Scar Revision Overview
Whether the result of chronic conditions, injury, or prior surgery, the appearance of scars can be reduced through any of a number of revision procedures. Techniques vary based on the type and severity of the scar being treated, which can include:
• Surface scars
• Hypertrophic scars
Less-invasive forms of treatment include the application of topical agents (such as bleaching creams), injectable agents (such as dermal fillers), dermabrasion, tattooing, and laser therapy. For deeper or more extensive areas of scarring, incisions, extraction, skin grafts, and/or tissue expansion may be needed.
In order to be eligible for scar revision, the skin must be free of active infections, including acne. During your pre-operative consultation, Dr. Vallecillos will examine the area to be treated and recommend the best treatment techniques. You will be instructed to avoid aspirin and anti-inflammatory medications to reduce the risk of bleeding during the procedure; vitamin K may be recommended to lessen post-operative bruising. Blood work may also be ordered. If a surgical procedure is required and you are over the age of 45, you may be asked to obtain medical clearance from an independent physician prior to receiving treatment.
Anesthesia will vary based on the extent and type of scar revision procedure. For topical and minimally-invasive methods, a numbing agent or local anesthetic should be sufficient. More extensive procedures may require the use of a local anesthetic in combination with a sedative, or general anesthesia.
- Scar revision, the reduction or elimination of skin damaged from accidents or surgery, can be accomplished in several different ways. One procedure involves silicone sheeting over an extended period of time to fade the appearance of scars. Scar revision can also involve cutting away the scarred area and using glue or stitches to close the skin. Another scar revision technique is called Z-plasty. During Z-plasty, the surgeon cuts flaps in the shape of a triangle from each end of the scar and transposes them, hoping to release the tension of the cording. This can lengthen and realign the scar. Finally, scar revision may be done through inking which restores the natural tones of pigmentation to the skin.
A variety of surface treatments are available. Some involve the application of topical agents to remove layers of damaged skin, such as dermabrasion and chemical peels. Laser therapy can also be effective. In cases where hyperpigmentation is the primary problem, a topical skin-lightening agent may be sufficient. Injectable dermal fillers are primarily used on recessed scars, to add volume and stimulate the production of collagen for ongoing repair.
Hypertrophic & Keloid Scars
Hypertrophic and keloid scars refer to a class of scars that are large, raised, and discolored. These scars occur directly at a wound site, and may extend beyond the original boundary of the incision. They are often painful and may grow over time.
Techniques to address these kinds of scars may include excision and stitches to reclose the skin, or other forms of surgical revision.
This type of scar often occurs as a result of a burn or other injury that involves extensive tissue loss, or when the wound crosses a joint and the resultant scarring restricts movement. Contractures may be treated with skin grafts (in which skin is removed from other areas of the body and grafted to the scarred area) or tissue expansion (in which the skin near the wound site is stretched over time, the scar is excised, and the skin is re-draped to cover the area). A flap technique known as Z-plasty may also be used and is often effective in releasing tension and increasing mobility in scarred areas.
Tattooing may be used independently or as an ancillary procedure and involves the injection of a skin-colored ink into scars that are discolored.
While scar revision is not a process for eradicating a scar completely, patients should see improvement; scars should be lighter, smaller, and overall less conspicuous.
Scar Revision FAQ
Who is a candidate for scar revision?
You should consider scar revision if you wish to reduce the appearance of one or more scars. Your skin should be free of active infections (such as acne). Scar revision cannot remove a scar entirely, but can significantly reduce its size, discoloration, and other distinguishing features for an overall improvement in appearance.
What is the recovery time for scar revision?
Recovery time for scar revision varies and will depend on the type, size, and severity of the scar being treated as well as the technique used. Dermabrasion, chemical peels, and laser therapy involve less patient downtime than surgical procedures. Dr. Vallecillos will provide you with a comprehensive post-operative plan.
Are there risks or side effects with scar revision?
Although scar revision techniques are generally safe and effective, some keloid scars do not respond well. Risks are unlikely but can include bleeding, infection, changes in skin sensation, and aggravated scarring.
How long do the results last?
Some scar revision treatments require multiple sessions, but the final results should be permanent. You can help to maintain results by avoiding sun exposure and following Dr. Vallecillos’ skin care instructions.