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, poor healing, or previous surgery.
Scar tissue forms as skin heals after an injury (such as an accident) or surgery.
How much scarring there is depends on:
- Size, depth, and location of the wound
- Your age
- Skin characteristics, such as color (pigmentation)
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).
There are several ways to improve the appearance of scars:
- The scar may be removed completely and the new wound closed very carefully.
- Scar massage and pressure therapy, such as silicone strips.
- 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.
- A laser may be used to soften the surface of the scar, and stimulate new collagen growth within the scar.
- Very large injuries (such as burns) can cause loss of a large area of skin and may form hypertrophic scars. These types of scars can restrict movement of muscles, joints and tendons (contracture). Surgery removes extra scar tissue. It may involve a series of small cuts (incisions) on both sides of the scar site, which create V-shaped skin flaps (Z-plasty). The result is a thin, less noticeable scar, because a Z-plasty may re-orient the scar so that it more closely follows the natural skin folds and releases tightness in the scar, but lengthens the scar during the process.
- Skin grafting involves taking a thin layer of skin from another part of the body and placing it over the injured area. Skin flap surgery involves moving an entire, full thickness of skin, fat, nerves, blood vessels, and muscle from a healthy part of the body to the injured site. These techniques are used when a large amount of skin has been lost in the original injury, when a thin scar will not heal, and when the main concern is improved function rather than improved appearance.
- Tissue expansion is used for breast reconstruction. It is also used for skin that has been damaged due to birth defects and injuries. A silicone balloon is inserted beneath the skin and gradually filled with salt water. This stretches the skin, which grows over time.
Why the Procedure is Performed
Problems that may indicate a need for scar revision include:
- A keloid, which is an abnormal scar that is thicker and of a different color and texture than the rest of the skin. Keloids extend beyond the edge of the wound and are likely to come back. They often create a thick, puckered effect that looks like a tumor. Keloids are removed at the place where they meet normal tissue.
- A scar that is at an angle to the normal tension lines of the skin.
- A scar that is thickened.
- A scar that causes distortion of other features or causes problems with normal movement or function.