Scar Revision Surgery

Scar revision is plastic surgery performed to improve the condition or appearance of a scar anywhere on your body. The goal of scar revision surgery is to minimize a scar to be more like your surrounding skin tone and texture.

What is a scar?

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.

Different Types of Scars

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.

Hypertrophic 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 hypertrophic 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 plastic surgeon will use to improve your scar.

Is Scar Revision Surgery a Good Option for You?

Scar revision can be performed on people of any age and may be a good 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

Scar Treatment Options

The degree of improvement that can be achieved with scar revision will depend on the severity of your scarring, and the type, size and location of the scar. In some cases, a single technique may provide significant improvement. However, your plastic surgeon may recommend a combination of scar revision techniques to achieve the best results.

• 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.
• Skin bleaching agents are medications applied topically to lighten the skin.

• Surgery. Sometimes for deeper scars an incision is needed to surgically remove the old scar.

Some scars require layered closure. Layered closure is often used where excision extends to tissue below the skin surface or in areas with a high degree of movement. The first step, or layer, requires sub-dermal closure (below the skin surface) with absorbable or non-removable sutures. Layers of closure continue to build, concluding with closure of the remaining surface wound.

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.

• Pharmaceutical tissue substitutes may be used if ample healthy tissue is not present for closure of a scar excision. This is more likely with revision of severe burn scars.
• 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.

More Information?

If you have questions, please contact us. We are always willing to help you determine the right treatment for you.

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.
• Hypertrophic 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 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.