Scar Revision
Overview
Scar Revision
What Are Scars?
Scars develop as a result of the body’s natural repair mechanisms to the disruption of the skin surface. Any damage to the skin that goes beyond the superficial surface called the epithelium will usually result in a permanent scar. Superficial epithelial damage, such as a simple graze that does not involve the underlying layer called the dermis, will usually heal with no scars. However, if there is significant trauma to the dermis, then the scarring will be permanent. The appearance of a healed scar depends upon the mechanism of injury. Sometimes scars develop from natural inflammatory processes such as acne. Another example is pregnancy and the expansion of abdominal skin leading to stretch marks (striae). The most common cause of scarring is external trauma. The type of injury (sharp, blunt, chemical, thermal), its location upon the body and the way that it is treated or managed will determine how a scar eventually matures. Sharp lacerations, if treated properly should end up as a thin scar. However the direction of a scar will also affect the eventual appearance. If a cut is orientated against the natural direction of the skin creases, it can often end up wider than a scar in more favourable position. Scars in areas such as the midline of the chest, the earlobes and the shoulder have a greater tendency to become thick or form keloids. Abnormally thick scars are called hypertrophic. Keloids are unsightly scars that have expanded beyond the area of the original scar. Keloids occur more frequently in darker skin.
Scar Revision
What is a Scar Revision?
Scar revision is any technique that improves the appearance of a scar or relieves the discomfort or any functional problems caused by a scar.
Scar Revision Techniques
Non-surgical techniques
Most surgical techniques will not be carried out until scars have become mature and pale. This takes about twelve months. During the maturation phase, when scars are red and hard, proper management such as massage, the use of emollients, topical silicone gels, tape dressings and garments (for large or broad areas of scarring) can reduce the chance of thick scar formation. However, if a scar is showing signs of becoming hypertrophic or developing into a keloid, steroid injections can be used to flatten the scar. Injections work best if carried out within 6 months after the original skin repair. Beyond 6 months the efficacy of steroid injections diminish. Too much steroid can make the scar weak and stretch and potentially make things worse. The use of camouflage makeup is also used to cover up permanent scars in exposed areas. There is some evidence that laser treatment such as fractionated laser therapy and CO2 laser resurfacing can affect scar maturation and diminish the redness and thickness of some scars. However, no non-surgical or surgical treatment can eradicate scars.
Scar Revision Techniques
Surgery
An indication for surgery is to reduce the tightness or tension caused by a scar. This is particularly relevant for scar contractures that stop joints from moving properly or distort structures such as eyelids. Specialised surgical techniques, such as skin grafting and a method called Z-plasty can be used for such problems. Z-plasty alters the direction and tension of scars by converting a straight tight scar into a zig zag. The Z-plasty relieves constrictions by redistributing the tension forces. Skin grafts are usually used for extensive scars and consist of skin taken from another area of the body. Grafts are used to resurface raw areas that cannot be closed after a scar has been removed. Lipofilling or injection of fat grafts that have been harvested from the tummy, can occasionally be used to diminish tethering or surface contour defects caused by scarring. Sometimes surgery is used to excise areas of unsightly or discoloured scarring, as well as localised thick or dented scars. The most extreme form of this kind of surgical scar revision is probably a tummy tuck (abdominoplasty). This involves removal of excess lower abdominal skin and associated striae. Every case has to be carefully judged. The location, size and the aims of the patient are factors that will be taken into consideration. It does take experience to determine whether an operation, a non-surgical technique or doing nothing at all is the most appropriate management for a problematic scar. An incorrect strategy can make things worse.
What to expect
What to expect with Scar Revision
Scar revisions at The Westbourne Centre are carried out under local anaesthetic as a day case. Sometimes sedation is used for more extensive cases. The recovery after sedation is rapid but for either method you will need a family member or a friend to take you to and from the centre. If you have had sedation, you will require someone to be with you overnight. After one week the new scar will be checked by an experienced wound care nurse at The Westbourne Centre. If non-absorbable sutures have been used to close the wound, these will usually be taken out at this first review. You will be advised on how to look after the scar so that it matures satisfactorily and remains flat and thin. If there are any problems, you will see the consultant at this early stage. Normally the consultant will see you after 6 weeks and anytime thereafter if there are any concerns, or just for reassurance. It will take about one year before the outcome of the scar revision can be definitively assessed. A scar revision is never an instant solution. The correct assessment, treatment, after care and patience are key elements to a successful outcome.
FAQ's
Your most common questions answered
Have a question about our procedures? Call us to find out more +44 (0) 121 456 8149 or check out the following frequently asked questions from customers.
Can I see before and after pictures of patients considering the same procedure?
Most certainly! During consultation I am happy to share before and after photos with you of people who have had the same procedure(s) you are considering. By doing this during the consultation, and in person, I have the opportunity to relate the example specifically to your situation, highlighting outcomes and helping with expectations.
Are you board certified?
Yes, I have been certified with the General Medical Council since July 1982 (GMC no: 2573614) and received my FRCS (Plast) in September 1995. I also hold a Master of Arts from Cambridge (MA) and medical doctorate for research into microsurgery and free radicals (MD).
How is the risk of infection during surgery minimised?
Infection is prevented by the appropriate surgical technique. This means very strict sterility of instruments and the technique has to be meticulous. The environment and correct theatre air flow conditions are very important and there are very strict safeguard controls concerning this. We also reduce infection rates by making sure that the patient is fit and healthy and is MRSA negative pre operatively.
How much does a private consultation cost?
A 1 hour initial consultation with me costs £160, which includes a free 15 minute follow up appointment.