Scars

Scar revision helps make the scar less noticeable and more cosmetically appealing; however, it does not erase it. Scar revision is also useful in restoring a poorly healed scar. Scar revision may include both surgical and non-surgical techniques. Complications of scar revisions can be reduced by proper planning and a surgeon’s experience.

How is scar revision performed?

Cutaneous scar revision can be performed under local anesthesia, intravenous sedation, or general anesthesia. The plastic surgeon may recommend a combination of scar revision techniques to achieve optimal results. These include:

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• Topical treatments: Gels, tapes, or external compression help in wound healing or reduce the skin’s ability to produce abnormal pigmentation. These may also help treat existing surface scars and discoloration. It may also be useful during the healing of a new scar made during the scar revision procedure.
• Injectable treatments: Dermal fillers are useful in filling depressed or concave scars. The results may last anywhere from three months to several years, depending on the injectable substance. Therapy should be repeated several times to maintain results.
• Surface treatments: These involve cosmetic improvement of the scar. It evens skin irregularities and reduces uneven pigmentation. The different types of surface treatments include:
  • Dermabrasion is a mechanical polishing of the skin.
  • Laser or light therapy brings about changes in the surfaces of the skin, leading to the formation of new, healthy skin adjacent to the scar site.
  • Chemical peel solutions even out irregularities in texture and color by penetrating the skin’s surface and blending it more gradually to the texture and lack of pigmentation in the scar itself.
  • Skin bleaching agents are applied topically to lighten the surrounding skin to blend with the scar tissue which has no pigment.
• Surgical excision: This may be required to surgically remove an old scar and replace it with a new one that is better oriented, to repair deeper structures that lead to the scar being depressed or whose progression can be manipulated to yield a better scar.

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Some of the advanced techniques in scar revision include:

• Skin graft placement (split thickness of various depths up to full thickness)
• Local flap closure (ranging from simple to complex), including Z-plasty, W-plasty, and reorienting flaps
• Distant flap closure and free flaps (moving skin with underlying muscle or even with bone into an area)

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