While scars cannot be eliminated, they can often be improved in appearance, either by making them appear finer, or re-orienting them in a direction that hides them more effectively. Hypertrophic scars are usually very thick, red, and raised scars that can develop in any area over the body. It is more often seen after wounds that take a long time to heal and close, in burns, and in surgical scars that were closed under significant tension. The quality of the scar revision is highly dependent on all of the individual factors relative to the scar, such as the location, the orientation, proximity to a joint, skin quality, and availability of surrounding excess skin. In general, Dr. Charles Hsu, a plastic surgeon in Koreatown and Beverly Hills, recommends that patients wait for one year after the scar initially heals before going forth with a scar revision procedure. Typically the body is still remodeling during this first year, and sometimes the body can remodel the scar more effectively than what can be done with surgery.
Best Candidates for Scar Revision
While no scar can be removed completely, Dr. Hsu can improve the appearance of a scar on almost any part of the body for various reasons, including:
Patients with scars from previous surgery or trauma
Patients who are reminded of unpleasant memories associated with a highly visible scar
Patients with keloids or hypertrophic scars with abnormal growth
Dr. Hsu will want to know about the circumstances or details surrounding how the scar was obtained, whether from prior surgery, from an accidental laceration, or otherwise. He will also ask about the patient’s medical history and then examine the scar and surrounding skin to assess whether there is a good chance for successful revision. Dr. Hsu will then explain the next steps in going forth with the procedure for suitable candidates and create their individual treatment plan.
Scar revision is a straightforward hour-long procedure that can be done under local anesthetic. After numbing the area, Dr. Hsu will excise the scar, free up the skin on each side, and sew the sides together to obtain an aesthetically improved appearance. Dr. Hsu uses a special technique to close the skin that involves multiple layers of stitches to relieve skin tension on the wound. Freeing up the skin on both sides and using the multiple layer technique prevents the new incision from being pulled apart as it heals, helping it to heal in a thin line and not to be widened over time.
Recovery and Post-Op
After the surgery, Dr. Hsu will wrap dressings around the surgical area, which will remain there for the first week. Because scar revision is a minor procedure, most patients can return to work right away. The biggest limitation for post-operative patients is driving as Dr. Hsu prefers that patients do not drive while they are on pain medication. Patients are usually off their pain medication after 1-2 days depending on the size of the scar, and can then plan their work schedule accordingly. Follow up appointments are scheduled immediately after surgery and for up to a year afterward.
From Dr. Hsu
“I’ve seen a variety of scars, from either trauma, prior surgery, piercings, and many other causes, and they can exist anywhere in the body. Although scar revision is a conceptually simple procedure, there needs to be some careful thought to determine why the scar did not heal well the first time, in order to individualize the revision procedure to maximize the outcome. Not all scars are the same!
Overall, I utilize techniques to try to camouflage the scar (either by moving it into a natural skin crease, if possible, or by breaking it up) as well as techniques to help the scar heal in a thinner fashion. Scar revision is really a case of trading the old, widened and thickened scar for a new scar that is thinner and flatter. My approach is to use some of the techniques used in reconstructive surgery to minimize tension across the incision and to help it to heal in an optimal way. Even for what appears to be a simple scar revision, I’ve found that these small details matter, and the outcomes can be better when careful thought is placed into exactly how the revision is performed.”
Frequently Asked Questions
How long does it take to recover from scar revision?
Because different parts of the body heal differently, recovery times and expectations vary depending on the procedure performed and the location on the body. Surgery to repair a scar on the leg may take as long as two weeks to heal, while a procedure on the face may take only about a week. Dr. Hsu will talk to each patient about what to expect after the surgery, as well as how to care for the wound. Carefully following these instructions will help speed recovery and give you the best chance for excellent long-term results.
What are the different scar revision techniques?
There are several types of scar revision procedures including the following:
Scar excision: If there is sufficient adjacent skin, the scar is excised or removed and the skin is closed.
Z- or W-plasty: The original scar is repositioned along the natural lines and creases in the skin.
Skin grafting: The scar is surgically removed, and skin from another part of the body is used to cover that area. This method is effective for large scars and burns.
Skin flap: Similar to a skin graft, skin and the tissue below the skin are moved from another part of the body to cover the site.
How to avoid complications?
While scar revision is normally safe, there is always the possibility of complications, as with any surgery. These may include infection, bleeding, and a reaction to the anesthesia or the recurrence of an unsightly scar. Patients can help prevent complications by carefully following all pre- and post-operative instructions.