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 factors can affect the severity of scarring, e.g., 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 unhappy the appearance of a scar to you is definitely of a personal view.

While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less conspicuous through the injection or application of certain steroid medications or through surgical procedures known as scar revisions.

Surgery of Facial Scars

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 wherever multiple layers of the skin have been affected. Once a scar forms, it is permanent but may be made less visible or relocated surgically.

With very few exceptions most people are self-conscious about facial scars. Some people may also experience diminished functioning of the eyes, mouth, or nose due to scarring. If you've wondered how facial scar revision could improve your appearance, your self-confidence, or your level of facial functioning, you need to know how scar revision works and what you can expect from this procedure.

Successful facial plastic surgery is a result of good understanding between patient and surgeon. Based on realistic expectations and exacting medical expertise, confidence develops in the consulting stages before surgery is performed.

Is Facial Scar Treatment For You?

The most basic requirement for all surgery is good health. Other requirements are more subtle and should be carefully considered in discussion with your surgeon. Expectations of the surgery and of the surgeon must be realistic. A person considering facial scar revision must understand that there is no way to remove scars completely. The goal is to improve the appearance of the scar either by disguising it, relocating it, or minimizing its prominence. Skin color and type, age, and the type of scarring, are all important factors that must be part of the discussion prior to surgery.

Different types of scars respond to different plastic surgery techniques. Timing of surgery is another important choice. 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 interval allows the body enough time to heal fully.

Making The Decision For Scar Treatment

Whether the surgery is desired for functional or cosmetic reasons, your choice of a facial plastic surgeon is of great importance. Your surgeon will examine the scar in order to decide upon the proper treatment and inform you of outcomes that can be expected from facial scar revision surgery.

Different scars require different treatments. For example, severe burns that destroy large sections of skin cause the skin to heal in a puckered way. As the skin heals, muscles and tendons may be affected in this "contracting" movement. Keloid scars are a result of the skin's overproduction of collagen after a wound has healed. These scars generally appear as growths in the scar site. Hypertrophic scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, can be unsightly and may also restrict the natural movement of muscles and tendons.

Some facial scars are unsightly simply because of where they appear on the face, while others affect facial expressions. All surgical possibilities should be discussed in the initial consultation along with risks involved for each type of scarring.

Because scars are highly individualistic and the patient's attitude toward scars is so personal, maximum improvement in facial scars may require more than one procedure, and more than one technique may be employed.

Understanding The Surgery

When a scar is of the contracture type, surgery generally involves removing the scar tissue entirely. Skin flaps, 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, and 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.

Dermabrasion and laser resurfacing are methods a surgeon uses to make "rough or elevated" scars less prominent, by removing part of the upper layers of skin with an abrading tool or laser light. Clearly, the scar will remain, but it will be smoother and less noticeable.

Keloid or hypertropic scars are often treated first with injections of steroids to reduce size. If this does not yield satisfactory result, the scars may be removed surgically, and the incisions closed with fine stitches, often resulting in less prominent scars.