Z-plasty for Scar Revison

Z-plasty is now being considered as a standard practice for scar revision. With doctors’ offices all over the world now using this technique, one would be hard pressed to find a different technique when it comes to camouflaging scars. This technique has been around for a century and yet, many people fail to realize how it works.

A Z-plasty works like this, at the end lengths of the scar, incision are placed horizontally so that the new incisions and the original wound/incision together form a Z. Once incised, the flaps of the flesh are sutured over and used to cover the wound overall, giving new less tense give to the skin in smaller units, and setting the transposed skin into overlapping “flaps” where their final positions are a three layered triangular fix.

This irregularity of wound closure causes a smaller, united scar that is less noticeable type of scarring that is better camouflaged than the straight line easily hyper-pigmented versions of incisions. This general realignment of the incisions can make for a better visual to surgery wounds.

The only other techniques that are comparable to a Z-plasty would be a W-plasty. A W-plasty, although slightly different, is just a variation of the Z-plasty technique, operating on the same basic principle of relieving overall tension on sutures and skin wounds to allow for a better healing process.

Scalp Scar Reduction

Scalp scars from any procedure such as scalp reduction, old plug surgery, trauma or neurosurgical procedures can be treated to minimize the look of the scar. Modern hair transplant yields natural, proven, and permanent results along with special wound closure techniques to minimize scars.

Here are some methods that a hair transplant surgeon can use to reduce the visibility of the scar:

Scar Revision

Left: Before Scar Revision, Right: After Scar Revision

1. Simple Scar Revision: This method can be used if there is a wide scalp scar due to the initial technical problem during the wound closure.
2. Scar Revision and Trichophytic Closure: This method allows the hair to grow inside the scar, which helps to minimize the contrast between the scar and the surrounding areas of the scalp.
3. Hair Transplantation inside the Scar: In this method, the hair will be harvested from other areas of the scalp and will be transplanted inside the scar to blend the scar with the rest of the hair. The hair will be harvested through the FUE hair transplant technique. The benefit of using this technique is that with FUE, follicles are extracted individually, giving the surgeon the opportunity to place them into the scar without having new scarring.
4. Scalp Micro Pigmentation on the Scar: By introducing dermal pigments into the scar, the visibility of the scar can be significantly improved because it helps reduce the contrast in color between the scar tissue and the surrounding scalp area.

In order to know which technique would fit your needs, it is recommended to visit an experienced hair transplant surgeon.

Scar Types

Skin is the largest organ of a person’s body. Any type of trauma including burns, injury, and surgery can cause a scar to appear on the skin. Scarring can happen on any part of the person’s body that the trauma occurred. Some scars may be small or in locations that aren’t visible to the public eye. However, some people may have scars that are visible, which bother them. There are treatments that can help improve the appearance of the scar, but you can never make it completely disappear.

Scarring happens when the healing process begins. The depth and the size of the wound are one of the many factors of how big and visible the scar will be. Other factors can be your age, ethnicity, genes, and location of the injury. When it comes to surgical scars, the way the surgeon closes the wound can affect the visibility and size of the scar.

There are different types of scars:

Different forms of scarring

Keloid Scar, Contracture Scar, Hypertrophic Scar, Acne Scar

1. Keloid scar: spreads past the original injury and begins to grow
2. Contracture scars: when you burn your skin
3. Hypertrophic scars: Red scars which are raised
4. Acne scars: forms when people have severe acne. Acne scars can vary, some can be deep and some can even have a little bump.

Acne scars can be treated depending on the size, location, and type of scar. Some scars can be treated by over the counter or prescription creams. Another form of scar treatment is by injections or by surgical removal. In order to find out what the best treatment is for you, it is recommended to see a physician. If you have a scar from surgery it is best to see the surgeon who performed the surgery. If you have acne scars, it is recommended to see a dermatologist.

Will I have More Than One Scar?

Patient’s who have had a hair transplant surgery through the traditional strip method have a linear scar in their donor area. Many patients wonder if they will end up with more than one scar if they get another hair transplant. They answer to that question is no.

When a patient receives a second hair transplant, the surgeon who is performing the surgery will include the old linear scar in the new strip that will be taken out from the donor area. Once that step is done the patient will end up with only one scar no matter how many hair transplant they might receive.

