Scar Revision

What is scar revision surgery?

Scar revision is performed to improve the condition or appearance of a scar anywhere on your body. After an injury or surgery, often a scar will remain as a visible sign of a wound that has healed. While scars are a natural part of healing, their development can be unpredictable. Scar revision surgery is meant to minimize the scar so that it is more consistent with your surrounding skin tone and texture. 

Whenever you’re considering a scar revision surgery, it’s important to remember that although scar revision can provide a more pleasing aesthetic result or improve a scar that has healed poorly, a scar cannot be completely erased.

Are there different types of scars?

Yes. Different types of scars can appear on your body in different ways, and each type of scar requires individualized treatment. The most common types of scars Dr. McKenna treats include:

• Discoloration and surface irregularity scars, which do not impair function or cause physical discomfort. They may include acne scars as well as scars resulting from minor injury and prior surgical incisions.
• Hypertrophic scars, which are thick clusters of scar tissue that develop directly at a wound site. They are often raised, red and or uncomfortable, and they may become wider over time. They can be hyperpigmented (darker in color) or hypopigmented (lighter in color).
• Keloids, which are larger hypertrophic scars. They can be painful or itchy and may also pucker. Keloids extend beyond the edges of an original wound or incision. They can occur anywhere on your body, but commonly develop where there is little underlying fatty tissue, such as on the breastbone or shoulders.
• Contractures, which restrict movement due to skin and underlying tissue that pull together during healing. They occur when there is a large amount of tissue loss, such as after a burn. Contractures may also form where a wound crosses a joint, restricting movement of the fingers, elbows, knees, or neck.

What are my options for scar revision surgery?

Dr. McKenna offers a variety of options for removing a lesion or scar.

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 the 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, and therapy must be repeated to maintain results. 

Surface treatments are most often used for cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Specific surface treatment options include:

• Dermabrasion, a mechanical polishing of the skin.
• Laser resurfacing, which changes the surface of the skin to allow new, healthy skin to form at the scar site.
• Chemical peel solutions, which penetrate the skin's surface to soften irregularities in texture and color.
• Excision of lesion, which surgically removes a scar. 

Advanced techniques in scar revision include complex flap closure to reposition a scar so that it is less conspicuous or to improve flexibility where contracture has restricted mobility. Some of these more advanced techniques include:

• Z-plasty is a flap technique that involves a "Z" pattern incision with multiple angles. This creates angled flaps on either side of the original scar site that can completely reposition or change scar direction, interrupt scar tension, or improve scar flexibility.
• Skin grafts are used if there is not enough healthy tissue present to close your scar removal wound. This is more likely with revision of severe burn scars. The graft may consist of healthy skin from other areas of your body, such as the abdomen or thigh.
• Tissue expansion can be a substitute for skin grafts. In this procedure an inflatable balloon, called a tissue expander, is placed under the skin near the scar site. The balloon is slowly filled with a sterile solution to expand the area of healthy skin. Once the skin has grown sufficiently, the expander is removed and new skin replaces the adjacent scarred tissue.

During any type of scar removal procedure, you will be sedated and/or anaesthetized while in surgery to keep you comfortable. Dr. McKenna will discuss your treatment plan with you in detail and recommend the best option for your needs.