Scarring differs for every patient. Patients may sustain traumatic injuries from childhood that can impair their self-esteem for years. Unfortunately, scars generally cannot be totally removed. Dr Smith performs scar revision surgery as a cosmetic procedure that helps minimize the appearance size and of an unsightly scar. He may also treat the scar with lasers to improve discoloration and surface irregularities. It’s important to have realistic expectations. This procedure can reduce the appearance of a scar, and allow patients to show their skin with more confidence.

TYPES OF SCARS

KELOID SCARS

Keloid scars are those that extend beyond their border of the initial injury. Patients of certain ethnicities may be more susceptible to develop these scars. Keloids typically require a series of steroid injections prior to laser treatments.

HYPERTROPHIC SCARS

Hypertrophic scars are thickened and raised scars. These scars are more common, and are caused by hyper inflammation of the scar tissue.

SURGICAL TECHNIQUE

Scar revision treatment will be chosen based on the scar’s location, type, size and overall extent. There are various techniques to consider.

SHAVE EXCISION

For scars that are raised, a shave excision may be performed to remove the top of the scar and even-out the surface with the rest of the skin. This creates a smoother, flatter appearance. During the procedure, a surgical shaver is used to slowly shave off the raised portion of the scar. Sutures are not needed in most shave excision cases.

SCAR REMOVAL/MODIFICATION

This is also a technique used for raised scars. It can be accomplished a couple of different ways. First, is the elliptical removal pattern. This involves removing the scar as well as an edging (ellipse) of skin encompassing the scar so a clean enclosure can be made. The sutures may be placed on the inside or outside of the skin. Sometimes a scar exists because the incision was closed poorly. By reopening the scar and resuturing the skin in a different direction, the new scar can be minimized.

SKIN GRAFTING/TISSUE EXPANSION

Large scars may require a skin graft (skin taken from another area on the body) to close the wound once the scar has been removed. Carefully placed sutures will be used around the graft to close and blend the skin together for healing. If a skin graft will not be used, tissue expansion may be used instead. During this process, a tissue expander will be placed under the skin where the scar resides and filled with a sterile solution. After the expansion process, the surgeon will stretch and join the edges together and place sutures carefully into the tissue wall.

INJECTABLE TREATMENTS

Scars that are depressed or concave may benefit from a filler material known as injectable derma filler. There are a wide variety of fillers on the cosmetic surgery market that may be considered. Collagen is a common filler used for scar revision. During the procedure, the injectable material will be injected into the skin through a syringe. The surgeon may manipulate the outside of the skin to help shape the surface accordingly.

SURFACE TREATMENTS

Some scars can be treated with a series of skin rejuvenation treatments, which can soften the surface of the skin, smooth out uneven scarring, reduce uneven pigmentation and lighten the skin where needed. Some scars may even become non-existent because of the skin removal mechanism. Skin surface treatments include laser skin resurfacing, chemical peels, dermabrasion and skin bleaching.

DURING/AFTER SURGERY

All scar revision procedures are performed on an outpatient basis using local anesthesia with mild sedation if desired.  Following this procedure, patients will need to adhere to a daily treatment regime so the wound site can heal. It is important to protect this area of skin from sun exposure to avoid any further skin discoloration. While this treatment does not make the scar disappear, the visible imperfections are minimized. Most patients feel more confident exposing the section of skin where the unsightly scar once resided. 

EXPECTED COST

The cost for scar revision treatment varies depending on what type of procedure was performed. Unfortunately, this can range from several hundred dollars for a skin resurfacing treatment, to several thousand for a surgical procedure.