Scar After 2 Hair Transplants

One of the factors for the size of the scar can depend on the Doctor that the patient chooses to have surgery with. Another factor will be how well the patient’s skin heals. Many doctors are now performing the trichophytic closure. Trichophytic closure technique helps hair grow inside of the donor scar. Once the hair grows and the scar heals it will help the donor scar blend in with the surrounding skin.

If a patient has had a hair transplant years ago, it is most likely that the scar they have is wider. Since technology has improved, the size of the scar can be reduced in most patients. Choosing an experienced hair surgeon is vital because if a professional hair surgeon does the procedure, the scar that you had from the previous hair transplant can most likely be reduced in size. Ofcourse, the results will always vary between every patient, but a good hair transplant Doctor will try to do everything to minimize the visibility of the scar for all patients.

New Science Helps in Healing Victims of War

Traumatic Injures of War

A young child in Mosul, Iraq is playing in a war torn neighborhood. Chasing a ball made of newspaper in tape she inadvertently steps on an IED. Outside Kabul a coalition humanitarian worker and a soldier a bring aid to an Afghan family. There vehicle hits a landmine they are severely burned and scarred from burns and loss of muscle. New technology promise hope for such victims.

University of Pittsburgh doctors have helped a soldier injured in Afghanistan regrow muscle to restore his strength and range of motion in his severely injured leg. McGowan Institute for Regenerative Medicine, at the University of Pittsburgh is headed by Stephen Badylak, doctors there are pioneering cutting edged treatments for recovery of traumatic battlefield wounds. These injuries include burns and blast injuries. These amazing treatments include wound healing, craniofacial reconstruction, and limb regeneration.

Wounded Soldier Facial Reconstruction

“Wounded Soldier Facial Reconstruction -Midway through surgical series.”

A new therapy developed at the institute is called the “skin gun.” It is actually a spraying device used to spray wounded areas with skin cells over burns on the ears and face. Skin can regrow over the affected burn areas in just a matter of days. The Bioreactor Group is under the direction of Professor Joerg Gerlach, they are the developers of this exciting restorative treatment.

There are three innovative treatment programs headed by the McGowan medical team. Extensive research on biominerlization (scaffolding) and bioceramic nanoparticles in non-viral DNA gene delivery. Professor Charles Sefeir leads the studies focused on the role of extracellular matrix in tissue engineering and biominerliazation.

One of the most critical areas of the centers work is the reconstruction of soldiers’ faces with the most normal looking appearance as possible for the patients. A cross functional team led by Professor J. Peter Rubin coordinate their complimentary expertise to bring about positive results with the advancement medical treatments of the McGowan Institute.

A Scars Story

Scar Truths and Tales

Scars, who doesn’t have one? A little annoying insect bite gets scratched obsessively becomes infected and though not deep it scars. The athletic endeavors of youth, life threatening accidents, surgery or to the catastrophic injuries of war can all leave our bodies scared. Scars can be the source of pride for some an icebreaker to tell an embellished tale at a family event or hob-knobbing with friends.

Scars can just be minor footnotes to our lives or major source of emotional and psychological angst. One on my right palm once stretched the full width; now, it is barely noticeable unless pointed out. It marks a dramatic bloody incident of falling in a 2nd grade foot race at recess. Then there is the one near my right eye a story that I don’t often want to recount. The visible one on my right shoulder blade always invites comment in a shirtless pickup game of basketball. Scars can be mileage markers on the amazing journey of our life. Sometimes, those scars bare even more tragic consequences to some people. They can infringe upon their well-being and devastate their quality of life.

View Amazing Scar Revision Surgery on Young Girl

The more I reflect my hands begin to braille my body through my clothing and my mind shuffles through vignettes of memories of burns and bruises, scrapes and scabs; bumps and lumps. Limbs and torso marked by stitches and scratches, gashes and slashes; all with the requisite blood; some of these scars bleeding more profusely causing parental angst and a flood of tears.
My active childhood, athletics and sporting lifestyle have given my dermis a lifetime of stories and embellished tales to share. Not a one would I remove. They are my story for better and worse.

