SCAR REVISION SURGERY
What is scar revision surgery?
While surgery cannot remove a scar entirely, Dr Sharp can sometimes improve the appearance and function of a scar by making it less noticeable or easier to conceal. Scar revision surgery is meant to minimise the scar so that it is more consistent with your surrounding skin tone and texture.
Scars are visible signs that remain after a wound has healed. They are unavoidable results of injury or surgery, and their development can be unpredictable.
Poor healing may contribute to scars that are obvious, unsightly or disfiguring.
Even a wound that heals well can result in a scar that affects your appearance.
Scars may be raised or recessed, different in color or texture from surrounding healthy tissue or particularly noticeable due to their size, shape or location.
Your treatment options may vary based on the type and degree of scarring and can include:
- Simple topical treatments
- Minimally invasive procedures
- Surgical revision with advanced techniques in wound closure
Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased and sometimes further surgery can even make them worse, especially if you are naturally prone to poor scarring.
Most scars can be improved using non surgical methods, which are often less expensive and don’t carry the increased risk of recurrent scarring. If you would like to explore your scar reduction options, we recommend looking at non surgical modalities first.
We offer free non surgical scar optimisation consultations with our clinician to assess whether these scar reduction options are suitable for you.
Non-surgical treatment of scars include:
- Prescriptive topical ointments
- Injection of a steroid (cortisone) into the scar
- Silicone gel dressings or bandages
- Compression garments
- Physical therapy
- Fraxel laser
- Chemical peels
- Soft tissue fillers including dermal filler gels, implants and autologous (patient’s own) fat
- Dermapen micro needling
Topical treatments, such as gels, tapes or external compression, can help in wound closure and healing, or to reduce the ability of skin to produce irregular pigment. These products may be used to treat existing surface scars and discoloration, and to aid in healing of scar revision procedures.
Injectable treatments are often used to fill depressed or concave scars. Depending on the injectable substance used and your particular scar conditions, results may last from three months to several years. Therapy must be repeated to maintain results. One form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size and texture of raised scar tissue.
Surface treatments are most often used for cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of either mechanically removing the top layers of skin or changing the nature of tissue. These treatment options include:
- Dermabrasion is a mechanical polishing of the skin.
- Laser or light therapy causes changes to the surface of the skin that allow new, healthy skin to form at the scar site.
- Chemical peel solutions penetrate the skin’s surface to soften irregularities in texture and color.
How do I know if my scar is normal or not?
The different types of scars include:
- Discoloration, surface irregularities and other more subtle scars can be cosmetically improved by surgery or other treatments recommended by your plastic surgeon. These types of scars do not impair function or cause physical discomfort and include acne scars as well as scars resulting from minor injury and prior surgical incisions.
- Hypertropic scars are thick clusters of scar tissue that develop directly at a wound site. They are often raised, red and/or uncomfortable, and they may become wider over time. They can be hyperpigmented (darker in color) or hypopigmented (lighter in color).
- Keloids are larger than hypertropic scars. They can be painful or itchy, and may also pucker. They extend beyond the edges of an original wound or incision. Keloids can occur anywhere on your body, but they develop more commonly where there is little underlying fatty tissue, such as on the face, neck, ears, chest or shoulders.
- Contractures are scars that restrict movement due to skin and underlying tissue that pull together during healing. They can occur when there is a large amount of tissue loss, such as after a burn. Contractures also can form where a wound crosses a joint, restricting movement of the fingers, elbows, knees or neck.
The type of scar you have will determine the appropriate techniques your therapist or Dr Sharp will use to improve your scar.
Scar revision is a highly individualised procedure and you should do it for yourself, not to fulfil someone else’s desires or to try to fit any sort of ideal image.
Scar optmisation can be performed on people of any age and is an option for you if:
- You are bothered by a scar anywhere on your body
- You are physically healthy
- You do not smoke
- You have a positive outlook and realistic goals for your scar revision surgery
- You do not have active acne or other skin diseases in the area to be treated
Some scars require direct closures, while others need grafts or flaps; this however, is very rare and usually avoided whenever possible.
