Candidates for scar revision surgery
Before Scar revision surgery
Types of scars and treatment
After Scar revision surgery
What is scar?
A scar is the body's natural way of healing and replacing lost or damaged skin. A scar is usually composed of fibrous tissue. Scars may be formed for many different reasons, including as a result of infections, surgery, injuries, or inflammation of tissue. Scars may appear anywhere on the body, and the composition of a scar may vary--appearing flat, lumpy, sunken, or colored. The scar may be painful or itchy. The final look of a scar depends on many factors, including the skin type and location on the body, the direction of the wound, the type of injury, age of the person with the scar, and his or her nutritional status.
What is scar revision?
Scar revision is surgery to improve or reduce the appearance of scars. It also restores function, and corrects skin changes (disfigurement) caused by an injury, wound, poor healing, or previous surgery.
Scar revision is plastic surgery performed to improve the condition or appearance of a scar anywhere on your body. The different types of scars include:
Discoloration or surface irregularities and other more subtle scars can be cosmetically improved by surgery or other treatments recommended by your plastic surgeon. These types of 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.
Scar tissue forms as skin heals after an injury (such as an accident) or surgery.
How much scarring there is depends on:
Depending on the extent of the surgery, scar revision can be done while you are awake (local anesthesia), sleeping (sedated), or deep asleep and pain-free (general anesthesia).
When to have scar revision done is not always clear. Scars shrink and become less noticeable as they age. You may be able to wait to have surgery until the scar lightens in color. This can be several months or even a year after the wound has healed. For some scars, it is best to have revision surgery 60 to 90 days after the scar matures. Each scar is different.
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There are several ways to improve the appearance of scars:
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Candidates for scar revision surgery
Only you and a qualified cosmetic surgeon can determine your individual candidacy for scar revision procedures. Candidates should be healthy and have scarring that is either unsightly, physically uncomfortable, or causes psychological discomfort and self-consciousness. Scar revision is such a custom procedure that it can be difficult to predict the results of each treatment. Patients will need to be realistic and strive for improvement over perfection. Scar revision is not an instantaneous solution, and candidates should be prepared to be patient and give the treatment time to work, which can be a lengthy process. However, good candidates can see significant improvement in scarring, which can have an immensely positive impact on overall quality of life.
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Before scar revision surgery
The various factors which should be considered before doing scar revision are:
It is important to explain to the patient that scar revision will improve and not erase the scar and it may require multiple surgical procedures along with adjunct treatment in order to obtain an optimal result over a period of many months or years.
Due to continuous collagen remodelling it takes around 12-18 months for the scar to mature and gain tensile strength of 70-80% of uninjured skin. Immature scars are prone to hypertrophy and give poor results after scar revision. Adjunct treatments like use of silicone sheet and intralesional steroid injections can be given during this period. However, if early intervention is needed it is wiser to do it only after 8-12 weeks in adults and 6 months in children smaller than 7 years of age.
A well-balanced diet is essential for good protein synthesis. Vitamin A, C, E and zinc help in wound healing. Herbal supplements and medicines which increase bleeding should be stopped 3 days to 2 weeks before scar revision. Medical conditions like diabetes mellitus and immunosuppression negatively effects wound healing.
Tobacco use causes hypoxia, thrombogenesis, vasoconstriction, aberrant cell function and delays wound healing. It is preferable to abstain the patients from smoking from 4 weeks before to 4 weeks after scar revision.
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Types of scars and treatment
There are many different types of scars, including the following:
These are thick, rounded, irregular clusters of scar tissue that grow at the site of a wound on the skin, but beyond the edges of the borders of the wound. They often appear red or darker in color, as compared to the surrounding normal skin. Keloids are formed from skin cells and connective tissue (fibroblasts) that begin multiplying to repair the damage. These scars may appear anywhere on the body, but more commonly on the face, neck, ears, chest, or shoulders. They occur more often in darker-skinned people. Keloid scars may occur up to one year after the original trauma to the skin.
Treatment for keloid scars varies. There is no one simple cure for keloid scar removal. Recurrence after treatment is common. Treatment may include the following:
Radiation treatment is often used in conjunction with surgery to decrease the risk of recurrence of a keloid scar.
Hypertrophic scars are similar to keloid scars; however, their growth is confined within the boundaries of the original skin defect. These scars may also appear red, and are usually thick and elevated. Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally, although this process may take up to a year or more.
In treating hypertrophic scars, steroids may be the first line of therapy with this type of scar, although there is not one simple cure. Steroids may be given as an injection or by direct application. These scars may also be removed surgically. Often, steroid injections are used along with the surgery and may continue up to 2 years after the surgery to help maximize healing and decrease the chance of the scar returning.
Contractures are an abnormal occurrence that happens when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together, causing a tight area of skin. This can also occur as scars heal. The decrease in the size of the skin can then affect the muscles, joints, and tendons, causing a decrease in movement. There are many different surgical treatment options for contractures. Some of which may include the following:
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After scar revision surgery
The initial healing phase of a surgical scar revision may include localized swelling, discoloration or discomfort and may take 1 to 2 weeks. Healing will continue for several weeks and as the new scar heals it will slowly refine and fade. With dermabrasion, chemical peel or laser resurfacing, you will experience similar conditions at the treated area, in addition to overall sensitivity.
The final results of your scar revision surgery will be long-lasting, however it may take several months for your final results to become apparent and in some cases it may take a year for the new scar to fully heal and fade.
The practice of medicine and surgery is not an exact science. Although good results are expected, there are no guarantees; and in some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
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Scar revision risks
There are risks with any surgical or laser treatment, though these can be minimized by choosing the right surgeon. Potential risks of surgical revision include:
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