Scar Revision :

What are the different types of scars?

• Keloid Scars - Keloids are thick, itchy, unsightly clusters of scar tissue that grow beyond the borders of actual wound. Keloids are formed due to excessive production of collagen by the body after the scar has healed. These scars sometimes appear red compared to the surrounding skin. Keloids are more common in dark skinned people and are more likely to develop in the earlobe, along the border of the jaw, the shoulder and the skin over the breast bone.
• Hypertrophic Scars - Hypertrophic scars look like keloid scars except the fact that they tend to remain within the boundaries of the wound or incision.
• Contractures - Contractures occur when a scar pulls on the edges of the skin making a tight area. These contractures can produce functional limitation and can affect the muscles, joints, and tendons. Contractures are usually common after burns and are also referred to as Burn Deformity. When a large area of skin is lost due to a burn, the surrounding intact skin pulls together to make up for the lost area of skin, thus forming a deformity that can limit your movement or function of that part of the body.
  

Who is an ideal candidate for Scar Revision?

If you have any type of scar (as described above) on any part of the body that bothers you or impairs function or limits movement of any of your joints, then you are an ideal candidate for Scar Revision.

What does surgical Scar Revision involve?

Depending on the type of scar, different surgical procedures are employed for Scar Revision. These surgical procedures for Scar Revision will be performed under local or general anesthesia. Depending on the extent of the scar, Scar Revision may take any where from 1 - 5 hours. It would certainly be worthwhile to find an experienced and reputable plastic surgeon as Scar Revision techniques requires immaculate skills and expertise of the plastic surgeon. Some of the Scar Revision procedures that are used popularly include:

• Surgical removal of Keloid Tissue - Surgery directly removes the keloid tissue and a skin graft may be used to cover the area. Skin Grafting is performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the surgery area.
• Laser Surgery - Different lasers are used to smooth, flatten or remove abnormal discoloration of the overlying skin of the scar.
• Skin Grafting - The procedure of skin grafting involves replacing the damaged area of the skin by healthy area taken from other part of the body.
• Skin Flap Surgery - Flap surgery is a procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site.
  Z - Plasty - is a Scar Revision procedure in which a Z-shaped incision is used. Z - Plasty is used to decrease the skin 'pull' in case of a contracture. This technique can also be used to try and blend the scar in the natural creases and folds of the surrounding skin.
• Tissue Expansion - The technique of tissue expansion is used in conjunction with Skin Flap Surgery. In this technique the amount of existing tissue is increased for re-constructive purposes.
  

How to prepare pre-operatively for surgical Scar Revision?

Prior hospitalization is not necessary for Scar Revision procedure. However, make sure that you inform your plastic surgeon about your health conditions and all the prescription and non-prescription medications that you are taking (including vitamin, mineral and herbal products). Stop smoking at least 2 weeks before the surgery and do not smoke for at least 2 weeks after the Scar Revision surgery.

What is the recovery period like after surgical Scar Revision?

Be sure to make arrangements for someone to drive you home as you will be sent home the same day after Scar Revision. You will heal gradually and be able to resume your daily activities within a week or so. The final results of your Scar Revision surgery will take a very long time to become completely apparent. The stitches will be removed within 3 - 5 days after Scar Revision surgery.

What is the outcome of surgical Scar Revision?

The goal of surgical Scar Revision is to make your scar less noticeable. There is 90% chance that the scar will look better after Scar Revision, seldom there might not be any change and in 1% of cases your scar may actually look worse after Scar Revision.

Benefits of Scar Revision

Scar Revision is performed not only for esthetic reasons, it is also performed for reconstructive and functional reasons. Keloids and contractures are not just unattractive and ugly to look at, they can be extremely limiting if they are are on your hand, around your mouth or on a joint surface. Scar Revision does not just make them less obvious, it can also improve the function of the affected part.

Risks of Scar Revision

• Bleeding
• Infection
• Allergic reaction to anesthesia
• Numbness
• Recurrence of scar
• Risks of not having a Scar Revision
• There is no guarantee that surgery will improve the functional limitation that is most often seen from contractures. However, when performed by an experienced surgeon, Scar Revision can definitely change that and make your movements more comfortable.

Alternatives to Scar Revision

• Steroid Injections - Steroid injections can reduce itching, redness and burning sensation in the scar tissue and may even reduce the size of the scar.
• Cryotherapy - The scar tissue is frozen off by medications
  Localized pressure - Pressure is applied to the scar with a pressure bandage to reduce the size of the scar. This method is not too effective.
• Dermabrasion

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