SCAR
REVISION

Scar revision is performed to improve the condition or appearance of a scar anywhere on your body. After an injury or surgery, a scar will often remain as a visible sign that a wound has healed.

While scars are a natural part of healing, their development can be unpredictable. Scar revision surgery is meant to minimize the scar so that it is more consistent with your surrounding skin tone and texture. The different types of scars include:

• Discoloration and surface irregularity scars — These 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.
• Hypertropic scars — These 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— These scars are larger than hypertropic scars. They can be painful or itchy and may also pucker. Keloids extend beyond the edges of an original wound or incision. They can occur anywhere on your body, but commonly develop where there is little underlying fatty tissue, such as on the breastbone or shoulders.

• Contractures— These scars restrict movement due to skin and underlying tissue that pull together during healing. They occur when there is a large amount of tissue loss, such as after a burn. Contractures also form where a wound crosses a joint, restricting movement of the fingers, elbows, knees or neck.

Although scar revision can provide a more pleasing aesthetic result or improve a scar that has healed poorly, a scar cannot be completely erased.

Scar revision can be performed at any age and is a good option if you:

• Are bothered by a scar anywhere on your body
• Are physically healthy
• Do not smoke
• Have a positive outlook and realistic goals for your scar revision surgery
• Do not have active acne or other skin diseases in the area to be treated

During your consultation, be prepared to discuss:

• Your surgical goals
• Medical conditions, drug allergies and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
• Previous surgeries

Your surgeon will also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Examine your scar in detail
• Take photographs
• Discuss your scar revision options
• Recommend a course of treatment
• Discuss likely outcomes of scar revision surgery and any risks or potential complications

Prior to surgery, you may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Scar revision surgery may be performed in your plastic surgeon’s office using only local anesthesia. If your scarring is more significant and sedation or general anesthesia is also necessary for you to be comfortable during the procedure, it may be performed in an accredited office-based surgical facility, licensed ambulatory surgical center or hospital. If you do require sedation or general anesthesia, you will need another adult to drive you home and stay with you for the first night following the procedure.

THE PROCEDURE

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Advanced techniques in scar revision include complex flap closure to reposition a scar so that it is less conspicuous or to improve flexibility where contracture has restricted mobility.

Z-plastyis a flap technique that involves a “Z” pattern incision with multiple angles. This 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.

Skin grafts or pharmaceutical tissue substancesare used if there is not enough healthy tissue present for closure of a scar excision. This is more likely with revision of severe burn scars. The graft may consist of healthy skin from other areas of your body, such as the abdomen or thigh.

Tissue expansioncan 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. The balloon is slowly filled with sterile solution to expand the area of healthy skin. Once the skin has grown sufficiently, the expander is removed and new skin replaces the adjacent scarred tissue.

RISKS & SAFETY

The decision to have scar revision surgery is extremely personal. You will have to decide if the benefits will help you achieve your goals and if the risks and potential complications are acceptable. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.

The risks include:

• Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
• Anesthesia risks
• Bleeding (hematoma)
• Change in skin sensation
• Damage to deeper structures, including nerves, blood vessels, muscles and lungs – may be temporary or permanent
• Deep vein thrombosis, cardiac and pulmonary complications
• Delayed healing
• Infection
• Pain, which may persist
• Possibility of revisional surgery
• Recurrence of an unsightly scar
• Skin contour irregularities
• Skin discoloration and swelling

These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions directly with your plastic surgeon.