While it is impossible for a scar to be completely removed through surgery, it is possible to dramatically improve its appearance so that it is hidden or barely perceptible. Sometimes, scars respond to topical gels, steroid injections, laser treatments, or dermabrasion. In other cases, our facial plastic surgeons may suggest surgical scar revision. They will carefully take into account the size and shape of a scar, as well as your skin tone, prior to making a customized treatment plan.
What is Scar Revision?
Scar revision is designed to diminish the appearance of scarring and skin trauma as much as possible for an improved aesthetic. When the body’s natural healing process attempts to repair damaged skin, the fibrous tissue that develops to mend the area structurally differs from healthy skin, resulting in scar formation. While some scars can be subtle, distinct or highly conspicuous scarring can be a great source of insecurity for some individuals. Many scars are characterized by an uneven tone or texture, abnormal pigmentation, skin depression or elevation, and/or impaired function of the sweat glands or hair follicles. For men and women seeking to minimize the visibility of unsightly scars, a number of surgical techniques can be utilized to blend the damaged areas with healthy skin for less prominent scarring.
Depending on the size, type, depth, and extent of scarring you wish to address, scar revision can generally achieve the following:
- Improve or reduce the appearance of obvious scarring
- Enhance the look of skin changes or disfigurement
- Reduce irritation, itching, pain, or inflammation
- Treat hypertrophic scars, keloid scars, or contracture scars
Because scar development can be unpredictable after the skin is inflicted with an injury or wound, some scarring can be treated with non- and minimally-invasive treatments while others may require surgery to effectively address. Dr. J. David Kriet and Dr. Clinton D. Humphrey can assess your concerns and treatment goals to formulate the most optimal course of action.
Surgical Scar Revision
When surgical revision is recommended, several approaches are often combined. These techniques may include scar excision, W-plasty, or Z-plasty. W-plasty and Z-plasty are methods of tissue rearrangement that are utilized to break up and camouflage a scar. This concealment is accomplished by repositioning the scar so that it follows the natural creases and marks of the skin, thereby making the defect less noticeable. Both W-plasty and Z-plasty may also be used to relieve pressure caused by contracture—a restrictive tightening of the skin’s edges commonly experienced during the healing process in burn wounds. Contracture typically limits mobility in the affected area and the tissue flaps created by Z-plasty have been shown to effectively increase flexibility where movement may be strained. Other ways to reduce discernible scarring may include tissue expansion or skin grafting.
What Types of Scars Can Be Treated?
The nature of your scar revision treatment will depend on the type of scar you seek to address. In general, the most commonly treated scars include:
- Surface Irregularities: Skin damage caused by acne, incisions, or minor injuries is often marked by discoloration or an irregular texture. In many cases, this type of superficial scarring can be corrected with cosmetic procedures, such as laser skin resurfacing, dermabrasion, chemical peels, topical treatments, and dermal filler injections, among others.
- Hypertrophic: Usually characterized by thick, wide, and raised tissue formation, hypertrophic scars generally occur within the borders of a wound or incision. They often develop from piercings, burns, cuts, or acne and can cause itchiness and discomfort.
- Keloid: Keloid scars typically appear as a rounded, solid mass and often form on the ears, shoulders, chest, or other areas with limited fat. Keloids often grow beyond the boundaries of the original wound and frequently cause pain and itchiness.
- Contracture: Contracture scars commonly develop from burns or areas of large skin loss. They are indicated by a scar that “pulls” the edges of the skin together, causing a tightening sensation that may restrict proper movement of the area.
Hypertrophic and keloid scars tend to arise more commonly in patients with darker skin types, but are seen in all skin complexions. These scars can be difficult to treat, but are frequently improved with a combination of medical and surgical therapy. Steroid injections are often used to soften the scars prior to any surgical intervention.
We offer a variety of treatment options to improve the appearance of a range of scar types. Please contact our practice for more information on scar revision.