Scar Revision Overview
A scar is the sign that a wound once existed. Scars can be unsightly or almost completely invisible. Scar revision treatment is a procedure offered by our Sarasota plastic surgeons, that is designed to improve the appearance of an unsightly scar, or the function of the area of skin surrounding the scar. Although scars cannot be completely removed, our skilled cosmetic surgeons are able to improve the overall visibility by reducing the size, lightening the color, or making it appear flatter. Scar revision treatment is most often performed on scars that develop to keloid, hypertrophic or contracture scars. A full analysis will be given during the consultation and a treatment plan provided to minimize the scar's appearance.
Types of Scars
Scar revision surgery and the approach taken will depend on the type of scar that is being addressed. It helps to understand the various types of scars:
- Superficial scars settle only on the top skin layer. It is the least noticeable of all types of scars.
- Keloid scars form tissues that grow beyond the wound’s edge. They can be dark, painful and lumpy.
- Hypertrophic scars look like keloids, however, the tissue growth is limited within the wound area.
- Contracture scars cover a large section of skin. A good example is severe burns. The newly formed tissues tighten the skin around the wound and may cause issues with mobility.
Scar Revision Reviews
"Dr, Scott Engle removed some glass that had been embedded in my face for over 2 years from a car accident. He was such an amazing doctor and his nurse was awesome too. Just a few days after the stiches came out friends had to get very close to see where I had been sewn up. The office staff is great to work with and the girls at the front are so welcoming and friendly. "- C.J. / Google / Jun 17, 2013
"Dr. Derby's first priority was making me feel at ease. He listened to me, checked the wound that I needed fixed because it would not close and explained step by step his procedure. During surgery under local anesthetic he constantly told me what was going on, check to make sure there was no pain and even called me that evening and the next day to check on me. I've had two follow up visits and I'm extremely pleased. I look forward to seeing him in about a year for another procedure."- S.S. / Healthgrades / Aug 08, 2016
"Breast Augmentation - My surgeon was very good at listening to my desires, and answering my questions with straight forward answers. He understood my goals and didn't pressure me to make a decision on size based on what he thought would look best. He also performed a scar revision that had long bothered me, but I ignored due to an expensive quote from another surgeon. His price was very reasonable so I could not say no!"- Anonymous / RealPatientRatings / Oct 29, 2017
"I thought I was having the worse day of my life when a neighbor's dog bit off a huge chunk of my upper lip. Instead, it turned out to be a great day. Dr Derby saw me immediately and repaired the defect so beautifully that the scar is hardly noticeable 6 weeks later. Plus, he is an awesome person - super sweet, humble, easy to talk to . . . off the charts winner!"- J.S. / Healthgrades / Feb 27, 2018
Scar Revision Surgical Technique
There are various techniques to consider during a revision surgery. Scar revision treatment will be chosen based on the scar’s location, type, size and overall extent and may include one of the following approaches.
Shave excision is performed when the scar tissue is raised. A surgical shaver is used to slowly trim away the scar and flatten out the surface. Local anesthetics may be used. The ‘shaved’ area will be treated with topical medications. This technique is simple and in most cases, sutures are not needed to close any wound.
Another technique that improves a raised scar is by completely removing it or reopening then reclosing the wound. By removal, incision is made in an ellipsis pattern with a small border of good skin and closing the wound with sutures within or outside of the skin. By modification, the scar is reopened by means of incision, but this time along a different direction to minimize visibility, and then the wound is resutured back. This is the ideal approach for scars that developed due to poorly closed sutures.
Skin Grafting/Tissue Expansion
There are cases in which the removal of large scars requires repair by fillers. In such circumstance, a skin graft with skin harvested from another part of the body is a popular method to make sure that the skin blends well during the healing process. Sometimes, tissue expansion is applied instead of the skin graft. In this process, a tissue expander is placed within the reopened scar. This expander is filled with a sterile solution. Sutures will be used to join the tissue walls together and to close the wound.
In some cases, scars are depressed instead of raised. This type of scar is best treated with a derma filler that is injected into the scar site. A common material for this is known as a derma filler, and there are many variants that are available as alternatives. In many cases where scar treatment is concerned, these fillers are collagen based. Once injected, the filler will puff the scar area so that it evens out with the normal skin’s surface. This is done while the doctor reshapes the skin outside to make sure the surface flattens out.
Surface treatments such as laser treatments, chemical peels, dermabrasion and skin bleaching may be considered for mild scars. The aim of these applications is to discard the top skin gradually and consequently, flatten out the surface, and possibly change the color of the skin tone. Skin lightening techniques are also applied when the skin on the scar area is darker than the natural skin tone.
Scar Revision During/After Surgery
Scar treatment is usually performed using a local anesthesia. In cases where a large area is going to be treated, a general anesthesia may be needed. Post-surgery care is critical when it comes to scar treatments. Patients must adhere to the medications and proper wound care to promote better healing of the new wound resulting in a less visible scar. Although a scar will still exist on the site, patients note a significant improvement. It usually takes between 6 months and longer for optimal results.
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