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, or previous surgery.
Scar tissue forms as skin heals after an injury (such as an accident) or surgery. The amount of scarring may be determined by the wound size, depth, and location; the person's age; heredity; and skin characteristics, including color (pigmentation). Not all the factors that affect a scar are completely understood.
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).
Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can reduce the symptoms of itching and tenderness. A treatment called silicone gel sheeting or ointment has been shown to benefit swollen, hypertrophic scars and may help flatten them or make them less painful. There is no evidence showing that any other topical (applied directly to the scar) treatment works. In fact, Vitamin E applied directly to the skin may actually cause the wound to heal more slowly and may cause irritation.
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 for surgical revision until the scar lightens in color, which can be several months or even a year after the wound has healed. For some scars, however, it is best to have revision surgery 60 to 90 days after the scar matures. Each scar is different.
There are several ways to improve the appearance of scars:
Dermabrasion involves removing the upper layers of the skin with a special wire brush called a burr or fraise. New skin grows over this area. Dermabrasion can be used to soften the surface of the skin or reduce irregularities.
Problems that may indicate a need for scar revision include:
Risks of anesthesia are:
Risks of scar revision surgery are:
Exposing the scar to too much sun may cause it to darken, which could interfere with future revision.
For keloid revision, a pressure or elastic dressing may be placed over the area after the operation to prevent the keloid from coming back.
For other types of scar revision, a light dressing is applied. Stitches are usually removed after 3 to 4 days for the facial area, and after 5 to 7 days for incisions on other parts of the body.
When you return to normal activities and work depends on the type, degree, and location of the surgery. Most people can resume normal activities soon after surgery. Your doctor will likely tell you to avoid activities that stretch and may widen the new scar.
If you have long-term stiffening of the joint, you may need physical therapy after surgery.
Avoid exposure to the sun for several months after treatment. Use sunblock or an adhesive bandage to keep the sun from permanently tanning the healing scar.
Whenever there is a cut through the skin, a scar results. No scar can be removed completely. How much the scar improves depends on the direction and size of the scar, the person's age, skin type and color, and hereditary factors that may affect the healing process.
Keloid revision; Hypertrophic scar revision; Scar repair; Z-plasty
Updated by: David A. Lickstein, MD, FACS, specializing in cosmetic and reconstructive plastic surgery, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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