Is Total Scar Removal Even Possible?
To understand scar revision surgery is to realize that it can only be used to improve the appearance of an existing scar, but not to fully eliminate it. Said differently, once you have a scar, you will always have a scar – at least with the state of medical science that exists right now. The only question is: which scar revision surgery can most completely remove and improve the overall appearance of the scar? The technique that best fits a particular scar depends, in large part, on what type of scar it is.
Timing Of Scar Revision
In the majority of cases, doctors recommend giving a scar about a year to mature before any surgical scar revision is considered. This is because scars naturally evolve over the first 12 months to the point that scar revisions no longer become necessary. Also, with the passage of time, the scar and surrounding skin become easier for the surgeon to work with making a successful procedure more likely. Many patients need to be convinced to follow this very good advice and are understandably anxious to proceed with unsightly scarring sooner. Remember that waiting may very well improve your results or even eliminate the need for scar revision altogether. In some cases, when it is obvious that a scar won’t improve with time, surgeons will agree to earlier scar revision surgery.
Techniques With Before And Afters
Thick Scars
A scar that is wide and/or thick and raised such as hypertrophic, keloid, and widespread scars, will often best be treated by a relatively straightforward scar revision surgery in which the scar is simply excised from the skin and the wound is then sutured closed with meticulous technique. This eliminates the problematic scar, pushing the “reset” button on the healing process. How this new incision heals and how the new scar develops will determine, to a great extent, how successful the procedure will be. Your doctor will generally recommend post-surgery preventative measures such as compression ear devices, silicone products, and cortisone injections.
Ear Keloids
Earlobe keloids are surgically removed, usually under local anesthetic. The keloid is removed and the area stitched together to reshape the natural ear contour. For large ear keloids, the upper skin of the keloid itself is used to resurface the area where the keloid was removed from. Your doctor will generally recommend post-surgery preventative measures such as compression ear devices, silicone products, and cortisone injections.
Scar Revision For Atrophic, Depressed, Pitted Scars
Scars that are atrophic (pitted scars such as seen with acne or chickenpox), can be treated by excision of the scar using a scalpel or punch tool. The wound is then stitched together turning it into a fine line. Smaller scars of this sort can also be treated by a process called subcision. Subcision uses a needle inserted under the skin to release the attachments on the underside of the pit that tethers it inwards. Collagen that forms under the pitted area acts to keep the pit “propped up” over time. Some atrophic scars can also be treated by using filler materials injected beneath the atrophic scar. The filler acts as a platform to prop up the affected area. Laser scar revisions and dermabrasion are also used for atrophic scars. Both work by blending the pitted scar into the surrounding normal skin.
Other Scar Revision Surgery Techniques
Scar revision surgery such as Z-plasty , W-plasty, and Scar Irregularization can be used to improve scars. These techniques can:
- re-orient the scar to more closely follow the direction of natural wrinkles and creases in the area, making it stand out a lot less.
- make a straight-line scar less noticeable by converting into a zig-zag shape which is harder for the human eye to perceive
- release tight scars that are tethering the skin or restricting motion at joints
These are some pictures that show the benefits of Z-plasty, W-plasty, and Scar Irregularization with before and after pictures.
DIFFERENT SCAR REVISION TECHNIQUES ARE USED FOR DIFFERENT SCAR TYPES
Surgical Scar Revision: Is It Worth It?
Whether scar revision surgery is worth it or not depends on how the revised scar compares to the original. Surgical scar revision is subject to most of the usual risks and complications associated with other surgeries. These include: infection, bleeding, slow healing, wound opening before fully healed, and unsatisfactory results in terms of scar improvement. Scar revision surgery is all about improving scars, so any complication that degrades scarring will substantially degrade the results. Focusing on post-operative instructions and best practices is therefore a key to the success of scar revision surgery.
Scar Revision Surgery: Who’s The Best Candidate?
Ironically individuals who developed a heavy scar due to a notable healing complication, such as infection or the wound opening, may actually be better candidates for scar revision surgery. A case can be made that if only the scar revision surgery heals without similar complications, it may well produce a much better scar than the original. On the other hand, if the original scar developed after normal healing, it may mean the person’s natural scarring tendencies are the main problem. In a case like this, scar revision surgery often produces a scar very similar in appearance to the original scar. Other factors that improve success rates for surgical scar revision include:
- good overall health, non-diabetic
- scars that are a year old or more
- very young and older patients tend to have better results
- scars over certain body areas like the face do better than others like the shoulder or upper back
- smaller scars often do better than larger, broader ones
- patients that have realistic expectations
SCARS THAT HEALED POORLY BECAUSE OF A COMPLICATION MAY BE MOST SUITABLE FOR SCAR REVISION
Why A Surgical Scar Revision Can Fail
Wound healing complications can like infection or stitches opening can severely degrade scar revision results. For individuals that are strongly prone to poor scars such as wide-spread scars or keloids, scar revision may fail. For example, a person that has dark skin tones and a strong family history for keloids would be at very high risk for reforming a new keloid after a scar revision procedure. Basically, the scar revision surgery heals with a poor scar too even when performed well by the surgeon. Knowing the extent to which you are prone to poor scarring is hugely important to understanding your chances for successful surgical scar revision. Determining any person’s natural scarring likelihoods, however, is a complex and convoluted task.
Scar Revision Surgery After-Care
Important points to keep in mind after scar revision surgery are:
- strictly adhere to your doctor’s after-care instructions because any healing complication can worsen scarring and lead to poor results
- put strenuous work and the exercise on the back-burner until you are fully healed to avoid complications
- stop or cut-down on cigarette smoking which increases the risk of healing complications
- make sure you have your after-care supplies in advance, including antibiotic ointments, high-quality sunscreen, and specialty products not usually available in most pharmacies such as:
| Type Of Scar Undergoing Revision | Example | Have These On Hand |
|---|---|---|
| hypertrophic or keloid |   | • silicone gel or silicone strips (read this if unsure which to buy) • compression ear devices for ear keloids |
| wide-spread |  | • support tapes such as Steri-Strips and |
Scar Revision Costs
Most insurance plans do not cover scar revisions being done for cosmetic purposes. Costs for scar revision vary widely based on many factors. In general, very minor scar revisions will cost somewhere around $400, whereas more complex procedures will have fees as high as $5000 or more. Factors that affect scar revision surgery prices include:
- body area (face more expensive than body)
- size of scar
- number of separate scars
- technique required
- supplies such as silicone gel, silicone stips, ear compression devices, skin tapes, etc.
- need for additional measures: cortisone injections etc.
- type of anesthesia (local less expensive than general or sedation
- surgeon factors: location, popularity, reputation