CONSULTANT PLASTIC SURGEON
SCAR REVISION
What is scar revision?
Scar revision surgery will attempt to minimize a scar so that it is less conspicuous and blends in with the surrounding skin tone and texture. Scars are visible signs that remain after a wound has healed. They are the unavoidable results of injury or surgery, and their development can be unpredictable. Poor healing may contribute to scars that are obvious, unsightly, or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be noticeable due to their size, shape, or location; they can also be raised or depressed and may differ in colour or texture from the surrounding healthy tissue.
​
Your treatment options may vary based on the type and degree of scarring and can include simple topical treatments, minimally invasive procedures, and surgical revision with advanced techniques in wound closure. Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased.
"Surgeons who have the necessary training, expertise, and experience in reconstructive surgery are fit to perform cosmetic surgeries with excellent outcomes. Those surgeons only trained in aesthetic procedures will have much more difficulty doing the same. The more tools and training in plastic surgery the surgeons have, the more qualified they are! "
What is a scar?
Scar revision is plastic surgery performed to improve the condition or appearance of a scar anywhere on your body. The type of scar you have will determine the appropriate techniques Dr Ricardo will use to improve your scar. The different types of scars include:
​
Discolouration or surface irregularities and other more subtle scars can be cosmetically improved by surgery or other treatments recommended by Dr Ricardo. 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.
​
Hypertrophic scars are thick clusters of scar tissue that develop directly at a wound site. They are often raised, red and/or uncomfortable and may become wider over time. They can be hyperpigmented (darker in colour) or hypopigmented (lighter in colour).
​
Keloids are larger than hypertrophic scars. They can be painful or itchy, and may also pucker. They extend beyond the edges of an original wound or incision. Keloids can occur anywhere on your body, but they develop more commonly where there is little underlying fatty tissue, such as on the face, neck, ears, chest or shoulders.
​
Contractures are scars that restrict movement due to skin and underlying tissue that pull together during healing. They can occur when there is a large amount of tissue loss, such as after a burn. Contractures also can form where a wound crosses a joint, restricting movement of the fingers, elbows, knees or neck.
Who is a good candidate for scar revision?
Scar revision can be performed on people of any age and is a good option for you if you are bothered by a scar anywhere on your body, you are physically healthy, you do not smoke or have stopped smoking recently, have a positive outlook and realistic goals for your scar revision surgery and if you do not have active acne or other skin diseases in the area to be treated.
What should I expect during a consultation for scar revision?
During your initial consultation, you will have the opportunity to discuss your goals. Dr Ricardo will evaluate you as a candidate for scar revision surgery and clarify what approach is best for you. Alternative and additional treatments may be considered, once he understands your goals and medical condition. It is important to be completely honest during the consultation and be prepared to discuss why you want the surgery, your expectations and desired outcome, medical conditions, drug allergies, and medical treatments, use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs, and previous surgeries.
​
Dr Ricardo will also evaluate your general health status and any pre-existing health conditions or risk factors, examine your scar in detail, take photographs for your medical record, discuss the approach to your surgery, including the type of procedure or combination of procedures and tell you whether your expectations are in line with typical results, discuss any risks or potential complications and share before-and-after photos of cases similar to yours.
​
The success and safety of your scar revision surgery depend very much on your complete candidness during your consultation. It's very important to understand all aspects of your procedure. It's natural to feel some anxiety, whether it's excitement about your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with Dr Ricardo.
How should I prepare for scar revision surgery?
Before scar revision surgery, you may be asked to get lab testing or a medical evaluation, take certain medications or adjust your current medications, stop smoking well in advance of surgery and avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding.
​
Your surgery will be performed in an accredited hospital and is usually performed on an outpatient basis unless you and Dr Ricardo have made other plans for your immediate postoperative recovery. You must arrange for a friend or family member to drive you to and from surgery and to stay with you the first night following surgery.
​
Dr Ricardo and the entire staff will provide thorough preoperative instructions and answer any questions you may have. The goal is to make your surgical experience as easy, comfortable, and safe as possible.
What are the steps of a scar revision procedure?
Step 1 – Anaesthesia
​
Medications are administered for your comfort during surgical procedures. The choices include local anaesthesia, intravenous sedation and general anaesthesia. Dr Ricardo will recommend the best choice for you.
​
Step 2 – The treatment
​
The degree of improvement that can be achieved with scar revision will depend on the severity of your scarring, and the type, size and location of the scar. In some cases, a single technique may provide significant improvement. However, Dr Ricardo may recommend a combination of scar revision techniques to achieve the best results.
​
Topical treatments, such as gels, tapes or external compression, can help in wound closure and healing, or reduce the ability of the skin to produce irregular pigment. These products may be used to treat existing surface scars and discolouration, and to aid in the healing of scar revision procedures.
​
Injectable treatments may also be used. Dermal filler can be used to fill depressed or concave scars. Depending on the injectable substance used and your particular scar conditions, results may last from three months to several years. Therapy must be repeated to maintain results. Another form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size and texture of raised scar tissue.
​
Surface treatments are most often used for the cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of either mechanically removing the top layers of skin or changing the nature of tissue. These treatment options include dermabrasion, laser or light therapy, chemical peel solutions and skin bleaching agents.
​
Step 3 – Sometimes for deeper scars an incision is needed to surgically remove the old scar
​
Step 4 – Closing the incisions
​
Some scars require layered closure. This procedure is often used where excision extends to tissue below the skin surface or in areas with a high degree of movement. The first step, or layer, requires sub-dermal closure (below the skin surface) with absorbable or non-removable sutures. Layers of closure continue to build, concluding with the closure of the remaining surface wound.
​
Advanced techniques in scar revision include complex flap closures and W-plasty or Z-plasty techniques. Flap closures may reposition a scar so that it is less conspicuous or improve flexibility where contracture has restricted mobility. Pharmaceutical tissue substitutes may be used if ample healthy tissue is not present for the closure of a scar excision. This is more likely with the revision of severe burn scars.
​
Tissue expansion can 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. Over time, the balloon is slowly filled with a sterile solution to expand the area of healthy skin. Once the skin has been stretched sufficiently, the expander and the scar are removed and the stretched skin is moved to replace the scar tissue. This process can involve multiple surgical stages or procedures to achieve the final results.
What should I expect during my scar revision recovery?
The initial healing phase of a surgical scar revision may include localized swelling, discolouration, 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 in 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.