Scar revision surgery minimizes the appearance of a scar by making it blend with the surrounding skin tone and texture. Patients often seek the help of a plastic surgeon after they have exhausted non-invasive treatments such as creams, ointments and silicone sheets. Since there are several types of scars, a doctor will need to evaluate the scar to determine which surgical method is appropriate. The treatment will be determined by several factors including:
- The anatomical location of the scar
- Type of scar
- Skin quality
- Skin type
- Availability of surrounding tissue
- Current functional impairment
- Possibility of decreased functionality after surgery
Scar Revision with Excision
The most common form of scar revision is excision and primary closure. In fact, scar excision is the most effective method to improve deep, wide or long scars. Excision may be necessary if the scar has healed in an unusual way. This method of scar improvement involves cutting the scar out and then rejoining the skin with layered sutures to close the wound. Although it will create another scar, the new scar will be straight and thin and have a chance to heal more discreetly.
In some cases, the closure may require some tissue arrangement. After cutting the scar away, the surgeon will realign the scar with geometric rearrangements such as a z-plasty to elongate or change the direction of the scar. If a patient does not have enough healthy tissue to suitably close the wound, the surgeon may need to use a skin graft. A pharmaceutical tissue substitution can be used to cover a large area, if needed, in cases such as a patient having large scars caused by burns. After healing from scar revision surgery, the patient generally ends up with a scar that is less noticeable than before. It can take six months before the patient sees an improvement and up to a year to see the final results.
There are many methods for treating scars including non-invasive and natural remedies. However, not all scars will respond to minimal treatment.
Laser therapies are often restricted to treating a recent scar, scars that are persistently red in color and light skin resurfacing for scars.
During scar revision with laser treatments, the surgeon uses a laser light beam on the scar and the surrounding skin. The laser removes the outer layer of skin by burning it off and this begins the regeneration of new skin. After it has healed, the new scar will look smoother as well as lighter in color. It may take multiple sessions to gain the desired appearance. Although laser therapy can make mild improvements, it is not an effective solution for most scars. Deep laser resurfacing and dermabrasion may work well for wide, raised scars that are not appropriate for excision.
Follow Post-Op Instructions
Scar revision is about improvement and not about “erasing” a scar since scars can never be completely removed. Furthermore, the lifestyle of a patient after scar revision surgery can impact the long-term outcome. Following post-op instructions and limiting sun exposure can help the scar heal better. Patients should cover the scar or apply sunscreen SPF 30 (or higher) before going outside to maximize the healing process.