Scars are visible signs that remain after a wound has healed. They are unavoidable results of injury or surgery, and their development can be unpredictable. Poor healing may contribute to scars that are obvious, unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be raised or recessed, different in color or texture from surrounding healthy tissue or particularly noticeable due to their size, shape or location.
Your treatment options may vary based on the type and degree of scarring and can include:
- Simple topical treatments
- Minimally invasive procedures
- Surgical revision with advanced techniques in wound closure
Scar revision surgery is meant to minimize the scar so that it is more consistent with your surrounding skin tone and texture.
Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased.
The decision to have scar revision surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Dr. Lanfranchi will explain in detail the risks associated with surgery.
Some of the risks include:
- Bleeding (hematoma)
- Delayed healing
- Anesthesia risks
- Change in skin sensation
- Damage to deeper structures including nerves, blood vessels, muscles and lungs can occur and may be temporary or permanent
- Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
- Skin contour irregularities
- Skin discoloration and swelling
- Skin sensitivity
- Pain, which may persist
- Possibility of revisional surgery or staged procedures
The degree of improvement that can be achieved with scar revision will depend on the severity of your scarring, and the type, size and location of the scar. In some cases, a single technique may provide significant improvement. However, Dr. Lanfranchi may recommend a combination of scar revision techniques to achieve the best results.
Topical treatments, such as gels, tapes or external compression, can help in wound closure and healing, or to reduce the ability of skin to produce irregular pigment. These products may be used to treat existing surface scars and discoloration, and to aid in healing of scar revision procedures.
Injectable treatments are often used to fill depressed or concave scars. Depending on the injectable substance used and your particular scar conditions, results may last from three months to several years. Therapy must be repeated to maintain results. One form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size and texture of raised scar tissue. It is sometimes possible to use Fat tissue for a better result (lipostructure – lipofilling).
Surface treatments are most often used for cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of either mechanically removing the top layers of skin or changing the nature of tissue. These treatment options include:
- Dermabrasion is a mechanical polishing of the skin.
- Laser or light therapy causes changes to the surface of the skin that allow new, healthy skin to form at the scar site.
- Chemical peel solutions penetrate the skin’s surface to soften irregularities in texture and color.
Some scars require layered closure. Layered closure is often used where excision extends to tissue below the skin surface or in areas with a high degree of movement. The first step, or layer, requires sub-dermal closure (below the skin surface) with absorbable or non-removable sutures. Layers of closure continue to build, concluding with closure of the remaining surface wound.
Advanced techniques in scar revision include complex flap closure to reposition a scar so that it is less conspicuous, or improve flexibility where contracture has restricted mobility.
The final results of your scar revision surgery will be long-lasting, however it may take several months for your final results to become apparent and in some cases it may take a year for the new scar to fully heal and fade.