Scar Revision

What Are Scars?

Scars are marks left on the skin or within body tissue following a wound, burn or infection. Certain injuries, if superficial on the skin, can heal without scarring, but deeper injuries leave a permanent scar. Scars can be seen as irregular lines, elevated or depressed tissue contours or variable colors from red to brown to white.

How Do Scars Heal?

All permanent scars go through a period of wound healing. For six weeks there will be redness, swelling and sometimes pain. Healing cells, fibroblasts, are laid down making the wound “lumpy and bumpy.” Over many weeks, up to a full year, the scar becomes flatter, smoother and whiter.

Early Treatment of Scars

In the early healing, massage, silicone applications (i.e. Kelocoat) and sunblock can help scar resolution. Unless there is a problem with function (for example, an eyelid or mouth scar), usually we wait a full year to assess if the scar revision is advisable. During this time, scars can sometimes be camouflaged with makeup, hair styling or spectacles. Steroid injections may soften an elevated, firm hypertrophic or keloid scar. The latter are rare, and grow outside the area of injury. They are more common in darker – skinned people.

Surgical Treatment of Scars

Surgically speaking, an elevated scar (or lesion) can often be improved by simply shaving it level. Dermabrasion or laser resurfacing can be used for a similar result, and certain lasers (for example, intense pulsed light) can decrease the redness of some scars.

However, some scars require complete excision and re-approximation of the skin and deeper tissues. These incisions are placed in the ideal direction, often along crease lines, or made in the shape of a “Z” or “W” to break up elevations, contractures and undesirable scar alignment.

Who Is A Good Candidate? 

Different people are affected differently by their scars. If a scar bothers you and is diminishing your sense of self-confidence or self-esteem, then you should consider scar revision. If not, don’t, unless there is an associated functional problem.

It is important to be physically and psychologically fit, and to have realistic expectations. Once revised, the new scar has to go through the entire healing process again. Patience is required. Many scars can be improved, and some made almost invisible, but “once a scar, always a scar.” Sometimes more than one procedure is required.

What Is The Recovery Time?

The revised scar goes through exactly the same healing phases as the original scar. Most procedures can be performed under local anesthetic, deep sutures dissolve themselves, and skin sutures (if not dissolvable), are usually removed in four to six days. Small anti-– tension tapes may be applied. Within one week, camouflage makeup can be applied. Bruising and swelling can be minimal or more pronounced – your surgeon will take measures to decrease this.

The vast majority of patients are very pleased with their revised scar. Revision decreases their social anxiety and gives them more confidence about their body image and better self-esteem.