If you have a scar that makes you feel uncomfortable or self-conscious, consider scar revision. Some facial scars, if serious enough, can impair normal muscle function. Consult with a qualified plastic surgeon to find out what reconstructive surgery options may be available to you.
With time, most scars become less obvious on their own. If your scar is due to an injury that happened less than a year ago, we recommend that you wait until a full year passes before undergoing scar revision. Also, it's important to note that no scar can be removed completely, but a qualified plastic surgeon may be able to make the scar less noticeable.
Most scar revision procedures are performed on an outpatient basis using a local anesthesia. Skin grafts and flap surgery, however, are more complex and require general anesthesia and a hospital stay.
Keloids and Hypertrophic Scars
Scars such as keloids and hypertrophic scars sometimes respond to steroid treatment or silicone gel therapy. If that fails, a plastic surgeon can attempt to remove the scar tissue surgically. Because these scars can be stubborn, your plastic surgeon may treat them with steroid injections during surgery.
When a large area of skin is injured, particularly due to burns, the skin tends to pull together or pucker. This type of scar tissue is called contractures. Not only is the scar unsightly, but also muscle and tendon movement may be restricted because of contractures. Treating contractures typically involves removing the scar tissue and replacing it with healthy skin flaps or skin grafts. Particularly when muscle function of a scarred area is affected, skin grafting and flap surgery usually can offer the best results. In some cases, tissue expansion or a procedure called Z-plasty may be used.
Dermabrasion or Laser Resurfacing
Dermabrasion or laser resurfacing may be used to improve facial scars. Both techniques serve to remove the superficial layer of the skin and flatten or plane down a raised scar. Laser resurfacing of a scar appears to work best when the scar is treated early or even at the time of wound closure. Both dermabrasion and laser resurfacing cause redness that resolves over time, sometimes taking months to fade.
Z-plasty is a surgical technique most commonly used to change the direction of a scar and, therefore, make the scar less visible. Scars that lie in the lines of facial expression tend to be less visible than scars that cross these lines of facial expression. The Z-plasty is used to put these scars in the lines of facial expression. While this will not make the scar disappear, it often makes the scar less visible and minor in nature.
Skin Grafting and Flap Surgery
Skin grafting is used to correct scar contractures or to close large areas of skin deficit such as burn scars. The skin graft is performed more for functional purposes (that is, to release the scar contracture), than it is to improve appearance. Split-thickness skin grafts are used to cover very large areas. In such cases, these grafts are usually taken from the thigh. For extensive burns, however, skin grafts may be needed for many areas. Full-thickness skin grafts are used to cover smaller areas where color match is important such as the nose, eyelid or other areas of the face.
Flap surgery is used to bring in healthy tissue to an area of skin loss. A flap will undergo less contraction than a skin graft. It also provides better soft tissue cover and match for the reconstructed area. However, the surgery does leave scars in the flap donor site.
Tissue expansion employs saline-filled implants to stretch areas of skin so that it can later be used as a flap. A temporary expandable implant, or balloon, is placed under the skin. The balloon is gradually expanded using saline, or salt water. (Expansion could take up to several months depending upon the size of the area to be corrected.) Once the skin over the expander has been stretched enough, the expander is removed, and the flap procedure can be performed.
Tissue expansion offers several advantages. The match of skin is nearly perfect; the success rate is high because the skin retains its own blood and nerve supply; and scarring is reduced. The downside is that while the skin is undergoing expansion, the patient has a temporary swelling at the repair site.
What is the risk?
All surgeries carry a certain degree of risk. Although rare, risks associated with scar revision include infection and bleeding. It is also possible that the improvement in the scar is less than one may have hoped for. Improvement cannot be guaranteed.
What about recovery?
After outpatient scar revision procedures, most patients return to work within a week. Complex procedures, such as skin grafting and flap surgery, require a longer recovery time.
Don't be alarmed if your scar looks worse following surgery. It may take up to a year for its appearance to improve.
Will insurance cover scar revision?
Although insurance ordinarily doesn't cover cosmetic procedures, it may partially cover scar revision if the procedure is performed to minimize scarring from an injury or to improve your ability to function. Check with your insurance carrier to be sure.
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