Scars can be distressing, whether the result of an injury or previous surgery. They may appear elevated, depressed, widened, or discolored. Scar revision is a surgical procedure that may reduce the appearance of a scar. Every scar and patient is unique. The best option for you will be discussed in consultation with a board-certified plastic surgeon.
"My patients are real women. Mothers and next-door neighbors, not models."
- DR. STEPHANIE POWER
What is Scar Revision?
Plastic surgery cannot eliminate scarring, but may be performed to reduce the final scar appearance. There are various techniques of scar revision that may achieve less prominent scarring. Before considering scar revision, it is important to wait until your scar is fully mature. It generally takes a full year for a scar to reach its final appearance. Immature scars may improve over time and respond to non-surgical treatments, including scar massage and silicone gel or sheeting. Steroid injections may be an option for more problematic scars to soften and flatten them over time. Sun protection is critical, particularly over the first year, to lower the risk of developing discoloration of the scar, whether hypo- or hyperpigmentation. These color changes may be permanent so it is recommended to wear at least SPF30 as your scar matures. If you are still concerned and self-conscious about a scar after it has fully matured, a board-certified plastic surgeon can discuss surgical options during consultation and help you understand what to expect from your surgical outcome.
Problematic scars that become more elevated and thicker over time are divided into hypertrophic vs. keloid scars. The difference between them is that a hypertrophic scar becomes elevated but stays contained within the boundaries of the original injury. A keloid scar becomes thicker and more elevated over time and extends beyond these boundaries. Treatment options are similar, including scar massage, pressure earring if it resulted from a piercing, topical silicone, and steroid injections. De-bulking is a surgical technique that may be performed in certain cases – removing most of the keloid while leaving a narrow cuff to minimize trauma to surrounding healthy tissue. A series of steroid injections is critical post-operatively to lower the risk of recurrence, generally performed every 6-8 weeks until the scar is stable. Conservative treatment is recommended for many keloids given the high risk of recurrence, which may be larger and more symptomatic than the current keloid. Dr. Power will discuss the best options for you regarding keloid improvement and create a customized treatment plan.
How is Scar Revision Performed?
Depending on the extent and technique of scar revision, it may be performed under local or general anesthetic. It is performed in either an office-based setting or operating room using meticulous techniques that may result in a less prominent scar than one created traumatically. A scar may be excised and closed in a layered fashion to reduce skin tension and lower the risk of recurrent scar widening. Depending on the orientation of a scar, it may be possible to reorient a scar through scar revision to follow natural crease lines. A tethered scar may also be released through a technique called subcision. You will receive detailed instructions regarding appropriate wound care, showering, and bandaging after surgery. If deeper stitches are required, they generally resorb over the first few months. If skin stitches are placed, they are removed at approximately one week post-operatively following facial surgery and at 10-14 days for other body sites.
Scar Revision Recovery
Dr. Power will provide detailed instructions to follow post-operatively to reduce further scarring and minimize scar appearance as healing progresses. You will generally be able to resume exercise within a week or two, potentially a little longer if more extensive surgery is performed. It is important to wash the incision with soap and water daily to lower risk of infection. Following suture removal, you will be given recommendations regarding scar management, including scar massage, sunscreen, and silicone gel or sheeting depending whether your scar is on your face or body, respectively.
Managing expectations is very important following scar revision. Dr. Power wishes for patients to understand that a scar will still be present, however may appear less prominent following plastic surgery techniques and appropriate aftercare as it matures. Your scar will reach its final appearance by one year post-operatively.
A main advantage of scar revision is that it converts a mature scar into an immature one, which is then responsive to ongoing non-surgical treatments as it matures. Sometimes old scars may not have been managed appropriately following traumatic injuries. It is not uncommon that patients present with discolored scars following sun exposure as they were not aware of the importance of UV protection during early healing.