Scar Revision

Scars are not predictable. They are caused by accidents or by surgery and how they develop depends as much on a patient's healing capacity as on the original injury or surgeon's skills. The severity of scarring is determined by the size and depth of the wound, by the blood supply to the area, the thickness and colour of the patient's skin and by the direction of the scar.

Scars that appear large and unattractive at first may become less noticeable with time. They can often be treated with steroids to relieve any tenderness and itching. Many plastic surgeons recommend waiting up to a year after injury or surgery before deciding to have scar revision therapy.

If a patient decides to proceed then the first step should be to consult a qualified plastic surgeon. The surgeon will examine the patient and discuss the possible methods of treating the scar, the risks and benefits involved and the possible outcomes.
No scar can be completely removed but the appearance of a scar can usually be mitigated by the injection or application of steroid medications or by surgical procedures known as scar revisions.

The following is a list of the most common types of scars, the procedures used to treat them, and the results to be expected. A lot will depend upon a patient's individual circumstances. It is recommended that patients consult a specialist for more information.

Keloid Scars

These are itchy clusters of scar tissue around the edges of a wound or incision, usually darker than the surrounding skin. They are caused by the body continuing to produce the tough, fibrous protein collagen after a wound has healed. They can appear anywhere on the body but are most common over the breastbone, on the earlobes, and on the shoulders. They are more common in dark skinned people than fair. The tendency to develop keloid scars lessens with age. The injection of steroid medication directly into the scar tissue will usually reduce redness, itching, and burning and in some cases will also cause the scar to shrink. If the steroid treatment is insufficient, the scar tissue can be cut out and the wound closed with stitches. This is usually an outpatient procedure performed under local anaesthetic. A skin graft may occasionally be used but the site from which the graft is taken may itself then develop a keloid scar. Irrespective of procedure, keloids tend to recur, sometimes even larger than before. The surgeon may combine scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy in order to discourage the recurrence. This is no guarantee that the keloid will not return and these procedures are sometimes repeated every few years.

Hypertrophic Scars

These are often confused with keloid scars as both tend to be thick, red, and raised. Hypertrophic scars however remain within the boundaries of the original incision or wound. They often improve unaided, though it may take a year or more and steroid applications or injections will usually help the process. If this fails they 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 anaesthetic depending on the scar's position.

Contractures

Some injuries, such as burns, may result in the loss of a large area of skin and a scar that pulls the edges of the skin together. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement. The correction usually involves cutting out the scar and replacing it with a skin graft or a flap.

Facial Scars

Because of its position, a facial scar is often considered a cosmetic problem, whether or not it is hypertrophic. There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with small stitches, leaving a smaller, less visible scar. If the scar lies across the natural skin creases 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 with a method called dermabrasion, which is a controlled scraping of the top layers of the skin using a hand held, high speed rotary wheel. This leaves a smoother surface to the skin but it will not completely remove the scar.

Preparation

Before undergoing scar revision surgery consideration and preparation are vital. Those who are considering the procedure should clearly outline their targets and openly discuss this with their consultant. Those who are considering the procedure should be aware of the risks and complications that can arise as well as the practical changes that are needed prior to surgery. Patients are required to stop taking medication which alters blood viscosity including aspirin, birth control and hormone correction. In preparation of surgery it is also highly recommended that patients avoid smoking to promote a quicker recovery.

After the Operation

The treated operation site may take up to several months to heal and a support garment or bandage may be necessary for up to a year.

Recovering from Scar Revision Surgery

With any kind of scar revision it is vital to follow your surgeon's instructions to make sure the wound heals correctly. Patients may be up and about very quickly but it is advisable to seek guidance from your surgeon on resumption of normal activities.
Bear in mind that no scar can be removed completely. It will depend upon the size and direction of the scar, the nature and quality of the patient's skin and how well patient cares for the wound after the operation.

For the large majority of adults who undergo a scar revision surgey the results will be a success with no unforeseen consequences. Despite this the capacity for risks and complications remain as is the case for almost all surgical procedures.

Risks and Complications

• The patient may experience excessive bleeding as a result of surgery.
• A negative reaction to the anaesthetic is possible.
• Permanent or intrusive scarring could occur.
• Grafting involves the transfer of healthy skin from elsewhere on the body to the injured area. The graft is said to "take" when new blood vessels and scar tissue form in the injured area. This is not always successful and in addition, all grafts leave some scarring at donor and recipient sites.

By nature all medical procedures carry an element of risk. While the majority of patients do not experience any complication during our scar revision procedures, before embarking on any medical procedure, it is advisable to consult fully with the McLean Academy so that our qualified staff can suitably discuss any risk or concerns that your procedure may pose.