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Scar Revision

Most scars that appear red, raised, and unattractive at first become less noticeable with time. For this reason, many plastic surgeons recommend waiting at least 6 months to a year or more after an injury or surgery before deciding upon scar revision. Some can be treated with steroid injections to relieve symptoms such as tenderness and itching. Meanwhile, there are several non-surgical treatments that can lessen the appearance of the scar. Massaging firm scars and protection from the sun are beneficial for the healing of any scar. Scars that are prone to thickening and becoming hypertrophic or keloid scars may benefit from daily application of topical silicone for at least 3 months.

Keloid Scars are thickened, raised areas of scar tissue that grow beyond the edges of the wound or incision. They are often red or darker in color than the surrounding skin and may have symptoms of itching or tenderness. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed. Keloids are often treated by injecting steroid directly into the scar tissue to reduce symptoms and in some cases, it will also soften and/or shrink the scar.

If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. A skin graft is occasionally used, although the site from which the graft was taken may then develop a keloid. No matter what approach is taken, keloid scars have a stubborn tendency to recur, sometimes even larger than before. To discourage this, a combination of scar removal with steroid injection, direct application of steroids during surgery, application of topical silicone, or radiation therapy may be recommended. A pressure garment worn over the area for as long as a year may also be recommended. Despite this, the keloid may return, requiring repeated procedures.

Hypertrophic Scars are often confused with keloid scars, since both tend to be red, raised and thickened. Hypertrophic scars, however, remain within the boundaries of the original incision or wound. They often improve on their own or with the help of steroid applications or injections, or the use of topical silicone, although it may take up to a year.

If a conservative approach doesn’t appear to be effective, hypertrophic scars can often be improved surgically. Dr. Rasmussen will remove excess scar tissue and may reposition the incision so that it heals in a less visible pattern. This surgery may be performed under local or general anesthesia, depending on the scar’s size and location. You may receive steroid injection during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming. Endermologie® may also be of benefit, and Dr. Rasmussen sometimes recommends this post-operatively for certain surgical procedures that are prone to forming hypertrophic scars such as tummy tuck.

Burns or other injuries resulting in the loss of a large area of skin or underlying tissue may form a scar that pulls the edges of the skin together, a process called contraction. The resulting deformity, contracture, may affect the adjacent tissue, sometimes even muscles and tendons, restricting normal movement.

Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a local tissue flap. In some cases, a procedure known as Z-plasty may be used, and other techniques, such as tissue expansion, may be alternatives.

Facial Scarring, due to it’s location, is frequently considered a cosmetic problem. There are several ways to make a facial scar less noticeable. Often it can can simply be cut out and closed with tiny stitches, leaving a thinner, less noticeable scar. If the scar lies perpendicular across the natural skin creases, it may be repositioned so that it is parallel to these lines, making it less conspicuous. Some facial scars can be softened using a technique called dermabrasion, a controlled sandpapering of the top layers of the skin using a special device. Dermabrasion leaves a smoother surface to the skin, but it won’t completely erase the scar.

Depressed Scars are indented scars, the classic depressed scar being a pock mark from acne scarring.  Dermabrasion and skin resurfacing lasers can help to minimize their appearance, but those treatments usually are performed as a “facial unit” since pigmentation irregularities will occur that may make the scar appear more noticeable. An alternative may be the use of injectable fillers to “fill in” the depression.  Bellafill® is a long term filler that is FDA approved (2015) for the treatment of scars by injection.

Lasers may be beneficial in the treatment of some scars. Vascular lasers can help to reduce the persistent red or pink (vascular) appearance of scars. If a scar is hyperpigmented, application of topical bleaching agents, or treatment with a pigment laser may be of benefit. Multiple laser treatments are often needed to obtain optimal results. FRAXEL™ and CO2 lasers may be of benefit if resurfacing is warranted to “smooth out” irregular scars. Similar to dermabrasion, these skin resurfacing treatments blend the scar into the adjacent skin; however, they won’t completely erase the scar.

Click here to learn more about Wound Healing and Scars.