighter scar )
2. not in level with the surrounding skin ( elevated or depressed )
3. scar lying across the natural skin creases (or “lines of relaxation”)
4. scars distorting the normal structures in the face ( pulling the eyelid or margin of the lip)
5. wide and diffuse scar
It is very important that we identify all these details and discuss you the all the option available with us to make a facial scar less noticeable.
Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar. This is where a well-trained plastic surgeon makes a difference.
If the scar lies across the natural skin creases (or “lines of relaxation”) the surgeon may be able to reposition it to run parallel to these lines, where it will be less conspicuous.
Some facial scars can be softened using the technique Fractional Laser through Alma CO2, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel. Fractional Laser leaves a smoother surface to the skin, but it won’t completely erase the scar.
Depressed scar can benefit with filler or fat graft.

2.5) Skin Grafting and Flap Surgery
Skin grafts and flaps are more serious than other forms of scar surgery. Smaller ones are performed under local anesthesia but bigger ones are more likely to be done using general anesthesia. The treated area may take several weeks to heal, and a support garment or bandage may be necessary for up to months.
Grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area. This does leave some scarring at the donor and recipient sites.
Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site. These are mostly done where skin graft is not suitable and where we want to avoid the poor cosmetic result of skin graft. In some flaps, the blood supply remains attached at one end to the donor site; in others, the blood vessels in the flap are reattached to vessels at the new site using micro-vascular surgery.
Skin grafting and flap surgery can greatly improve the function of a scarred area. The cosmetic results may be less satisfactory, since the transferred skin may not precisely match the color and texture of the surrounding skin. In general, flap surgery produces better cosmetic results than skin grafts.

After Scar Revision
With any kind of scar revision, it’s very important to follow your surgeon’s instructions after surgery to make sure the wound heals properly. Although you may be up and about very quickly, your surgeon will advise you on gradually resuming your normal activities.
As you heal, keep in mind that no scar can be removed completely; the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. Sun protection is one of the most important precaution you should take to attain the best result. Immediately after surgery, scar may not look as you expected, but don’t panic –it will improve with time and care, and the final result of your surgery will only be apparent after months or even up to a year.