Advanced techniques in scar revision include complex flap closure to reposition a scar so that it is less conspicuous, or improve flexibility where contracture has restricted mobility.
Tissue expansion can be a substitute for skin grafts. In this procedure, an inflatable balloon called a tissue expander is placed under the skin near the scar site. Over time, the balloon is slowly filled with sterile solution to expand the area of healthy skin. Once the skin has been stretched sufficiently, the expander and the scar is removed and the stretched skin is moved to replace the scar tissue. This process can involve multiple surgical stages or procedures in order to achieve the final results.
Scar revision recovery: progress and healing
The initial healing phase of a surgical scar revision may include localised swelling, discoloration or discomfort and may take 1 to 2 weeks. Healing will continue for several weeks and as the new scar heals it will slowly refine and fade. With dermabrasion, chemical peel or laser resurfacing, you will experience similar conditions at the treated area, in addition to overall sensitivity.
The final results of your scar revision surgery will be long-lasting, however it may take up t9o two year for your final results to become apparent while the new scar to fully heals and fade. Patience is vital!
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee, in some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
The decision to have scar revision surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Dr Sharp will explain in detail the risks associated with surgery.
You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo, the alternatives and the most likely risks and potential complications.
Some of the risks include:
- Bleeding (hematoma)
- Delayed healing
- Anesthesia risks
- Change in skin sensation
- Damage to deeper structures including nerves, blood vessels, muscles and lungs can occur and may be temporary or permanent
- Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
- Skin contour irregularities
- Skin discoloration and swelling
- Skin sensitivity
- Deep vein thrombosis, cardiac and pulmonary complications
- Pain, which may persist
- Possibility of revisional surgery or staged procedures
Be sure to ask questions: It’s very important to ask Dr Sharp questions about your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with Dr Sharp.
Follow all postoperative instructions carefully, including cleansing and at-home treatment regimens, and avoid sun exposure. Your cooperation will influence the outcome of your surgery.
Your scar revision consultation
The success and safety of your scar revision procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
Be prepared to discuss:
- Why you want the surgery, your expectations and desired outcome
- Medical conditions, drug allergies and medical treatments
- Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
- Previous surgeries
Scar revision words to know:
- Chemical peel solutions: Substances that penetrate the skin’s surface to soften irregularities in texture and color.
- Contractures: Scars that restrict movement due to skin and underlying tissue that pull together during healing and usually occur when there is a large amount of tissue loss, such as after a burn.
- Dermabrasion: Mechanical polishing of the skin.
- Excision: Surgical removal of a scar.
- General anesthesia: Drugs and gases used during an operation to relieve pain and alter consciousness.
- Hyperpigmented scar: A scar that is darker in color.
- Hypertropic scar: Thick clusters of scar tissue that develop directly at a wound site.
- Hypopigmented scar: A scar that is lighter in color.
- Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
- Keloids: Large scars that can be painful or itchy, and may also pucker which can occur anywhere on your body, developing more commonly where there is little underlying fatty tissue, such as on the breastbone or shoulders.
- Laser resurfacing: A method to change to the surface of the skin that allows new, healthy skin to form at the scar site.
- Light therapy: (Intense Pulsed Light) Pulses of light that can be used to treat discoloration and texture changes of the skin.
- Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
- Skin grafts: Healthy skin taken from other areas of your body, such as the abdomen or thigh, to revise a scar.
- Tissue expansion: A procedure that can substitute for skin grafts. An inflatable balloon called a tissue expander is placed under the skin near the scar site to stretch additional skin to be used to revise a scar. Oftentimes, multiple procedures are needed.
- Z-plasty: A surgical technique that creates angled flaps on either side of the original scar site that can completely reposition or change scar direction, interrupt scar tension or improve scar flexibility.