By now you’re asking the purpose of this tale. My many scars have left to date only memories to be romanced and morphed into heroic tales. This is not true for many people. Scarring can deeply mar the psyche of a person and impact their life at every level.

Scar revision provides an opportunity to effect positive change on such people’s self image and esteem. The effect of scarring can be compounded by the onset of depression; a too often debilitating life-cycle if untreated.

It can be a vitally important step in their journey to inner and outer healing to treat the scar through the wonderful advancements in scar revision treatment. If you or a family member or friend struggle with issues regarding scars; consult with a dermatologist and or cosmetic surgeon. Scar revision in the 21st century has come a long way in providing wonderful results for many.

Types of Surgical Scar Revision

Description of Types of Surgical Scar Revision

Listed below are the most common surgical techniques utilized in scar revision.
Z-plasty Before & After

Z-plasty is a reconstructive surgery procedure. Its utilization is for improving the functional and aesthetics of scars.  Functionally refers to the lengthening of the scar the lengthening of a scar which helps relax or release linear burn scar contractures. The availability of mobile adjacent skin is a predicator for the use of this medical procedure. Z-plasty can procedurally make the scar less noticeable. Re-alignment of the central element can place the scar in natural skin tension lines and thereby disguise it. Utilizing this procedure the surgeon can rotate the tension line of a scar and or make a contracted scar elongated. In Z-plasty the midline of the Z-shaped incision is made along the meridian of highest tension or contracture. Triangular flaps are raised on the opposite ends of this incision. The flaps are than transposed and closed.

W-plasty is another reconstructive plastic surgery technique used for the excision of unaesthetic scarring. The excised edges of the scar are cut in a zig-zag pattern is like a connected row W’s. The borders are interdigitated for suturing. This method is very effective in rendering a linear scar irregular and less visible.

W-plasty Diagram

W-plasty revisions the scar into a ‘pinking shear pattern; which will interlock when sutured. Optically, it is more difficult for the eye to follow an irregular line. This makes W-plasty a favored method for revisioning linear scars. Often there is no discreet skinfold to hide a scar. Think of areas such as the forehead, the side of the face or cheek. Still is the irregular pattern is uniform visibility is not obscured. For that reason W-plasty is most often combined with

Geometric Broken Line Closure (GBLC).

W-plasties are not usually employed on their own throughout the entire scar. Visibility of the scar can be better reduced by combining other patterns with the W pattern. This is a more sophisticated procedural technique of scar revision is known as geometric broken line closure (GBLC).  W-plasty is the basic technique and then other shapes besides triangular flaps are utilized for interdigitation creating a very irregular irregularity. This procedure offers the optimal potential for camouflaging the scar. Added to this is also dermabrasion which is done approximately two to three months after the surgery.


The object of electing M-plasty in reconstructive surgery is to better preserve healthy tissue and to reduce the chance of secondary tissue deformity.  Proper technique in M-plasty reduces the loss of surrounding health tissue by nearly fifty percent.  The M-plasty is performed by creating two separate thirty degree angles instead of a single one.


Adjunctive Techniques of Scar Revision



  • precisely and in a controlled deliberate manner superficial abrading of the scar and surrounding skin. The end result is a smooth texture and in some cases further reduced visibility.
  • Abrasion can be used in a process that will improve the appearance of uneven scar edges including: scar edges, grafts and or flaps.
  • Dermabrasion works best on lighter complexions because of the lower risk of dyspigmentation.

Intralesional Steroids

  • Hypertrophic linear scars, bulky grafts and flaps, can be treated with intralesional corticosteroids. Injections can be instituted at approximately 1 month postoperatively.
  • A small amount (as little as 0.1 mL) of low-dose triamcinolone acetonide  at 5 to 10 mg/mL is injected into the scar; this dosage can be repeated monthly until the scar has flattened.
  • Side effects include atrophy (if the injection leaks out into healthy skin ),  hypopigmentation and telangiectasias when injected in higher concentrations into the dermis.


The reasons for a patient not to undergo scar revision include:

  1. The present psychological status of the patient does not prepare the patient for a positive outcome.
  2. The patient’s expectations are unrealistic limiting the opportunity for a favorable visible outcome.
  3. An individual’s history for hypertrophic and or keloid scarring represent a poor risk for a pleasing aesthetic result.
  4. Patient’s with thickened skin from the trauma reducing compliancy endure the risk of a compromised scar revision.

