Scar Revision is a surgical procedure in which a plastic surgeon tries to make the scar less obvious and improves its appearance. Scar Revision may also be performed to improve function of that part of the body.
What are the different types of scars?
• Prominent Scars - Scars can look prominent if they are not placed along skin crease/fold line, broad or stretched out or if they are elevated or depressed when compared to surrounding skin.
• Keloid Scars - Keloids are thick, itchy, unsightly clusters of scar tissue that grow beyond the borders of actual wound. Keloids are formed due to excessive production of collagen by the body after the scar has healed. These scars sometimes appear red compared to the surrounding skin. Keloids are more common in dark skinned people and are more likely to develop in the earlobe, along the border of the jaw, the shoulder and the skin over the breast bone.
• Hypertrophic Scars - Hypertrophic scars look like keloid scars except the fact that they tend to remain within the boundaries of the wound or incision.
• Contractures - Contractures occur when a scar pulls on the edges of the skin making a tight area. These contractures can produce functional limitation and can affect the muscles, joints, and tendons. Contractures are usually common after burns and are also referred to as Burn Deformity. When a large area of skin is lost due to a burn, the surrounding intact skin pulls together to make up for the lost area of skin, thus forming a deformity that can limit your movement or function of that part of the body.
Who is an ideal candidate for Scar Revision?
If you have any type of scar (as described above) on any part of the body that bothers you or impairs function or limits movement of any of your joints, then you are an ideal candidate for Scar Revision.
What does Surgical Scar Revision involve?
Depending on the type of scar, different surgical procedures are employed for Scar Revision. These surgical procedures for Scar Revision will be performed under local or general anesthesia. Some of the Scar Revision procedures that are used include:
• Scar Excision - The procedure involves excision of prominent scar and re-suturing it with plastic surgery techniques which provide long term support to wound edges to prevent scar stretching. Patient may also need other modalities of treatment like pressure garments, silicone gel sheet and other local application of ointments and gels to make scar imperceptible.
• Surgical removal of Keloid Tissue - Surgery directly removes the keloid tissue and a skin graft may be used to cover the area. Skin Grafting is performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the surgery area.
• Laser Surgery – Carbondioxide Fractional laser is used to smooth, flatten or remove abnormal discoloration of the overlying skin of the scar.
• Skin Grafting - The procedure of skin grafting involves replacing the damaged area of the skin by healthy area taken from other part of the body.
• Skin Flap Surgery - Flap surgery is a 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.
• Z-Plasty/W-Plasty - are Scar Revision procedure in which a Z or W shaped incision is used. Z - Plasty is used to decrease the skin 'pull' in case of a contracture. This technique can also be used to try and blend the scar in the natural creases and folds of the surrounding skin.
• Tissue Expansion - The technique of tissue expansion is used in conjunction with Skin Flap Surgery. In this technique the amount of existing tissue is increased for re-constructive purposes.
Benefits of Scar Revision
Scar Revision is performed not only for aesthetic reasons, it is also performed for reconstructive and functional reasons. Keloids and contractures are not just unattractive and ugly to look at, they can be extremely limiting if they are are on your hand, around your mouth or on a joint surface. Scar Revision does not just make them less obvious, it can also improve the function of the affected part. The goal of surgical Scar Revision is to make your scar less noticeable. There is 90% chance that the scar will look better after Scar Revision
Alternatives to Scar Revision
• Steroid Injections - Steroid injections can reduce itching, redness and burning sensation in the scar tissue and may even reduce the size of the scar.
• Cryotherapy - The scar tissue is frozen off by medications
• Localized pressure - Pressure is applied to the scar with a pressure bandage to reduce the size of the scar.