Scar Revision

Scar revision treatment is surgery to improve or reduce the appearance of scars. It also corrects skin changes and disfigurement caused by an injury, wound, poor healing, or previous surgery. It also minimizes a scar so that it is less conspicuous and blends in with the surrounding skin texture and tone.
Scars are obvious, visible signs that remain even after a wound has healed. They could be due to a prior surgical procedure, or due to an injury. Poor healing may result in scars that are unsightly, obvious, and disfiguring. A scar can result even after a wound heals well. Scars can be noticeable due to their shape, size, and location. Also, they may be raised or depressed and may differ in appearance from the surrounding skin.
Your treatment options depend on the extent of scarring and can include simple topical treatments, minimally invasive procedures, or then, surgical revision with advanced techniques in wound closure.
There are different types of scars. Some of them are:

• Discoloration and surface irregularities: These are subtle scars that can be improved by cosmetic surgery by a skilled cosmetic surgeon. These types of scars do not impair function and examples of such scars include acne scars, scars resulting from a minor injury, and scars due to prior surgical incisions.
• Hypertrophic scars: These are thick clusters of scar tissue that develops directly at the wound site. They are often red, raised, and uncomfortable and could become wider over time. They can be darker in color or lighter in color as compared with the surrounding skin.
• Keloids: These are larger than hypertrophic scars and could be painful and itchy. They could also pucker and extend beyond the edges of an original incision or wound. Keloids can occur anywhere in the body, but typically occur where there is a paucity of fatty tissue. Common sites include the face, the neck, the ears, the chest, or the shoulders.
• Contractures: These are scars that restrict movement, due to the skin and underlying tissue pulling together during healing. They occur when there is a large amount of tissue loss, such as after a burn. Contractures can also form when the scar crosses a joint, restricting movement of the fingers, elbows, knees, or neck.

Dr. S. Suma is a skilled cosmetic surgeon who is a scar revision specialist and the best scar revision surgeon. She understands the impact that unsightly scars have on a person’s self-esteem and self-confidence. She will work with you both physically and mentally to prepare you for scar revision surgery, if necessary.

Scar Revision Surgery can be performed at any age. You are a good candidate for scar revision surgery if you are bothered by a scar anywhere on your body; if you are physically healthy; if you have a positive outlook and realistic expectations regarding your scar revision surgery, and if you do not have active acne or other skin diseases in the area to be treated.

Prior to scar revision surgery, your doctor may ask you to get certain lab tests and a medical evaluation. She may also ask you to take certain medications, or then stop taking others. Some of the latter could be aspirin-based medications, certain anti-inflammatory drugs, blood-thinners, and herbal supplements as these cause increased bleeding. Your doctor may also give you special instructions prior to your surgery and will address all of your questions about the procedure as also about your postoperative care and follow-up.

Dr. S. Suma is well aware about the importance of your cosmetic scar removal surgery and will not take it lightly. She will work empathetically with you before your surgery to ensure that you are completely comfortable to undergo this procedure and that you will work closely with her for optimal results.

Your doctor may use either general anesthesia or local anesthesia with sedation. Your doctor will choose the option that is best for you. The actual scar treatment will depend on the severity of your scarring, and the type, size, and location of your scar. In some cases, your surgeon will only use a single technique, which will provide optimal results. In other instances, your cosmetic surgeon will recommend a combination of different scar revision techniques to achieve the best results.
The different types of treatments are:

• Topical Treatments: These include gels, tapes, or external compression. These help in wound closure and healing. They also help in reducing the ability of the affected skin to produce irregular pigment. These can be used to treat surface scars and discoloration and to aid in the healing of scar revision procedures.
• Injectable Treatments: These include Dermal Fillers to fill depressed or concave scars. Depending on the substance used to fill the scars, your results may last from three months to several years. You must repeat therapy to maintain results. Another form of injection therapy uses steroid-based compounds to reduce collagen formation. This may alter the size, appearance, and texture of scar tissue.
• Surface Treatments: This is used for the cosmetic improvement of scars. These methods can reduce uneven pigmentation and can soften surface irregularities. Some of the treatments under this category include Dermabrasion, Laser or Light Therapy, Chemical Peel Solutions, and Skin Bleaching Agents.
• Incision/Surgical Treatments: In some stubborn cases, with very deep scars, your cosmetic surgeon may recommend incision or surgical treatment. This will surgically remove the old scar. Some scars require a layered closure. This is used where the excision extends to tissue below the skin surface or in areas with a high degree of movement. Advanced techniques in scar revision includes complex flap closures, W-plasty, S-plasty, or Z-plasty techniques. Flap closure may reposition a scar so that it is less conspicuous. It may also improve flexibility where a contracture has restricted mobility. If ample healthy tissue is not present to close the scar, pharmaceutical tissue substitutes can be used. This is more likely with severe burn scars.

Tissue expansion can also be used as a substitute for skin grafts. In this procedure, a tissue expander, which is an inflatable balloon, is placed under the skin near the site of the scar. It is then slowly filled with a sterile solution to expand the area of healthy skin. Once the skin has been stretched sufficiently, the tissue expander and the scar are removed and the stretched skin replaces the scar tissue.

As there are several surgical techniques for scar revision, you should discuss all of these with your cosmetic surgeon, who will then recommend the best technique for you. You should also ensure that you are in the right frame of mind for scar revision surgery.

While you should be in the right frame of mind for scar revision surgery, you should also have realistic expectations about the surgery. You should also ensure that all your questions regarding the surgery are answered. Your cosmetic surgeon will recommend either a single scar revision procedure, or then a combination of different procedures. Also, your scar may not be removed in one surgery, but may require multiple sessions. You should be psychologically ready for all of this.

Scars may take time to heal post-surgery and your doctor will recommend how you can take care of the wound site. You may experience some bruising and swelling at first. However, sutures are removed after some time, and wound healing begins. The body brings in natural building blocks, such as collagen, to the area of the wound to allow the scar to be bridged and healed.