Scar Revision

Damage to the skin as a result of surgery, trauma of a burn can result into scar formation. A scar revision excises a scar to try and produce a new scar that is thinner, flatter with a better color match and therefore less obvious.

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SCAR REVISION

Damage to the skin as a result of surgery, trauma of a burn can result into scar formation. Scars may become thickened (hypertrophic) or even grow beyond the original damage and become keloid scars. This excessive scar formation is more often seen in darker skin types and very fair skin types. Certain areas of the body, such as the shoulder region and sternum are more susceptible to excessive scar formation. One factor that can influence scar formation is the direction of the scar in relation to the tension lines of the skin. In the face you can clearly see the lines when you activate your facial muscles. When crossing a joint, scar can also form a contracture of the skin causing a limitation in the range of motion. If the underlying fat is diminished scars can become depressed. Due to shadow formation of the depression these scars can become more obvious. Wounds that are the result of sharp knives produce better scars than wound produced by crush or avulsion injuries. Increased tension on wound closure, often produce a widened scar. It appears that young people and children due to their tighter skin have a higher chance of developing scar formation than older people. A scar revision needs to produce a less obvious scar, but the scar will never disappear.

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DETAILS OF THE TREATMENT

THE FIRST CONSULTATION

During the first consultation, you will be asked in detail about when and how the original injury was incurred and how it was treated. The location of the scar, its size, length, width, height, color, direction it runs, and whether it distorts the surrounding anatomy are assessed. The various options that can improve the appearance of the scar will be discussed.

CONSERVATIVE TREATMENT OF SCARS

It is important to realize that the total wound healing process can take up to a year. In the beginning scars are often red, thickened and sensitive. As the wound healing progresses in the weeks and months to come become lighter in color, flatter, softer and less sensitive. For normal wound healing patience is often the best treatment. It is important that fresh scars are protected from sun exposure. Massage can soften and flatten scar quicker. Continuous pressure also has a positive effect on the outcome of scars, as is achieve with pressure garments on severe burn scars. Silicone also is beneficial for thick hypertrophic scars. In keloid scars the scar formation grows beyond the original area of trauma and form very ugly, thick, aggressive, painful and itchy scars. Steroid injections are often effective to stop their growth and to soften and flatten them. They will not become thinner. In some instances radiotherapy may be useful to control the growth of persistent, but this in not first choice. Certain lasers may have a positive effect on scars. Color differences of scars in relations to the surrounding skin are best camouflaged with make-up or in some instance tattooing may be beneficial.

SCAR REVISION

A scar revision excises a scar to try and produce a new scar that is thinner, flatter with a better color match and therefore less obvious. The newly created wound is then sutured with the utmost precision possibly with a change of direction to decrease the tension on the wound. The wound healing process then starts again. During this process conservative measures can also be applied to improve on the final outcome. In case of a scar contracture, when for instance an eyelid is pulled down, the surrounding skin can be moved to create more length. This will result in a longer scar, but it lies in a better direction. Most scar revisions are performed under local anesthetic, but in case of extensive revisions a general anesthetic may be preferable.

AFTER THE PROCEDURE

After the procedure, a greasy antibiotic ointment is applied to the wound until the sutures are removed 5-7 days later. The wound area will be somewhat swollen, bruised and tender. Most of that will subside after one or two weeks. Healing continues and the scars will continue to improve in the months after. Meanwhile, the new scar must be protected from the sun and scar cream can further improve the result. After 3 months, the healing is 70-80% complete and the maturation process continues up to a year after the revision.

RISKS AND COMPLICATIONS

Even though a scar revision is performed with the utmost care and expertize, the final result may sometimes be disappointing. After a scar revision one must take into account that scars can be thickened, itchy and even painful for a while. Some scar widen with time more than expected and sometimes the color difference remains the most obvious part of the scar. Plastic surgery is not an exact science and a guaranty on the results or uncomplicated course can never be given.

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