When the skin is in the process of recovering from an injury, whether the result of an accident, surgery, a burn, or acne, scarring will occur whenever multiple layers of the skin have been affected. Once a scar forms, it is permanent but may be made less visible, relocated surgically, or minimized in its prominence.
During a patient’s complimentary first visit, a full medical history will be taken. Physical examination will focus on age, genetics, skin color and type, and elasticity. It is important to discuss any pre-existing conditions, allergies, and the history of your scar. The surgeon will ask about your expectations for scar revision. Once your surgeon understands your expectations, mutual, realistic goals can be set.
Insurance does not generally cover surgery that changes one’s appearance, which insurance considers to be cosmetic. However, some patients may have functional limitations of the eyes, mouth, or nose, and those surgeries may be reimbursable in whole or in part.
Some surgeons advise against any scar revision in cases of injury for a period that might extend up to a year after the injury. This allows the body enough time to heal fully. Frequently, scars that are very prominent after injury will fade with time.
Different types of scars often require different treatments. A burn scar is very different from a keloid scar, for example. Different scar types are found below. Because scars are highly individual, some may require more than one procedure and more than one technique may be employed.
- Severe Burn Scars
Severe burns that destroy large sections of skin cause the skin to heal with a puckered texture. As the skin heals, muscles, and nearby tendons may be affected by this movement.
- Keloid Scars
Keloid scars are a result of the skin’s over-production of collagen after a wound has healed. These scars generally appear as growths at the scar site. They are often treated first with steroids to reduce their size.
- Hypertrophic Scars
Unlike keloids, hypertrophic scars do not grow out of the boundaries of the scar area, but because of their thick, raised texture, they can be unsightly and may restrict the natural movement of muscles and tendons. They are often treated first with steroids to reduce their size.
Scar Revision Techniques
Steroid injections are injected directly into the scar tissue to help decrease the itching redness and burning sensation and may decrease the size of the scar. Often steroid injections are used along with surgery and may continue up to two years after the surgery to help maximize healing and decrease the chance of the scar returning.
Skin flaps are performed after the scar tissue is removed, composed of adjacent healthy, unscarred skin, are then lifted and moved to form a new incision line.
Where a flap is not possible, a skin graft may be used. A graft involves taking a section of skin tissue from one area and attaching it to another. Time must be allowed following surgery for new blood vessels and soft tissue to form.
Z-plasty is a method to move a scar from one area to another, usually into a natural fold or crease in the skin to minimize its visibility. While Z-plasty does not remove all signs of a scar, it does make it less noticeable.
Laser resurfacing makes rough or elevated scars less prominent, by removing part of the upper layers of skin with laser light. The scar will remain, but it will be smoother and less visible.
Tissue expansion is a newer technique that involves a process that increases the amount of existing tissue available for reconstructive purposes and is often used in conjunction with flap surgery.
For at least two weeks before surgery, patients are required to refrain from smoking, alcohol and all aspirin products. Smoking interferes with circulation and healing, and products containing aspirin or ibuprofen thin the blood and increase the risk of bleeding.
A dressing may be applied. Sitiches are removed 4 to 7 days after the procedure.
You can expect to feel some discomfort after facial scar revision surgery. There will likely be some swelling, redness, and bruising. You will be advised to sleep with your head elevated, to apply cold compresses to reduce swelling, and to avoid any activity that would put stress on the incision site.
Avoid sun exposure for several months after surgery. Use sunblock (with SPF 15 or above) or a dressing to protect the incision site.
It is important to remember that scar tissues require a year or more to fully heal and achieve maximum improvement in appearance.
There may be some post-operative bleeding which usually resolves itself. Other risks include infection, hematoma (accumulations of blood under the skin), blood clots, scar recurrence and keloid formation (or recurrence).
Scar revision can improve or reduce the appearance of scars. It can also restore function and correct disfigurement caused by an injury, wound or previous surgery.