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Scar Revision



Overview

One of the most common procedures most plastic surgeons are asked to perform is scar revision. Some people believe that a plastic surgeon has the ability to completely remove scars as if the injury never occurred. Obviously, this is not possible. Once the skin is cut is can only heal by scar tissue. The key to scar revision is to make the scar as unnoticeable as possible. This is the art of plastic surgery.

Before performing a scar revision, plastic surgeons examine all the characteristics regarding the scar and where it is located. Typically, a scar revision requires excision of the old scar and precise repair. Also, important is changing the direction of the scar so that it falls into a natural skin crease where it is much less noticeable. For example, a 2 inch scar on the forehead is much more noticeable if it is a vertical scar compared to if it is horizontal. This is because the natural skin creases of the forehead run horizontal.

Another important aspect of scar revision is understanding the differences between the different types of scars and the different ways people heal. Scars can be classified into three different types. The first and most common type is the unfavorable scar. This type of scar can usually be dramatically improved if the precise plastic surgery planning and repair is performed. It is caused by either poor original repair or no repair at all leaving the wound to heal in on its own. The second type is the hypertrophic scar. This type is widened and is usually hard. It too is amenable to scar revision. The third and most difficult scar to revise is the keloid. A keloid is a scar that does not know when to stop growing. The scar keeps forming. It gets bigger and bigger until eventually it is bigger that the original injury. This type of scar is prone to return.

In addition to surgical technique, there are medications and injections that can be used to make scars heal better as well as making them softer and less itchy.

Benefits

The benefits of scar revision are that it brings you back as close to normal as possible. You become less self-conscious about people noticing your scar. You do not have to spend as much time applying the right makeup or wearing the right clothes to conceal the scar. Here is a summary the benefits.

  • Improvement in self confidence.
  • An inconspicuous scar is less painful and less itchy.
  • You do not have to worry about concealing the scar with makeup or clothes.
  • Poor scars especially on the face or hands can cause significant problems with movement and function.
  • Scar revision surgery is relatively quick, low cost and with little down time.
  • It is the only hope for large scars such as in burn victims or serious injury.

Are you a good candidate?

Most noticeable scars are amenable to scar revision. Those that benefit most are listed below.

A widen scar. A scar that is either elevated or depressed compared to the normal skin around it. Scars that distort the face especially when smiling or forehead movement. Discolored scars. Most scars of the face. Keloid scars are often amenable but the patient must understand that a recurrence is possible.

Possible complications

The most common complication after scar revision is inadequate scar improvement. This is minimized by making sure the patient understands what can and can not be done. Other complications are those that are possible with any operation. These include infection and wound healing problems, unfavorable scarring, fluid or blood collection, numbness, asymmetry, and contour irregularities.

Do's and Dont's prior to surgery

Scar reduction surgery is usually done under local anesthesia. There are not many do's and don'ts. The most important thing is to avoid aspirin and aspirin containing products for at least two weeks prior to revision. Ingestion of these products will lead to more bruising and swelling.

Smoking dramatically decreases the body's ability to heal. Therefore, it is recommended to stop three weeks before and after the revision. It is advised not to eat within four hours prior to local anesthesia.

Anesthesia

Scar revision is typically done under local anesthesia. If you would like sedation can be added to make you more comfortable.

If more anesthesia is necessary, ICRS only uses board certified anesthesiologists to make sure you have the best anesthesia possible. The anesthesiologist will discuss with you what type of anesthesia is best for you. He will take into consideration your medical history, the procedure, and your personal wishes.

After the procedure

Immediately. Right after the operation you will be watched for about and hour and encouraged to walk around. You may have a dressing over the wound. Leave the dressing on until the next day. If the procedure is done under local you can drive yourself home, otherwise, you must have someone drive you.

That evening. It is recommended that you take it easy. Generally, there is not much pain. You should take as much pain medication as necessary and try to go to sleep early. If the revision was done on the face or head it is best if you sleep with your head elevated to promote proper lymphatic drainage and keep the swelling down.

First 48 hours. You can take a shower the day after and move around. Reapply a dressing only if there is drainage from the wound or if you are wearing clothes over the incision. Otherwise, let the incision air dry.

Beyond. Swelling will not completely resolve for six to twelve weeks but the majority of it will be gone by the end of the first week.

Recovery time

Some people with sedentary jobs go back to work right after the revision. If your job, however, requires strenuous activity it may take as long as two weeks to return to work. Most people return to work in about two to three days.