Scars occur when the skin recovers from an injury—due to an accident, a burn, after surgery or because of acne—that affects multiple layers of skin. Once a scar forms at the site of injury, it is more or less permanent. There is no way to remove or erase a scar completely, but scars can be made less prominent with the help of a number of scar treatment methods, including surgical relocation.
This article gives you the basic information you need before making a decision to undergo scar revision surgery on your face. It outlines the different types of scars, the degree to which they can be changed or removed, how scar revision surgery is performed and what you can realistically expect as outcomes. This article is not intended to be a comprehensive guide to scar revision surgery; neither should it be considered an alternative to a thorough and detailed discussion with your chosen facial plastic surgeon.
Successful outcomes in facial scar revision surgery, as with all surgery, are a result of teamwork and rapport between you and your facial plastic surgeon. Only your surgeon can answer questions about your specific scar revision needs.
Is Scar Revision Surgery for You?
It is essential that you have realistic expectations when considering any scar revision treatment. A scar, once it forms, is permanent, and all that can be done to make it less prominent is hide it within natural skin folds or move it surgically to a less visible position.
When surgeons undertake scar revision treatments, their goal is to improve scar appearance by minimising prominence, disguising or relocating scars to make them less visible. In determining the exact course of action needed, your surgeon will consider the type and age of the scar, your skin type and skin colour. These factors, as well as how your skin typically reacts to injury, are important factors to be discussed prior to proceeding with scar revision surgery.
The specific techniques your surgeon chooses depends on the type of scar you have. Different types of scars respond to different techniques.
Some surgeons do not recommend scar revision procedures for at least one year after the injury that resulted in a scar. This period allows the body sufficient time to fully heal from the injury or surgery that caused the scarring.
As with all elective surgery you must be in good health at the time of surgery.
Before You Have Scar Revision Surgery
Choosing a facial plastic surgeon you can trust is one of the most important decisions you can make. Your trust should be based on the verifiable qualifications and expertise of the surgeon, his or her reputation and past experience with this type of surgery. The rapport you develop with your surgeon during the initial consultation process is also very important, as is your commitment to follow your surgeon’s pre- and post-operative instructions.
At the initial consultation your surgeon will examine your scar to determine the best course of treatment. You will learn about the different types of scars and the treatments they require.
- Burn scars If a severe burn has destroyed a large section of skin, the new skin can pucker up as it heals, affecting muscles and tendons as part of this contracting movement.
- Keloids Keloid scars occur when the skin continues to produce collagen even after a wound has healed, giving an appearance of growth where the wound used to be.
- Hypertrophic scars Hypertrophic scars do not grow out of their boundaries like keloids do, but because of abnormal growth they present a thick, raised and unsightly appearance. These scars sometimes end up restricting the natural movement of muscles and tendons in the area.
Your surgeon will discuss all surgical options during this initial consultation, addressing the risks involved with each type of scar treatment. This discussion should be an open and honest exchange of ideas between you and your surgeon, and should help establish reasonable expectations for the outcomes of surgery.
It is important to remember that scarring and wound healing are unique to each individual. The final outcome of any procedure depends on how an individual’s body reacts to wounds and treatments. Even the very best surgeons will not guarantee the complete erasure of a scar. Your surgeon may tell you that more than one technique will be employed during treatment and/or that more than one surgical procedure will be needed to achieve the best results.
When you have made the decision to go ahead and agreed on the best course of treatment, your surgeon will explain the type of anaesthesia to be used and provide you details of the surgical facility where your procedure will take place.
You will be asked to provide a thorough medical history to bring to your surgeon’s notice any conditions that could increase your level of risk during surgery.
As part of the informed consent process, your facial plastic surgeon will also explain to you alternative procedures that could achieve a similar outcome and inform you of the costs involved for the proposed procedures.
Understanding the Surgery
Contracture-type scars generally require complete removal of scar tissue. Skin flaps made of healthy, unscarred skin from adjacent areas are lifted and moved to form a new incision line. Sometimes a skin graft is used when for some reason flaps are not possible. A skin graft involves removing skin tissue from another area of the body and attaching it to the area that needs to be covered. It takes time for new blood vessels and soft tissue to form and sustain the grafted skin.
Z-plasty is a method that moves a scar from one area to another, to minimise visibility without actually removing it. The scar will typically be hidden in a natural fold or crease in the skin.
For rough or elevated scars, your surgeon may recommend dermabrasion and laser resurfacing techniques. These methods involve using an abrasive material or a laser light to make the scar surface smooth and less prominent.
If you have keloid or hypertrophic scars, they may first be treated with steroid injections to reduce the scar size. If your scars do not satisfactorily respond to this treatment, they may be surgically removed. The resulting incisions are closed using fine stitches that typically result in less prominent scars.
How long scar treatment surgery takes depends on your scars and the specific techniques chosen by your surgeon. Types of anaesthesia that may be used will also depend on the technique chosen.
What to Expect After Scar Revision Surgery
It is natural to feel some discomfort after facial scar revision surgery. Swelling, bruising and redness are generally unavoidable.
Your surgeon will tell you what to do during the recovery period, and it is important to follow these instructions closely to get the best results from your treatment. Although any sutures used will be removed a few days after surgery, your skin will require some time to heal. Scar tissue often requires a year or more to heal completely.
You will be told to limit activity for a time after surgery, especially anything that could place undue stress on or around the incision. Your surgeon will tell you what types of activities to avoid. Keeping your head elevated when sleeping or lying down helps minimise swelling. You can use cold compresses to control swelling as well. Avoid taking any medications without first checking with your surgeon.
Facial plastic surgery can diminish the appearance of facial scars resulting from injury, facial surgery or skin conditions such as acne.
Insurance does not generally reimburse costs of elective cosmetic surgery. However, if scar revision surgery is undertaken as part of treatment for an injury or to correct a deformity, you may be able to get full or partial reimbursement of the costs. Just to be sure, always check with your insurance plan on the specifics of coverage.
You can find accredited facial plastic surgeons who perform scar revision surgery among members of the Australasian Academy of Facial Plastic Surgery.