Scar Revisions New Horizons with Lasers

Laser Instrumentation for DermatogistsScars are immensely varied and come in all shapes and sizes. Surgery remains the best option for more severe scars, other scars can be treated with the advance development of lasers for dermatological use. Treatment of scars with laser has steadily grown, giving both patients and physicians more flexibility to determine the best method of treatment.

Two Main Goals of Treatment
Scars appear different, depending on the injury sustained. According to some experts the color be it, white, red, or brown, can be an indicator of the type of texture the scar will show.
• Make the scar smooth without the is not depressed or elevated
• Blend the color around and within the scar so that it blends with the outlying pigment

Ablative Technology

For larger and more severe scars, such as burns and contractions associated with scars, ablative technology is a better option. Ablative technology is a process of placing tiny holes in the skin with lasers that allow tissue to bend more easily, thus potentially increasing the range of motion in severe scars. This technology continues to improve through the enabling deeper penetration of the lasers.
With lasers now offering the ability to go deeper into the skin scar treatment will continue its dramatic changes.

Some dermatologists and researchers theorize that deeper treatments will allow for more range of motion in scars that restrict movement; this may open up whole new possibilities for scar treatments. Lasers in the future will allow for even deeper penetration of the dermal layers.

Given the nature of scars, there will likely never be a definitive treatment for all scars, no matter how much the technology advances. Still the current levels of laser therapy provide wonderful new treatments to diminish scarring; with greater promise on the future.

New Cosmetic Procedures for Scar Revision

Scarring negatively affects a person’s self image. Advancements in cosmetic procedures surgical and non-surgical provide alternatives in revising hair transplant scars or scars in other areas of the body that have hair.

FUE and SMP Transplant for Scalp Scar Revision
Follicular Unit Extraction (FUE) allows a hair transplant surgeon to individually remove donor grafts without a measure incision in the patient’s scalp. This means a small number of grafts can be used and placed within recipient sits within a scar. This means scars in other places that have hair (eyebrows, pubis etc…) can be treated by transplanting of a small number of follicular units into the scar and on its margins to blend it to the surrounding area.

Scalp Micro-pigmentation is used to simulate stubble hair making it also good for obscuring scars.
Scalp Micro-pigmentation is used to simulate stubble hair making it also good for obscuring scars.

Scalp Micro-Pigmentation
SMP for Scar Revision

Scalp Micro-Pigmentation (SMP) is a non surgical cosmetic procedure that can be used in scar revision. It can works well with scalp scars. Special pigments are injected into the scar. The appearance is like stubble hair. It is injected into the scalp in a manner to obscure the scar or make it blend into the surrounding area.

These more recent advances in cosmetic procedures; FUE and SMP are performed in Los Angeles hair transplant centers like US Hair Restoration.

Understanding Scarring and Scar Revision

The role of scar revision is to restore self-esteem and improve the quality of life. The skin is actually the largest organ of the body and vital to not only our physical health but also it’s health and beauty important to our emotional well-being. Scars have a natural process or progression towards a mature scar. This represents the completion of the healing process.

There are individuals who heal with very little scars and others who scar from the slightest of skin injury. Any injury to the the skin, that is a rupture to the integrity of its’ surface or that results in an opening or damage to the dermis, will heal with a scar.

Facial Scars effect self image.
Life changes that effect our hormones can effect the way our skin heals. Childhood to puberty, adulthood and finally to old age can represent significant changes in how our skin heals. Predicting how a person heals cannot be done with medical certainty. It is a persons observation of their own healing history and familial history that provides the best indicators.

However through observation of certain skin types that we understand their tendencies to produce abnormal scarring and formation:

  • Pigmented skin and Celtic skin have a higher risk of Hypertrophic and Keloid scarring
  • the chest and shoulders, eyelids, lips or labia heal with inconspicuous scarring
  • The goal of scar revision surgery is to make the scar to blend or making it inconspicous. Scars that result from injuries, burns or cancer excision can have a major psychological impact. This impact from the scarring can be profound adversely effecting self-esteem, self-confidence and social interaction. If you suffer from such issues a cosmetic surgeon can often help.