Scar Revision

One of the most frequent aesthetic concerns that patients have about their face and body involve the presence of scars.  Scarring can be a traumatic, disheartening event that can dramatically impact self-esteem and outlook.  Although scars cannot be removed completely, it is possible to camouflage or hide them through aesthetic surgery.  Thousands undergo surgical and cosmetic treatment each year to improve the appearance of facial scarring.

What is a scar?

After an injury to the skin, important initial healing occurs during the first six-weeks, although complete healing is not achieved until approximately one year after the injury.  Ideal wounds heal with a thin faint line minimizing any color differences between the scar and the surrounding tissue. The best wounds also follow natural skin folds and lines of the body. For example, in the forehead region, horizontal scars are preferred because they line up with the natural creases of the forehead.

What kinds of scars are there?

Normal scars are thin and generally not too visible.   Hypertrophic scars, however, result from a more aggressive healing process after wound formation. These types of scars appear thick, red, and sometimes raised or swollen. Though they usually remain within the boundaries of the wound, they can take longer to heal.  Treatment is important during the healing phase in order to minimize any long-term aesthetic problem. Topical steroid applications are beneficial in the treatment of hypertrophic scars, as well as some surgical treatments depending on the character and location of the scar.
Keloid scars are much more aggressive than hypertrophic scars and they tend to develop prominently in the upper chest, neck, and facial regions.  Individuals of color tend to be at higher risk, such as those of African-American descent.  A key distinction of keloid scarring that distinguishes it is growth and swelling beyond the confines of the healing wound. Treatment for keloid scars is somewhat similar to that of hypertrophic scars, but it should be understood that effective long-term treatment for keloids is difficult and a long-term cure has yet to be created.

The Solution

Many times surgical treatment can significantly improve unsightly scars. When dealing with prominent scars there are certain guidelines to maximize our results.   Scar thickness, rough edges, irregularities, prominences, and depressions are all important issues that need to be addressed when considering the wound and its healing.  In addition, the direction and position of scars significantly influences the visibility of the wound. Redirection of the scar can help minimize its prominence.
The goal of surgical scar revision is the reduction of pressure on the wound site while it heals.  Multilayer closure techniques and outer layer tape support are some of the methods used to decrease skin tension during the healing phase. Scars can also be broken up into geometric surgical configurations via a “z-plasty” or comparable flap technique to minimize visibility.
Resurfacing techniques using the Ultrapulse CO2 or state of the art Sciton laser play an important role in scar revision also. Typical laser resurfacing is performed approximately three to eight weeks after the initial injury, surgery, or revision surgical treatment.  Most patients who choose laser therapy experience substantial improvement in the ultimate appearance of the wound.

What can I expect?

Each individual and each scar is unique, and the best treatment is tailored to the specific circumstances of the case.  Some individuals will only require simple revision, while others may be encouraged to undergo combination procedures utilizing surgical revision plus skin resurfacing treatment. Generally, most individuals will achieve improvement with treatment. It is rare to see a wound worsened by a revision procedure.  It is important to bear in mind, however, that realistic expectations are imperative for all aesthetic procedures.  Once a scar forms the scar will always remain.  Timely treatment, however, can significantly improve its appearance and make the scar considerably more pleasing.