Scar Revision: Improving the Appearance of Scars

 

Scar Revision

Scars, and scar healing, are unpredictable. The way a scar develops depends on many factors including how your body heals, the type of the original injury, and on the surgeon's skills who initially treated the wound.

Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar.  Whether the appearance of a scar bothers you is a highly personal matter.

While no scar can be removed completely, Dr. Aharonov is a skilled Facial Plastic Surgeon who can often improve the appearance of a scar, making it less obvious.  He is an expert in both scar revision surgery, and less invasive non-surgical treatments to diminish the appearance of scars.

If you're considering scar revision, this will give you a basic understanding of the most common types of scars, the procedures used to treat them, and the results you can  expect.  Since the nature of each scar is so varied, Dr. Aharonov will develop an individualized treatment plan for you during your consultation in his Beverly Hills office.

When Should Your Scar Be Treated?

Many scars that appear large and unattractive at first may become less noticeable with time.  Some can be treated with steroid injections to relieve symptoms such as tenderness and itching. For these reasons, it is recommended to wait as long as a year after an injury or surgery before you decide to have scar revision.

If you're bothered by a scar, your first step is to contact our Beverly Hills office.  Dr. Aharonov will examine you and discuss the possible methods of treating your scar, the risks and benefits involved and the possible outcomes. Be frank in discussing your expectations with him, and make sure you're realistic. Don't hesitate to ask any questions or express any concerns you may have.

Scar Revision Treatments or Surgery

Depending on the scar, Dr. Aharonov will usually suggest less invasive treatments to minimize the appearance of your scar. These minimally invasive treatments include dermabrasion, pressure treatments, steroid or botox injections. If after your examination, he determines that your scar will require scar revision surgery, he will discuss this in depth with you. For the majority of scars, scar revision can be preformed in our Beverly Hills office with local anesthetic. However, depending on their location and size, some scars will require scar revision surgery. Scar  revision surgery is a quick outpatient procedure performed in our  AAAHC accredited Beverly Hills surgery center.  Many patients combine scar revision with another cosmetic procedure they wish to have. While scar revision is normally safe, there is always the possibility of complications. These may include infection, bleeding, a reaction to the anesthesia, or the recurrence of an unsightly scar. Board certified anesthesiologists, which are medical doctors, perform all of his cases. Dr. Aharonov prefers to have a physician caring for your anesthetic needs during your scar revision, as their experience minimizes the potential of unpleasant  postoperative side effects. For his surgical cases, Dr. Aharonov uses an extremely safe combination of iv sedation and local anesthetic, not general anesthesia. This technique provides superior operating conditions combined with maximal patient safety and comfort.

You can reduce your risks and optimize your results by following all of Dr. Aharonov's advice, both before and after surgery.

Facial Scars

There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar.

If the scar lies across the natural skin creases Dr. Aharonov may be able to make it appear less conspicuous by repositioning it to run parallel to these lines. This is known as a Z-plasty.

Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar.

Keloid Scars

Keloids are thick, puckered, itchy clusters 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. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.

Keloids can appear anywhere on the body, but they're most common over the breastbone, on the earlobes, and on the shoulders. They occur more often in dark skinned people than in those who are fair. The tendency to develop keloid scars lessens with age.

Keloid scars are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar.

If steroid treatment is inadequate, the scar tissue can be removed and the wound closed with one or more layers of stitches. This is generally an outpatient procedure, performed under local anesthesia. You should be back at work in a day, and the stitches will be removed in a few days. A skin graft is rarely used.

No matter what approach is taken, keloid scars have a stubborn tendency to recur, sometimes even larger than before. To discourage this, Dr. Aharonov will combine scar removal with steroid injections, direct application of steroids during surgery and pressure therapy over the scar.  Even so, a keloid scar may return, requiring a repeat procedures in a few years.

Enlarged Scars or Hypertrophic Scars

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

If a conservative approach doesn't appear to be effective, hypertrophic scars can often be improved surgically. The plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anesthesia, depending on the scar's location and what you and your surgeon decide. You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.

Contractures

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

Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases a procedure known as Z-plasty may be used. New techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.

Z-Plasty

Z-plasty is a surgical technique Dr. Aharonov uses to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by scar contracture. However, not all scars can be repaired with a Z-plasty.  During your consultation with Dr. Aharonov in his Beverly Hills office, he will examine your scar, and determine if this will help diminish the appearance of your scar. While Z-plasty can make some scars less obvious, it won't make them disappear completely.  A portion of the scar will still remain outside the lines of relaxation.

In the Z-plasty procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a "Z"pattern. The wound is closed with fine stitches, which are removed a few days later. Z-plasty is usually performed as an outpatient procedure under local anesthesia in our Beverly Hills surgery center.

After Scar Revision

After your scar revision treatment, it's very important to follow your Dr. Aharonov's instructions after surgery to make sure the wound heals properly. Although you may be up and about very quickly, he will advise you on gradually resuming your normal activities.

As you heal, remember that no scar can be removed completely; the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. It is quite normal for your scar to look worse initially. It's important to remember that the final results of your surgery may not be apparent awhile. All of our Los Angeles California patients have been extremely happy with their scar revisions.