Are You a Candidate?

The best candidates for scar revision surgery understand these benefits and limitations and are willing to follow the surgeon's instructions before and after the procedure. Some doctors believe the best time for scar revision surgery is a few months after a scar develops, when it is fairly new. Others prefer to wait a year or more until the scar is completely healed and has thinned and lightened.

Your plastic surgeon will recommend the scar revision technique that will best improve your appearance. A series of treatments may be needed, and some scars, especially keloids, can recur, as mentioned above. Although the proper treatment can make your scar less obvious and greatly improve its appearance, no scar can be completely removed .

Scar Revision Therapies

Steroids

	The laser eliminated the scar by resurfacing the top layer of skin.

The initial treatment for keloid and hypertrophic scars is usually cortical steroid injections.When injected into scar tissue, these steroids can reduce itching, burning, and redness and may break down collagen, shrinking the scar as well.Topical steroids may be applied during surgery and for up to two years afterward.

Also, applications of silicone sheeting, which are rubber-like bandages containing silicone, may lighten and flatten scars over a period of several weeks; they may also prevent keloids from developing. How does the silicone work? It is believed that static electricity from the silicone helps align collagen fibers in the scar. It is also possible that the silicone traps moisture, which can help scars fade.

Laser Treatments

To smooth rough or raised scars, your surgeon may use a series of laser treatments over a six- to eight-week period. High-intensity laser light can flatten scars and change their color to blend be tt er with surrounding skin.There is usually some bruising immediately after the treatment. A mild degree of pigment change occurs in approximately 20 percent of cases, but is usually temporary.

Cryotherapy

Cryotherapy involves the scar being frozen off by a medication. Liquid nitrogen is applied or sprayed onto the scar, causing the scar to blister. With repeated treatments, the scar usually flattens.This technique carries the risk of depigmentation around the scar area.

Pressure Therapy

Pressure therapy involves a type of pressure appliance worn over the area of the scar. These may be worn day and night for up to four to six months.

Scar Revision Surgery

Treatment for scars may also involve surgery to remove the scar tissue and replace it with healthy skin.This skin may be in the form of a skin graft, which is taken from another area of the body. When transplanted, these thin layers of healthy skin interact with the surrounding tissues to form a new blood supply.

A second option is for the skin to come from a flap, which is adjacent skin and underlying tissue that is lifted and moved. Skin flaps bring their blood supply to the new site, since not only healthy skin but also its underlying fat, nerves, blood vessels, and muscle are moved from the donor site to the scarred site. Skin flaps and gra f t s are often performed in an ambulatory surgery center or in a hospital under general anesthesia. However, it is not uncommon for smaller flaps and grafts to be performed in a surgeon's office suite.

The surgeon may combine surgical removal with steroid applications, and patients may have to wear a pressure dressing for many months after the scar removal procedure.

W-plasty and Z-plasty

Your surgeon can camouflage a straight scar by removing the scar and making new incisions that are harder to see.The surgeon may make a zigzag incision, which is referred to as W-plasty or zigzag plasty. Or your surgeon may make a new incision using a Z shape, known as Z-plasty. These approaches change the direction of the scar, interrupt the scar line, and lengthen the scar. As a result, the irregular lines are harder for the eye to follow and are less obvious than straight lines.

After Your Scar Revision Surgery

As you recover, your scar may look worse before it looks better. It can take a year or longer for the benefits to be fully apparent. Your doctor might have you wear a compression bandage; the length of time you may need to wear it depends on the type of scar. You should stay out of the sun and away from tanning beds for up to a year.

Side Effects, Risks, and Complications

Short-term bruising, redness, swelling, and slight bleeding from the incision are common after scar revision surgery. Scars are unpredictable, and there's a small chance your scar won't be improved by surgery or that some scarring, especially keloids, may recur.

Questions to Ask the Surgeon ?

• What type of scar do I have?
  
• Which scar revision procedure can make my scar less obvious?
  
• Is the scar likely to come back after surgery?
  
• What can I do to promote healing and a good outcome?
  
• How long will the results of my surgery last?

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