Scar Revision - Types, Procedures, and Complications

What Is Scar Revision?

Scar revision reduces scars, makes them less noticeable, and fits in with the surrounding skin tone and texture. After a wound has healed, visual traces like scars are left behind. They might develop in an unforeseen manner and are the inevitable result of surgery or damage. Clear, ugly, or disfiguring scars may result from poor healing. Even a wound with a good prognosis can leave behind a scar that detracts from your appearance. Due to their size, shape, or placement, scars may be evident. They can also be elevated or depressed, and their color or texture may differ from the healthy tissue around them.

What Are the Different Types of Scars?

A scar is a tissue growth in the skin caused due to healing after injury. There are different types of scars. These include:

Discoloration or Surface Irregularities: These are small scars caused due to injury or prior surgeries. These scars are discolored from surrounding skin and can be treated cosmetically by plastic surgeons. They do not cause any discomfort or physical restriction for the patient. Acne scars belong to this category.

Hypertrophic Scars: These types of scars are usually elevated from the skin surface and become wider over some time. These are developed directly from the wound site. They can be either hypopigmented (lighter in color from the surrounding skin) or hyperpigmented (darker in color from the surrounding skin).

Keloids: These are called hypertrophic scars. They are usually seen on the face, neck, hands, ears, chest, or shoulders. They are typically raised above the skin and margins of the wound and are usually painful.

Contractures: These are usually seen in burns. They typically pull the skin and underlying tissues and restrict their movements. Skin is generally non-elastic and wrinkled in appearance compared to normal skin. These scars are also seen in wounds involving joints such as the fingers, toes, neck, and elbow and hinder their function.

Who Is a Potential Candidate for Scar Revision?

Individuals of any age can get scar revision done along with those who have the following criteria:

• Prominent scars on visible parts of the body.

• Non-smokers.

• Healthy individuals without any systemic illness.

• Scars that interfere with functional activities.

• Individuals with realistic and positive approaches towards the outcome.

What Are the Preoperative Preparations for Scar Revision?

• Before performing the surgery, a plastic surgeon will evaluate the patient.

• Patients' overall health and medical history are checked thoroughly to rule out systemic illness and drug allergies.

• Patients are advised to stop certain medications such as blood thinners like Aspirin, Clopidogrel, and anti-inflammatory drugs before the surgery to prevent excess bleeding.

• Habits such as smoking should be avoided one week before and after surgery until complete healing is achieved.

• Patients should discuss the issues which need to be addressed, and the doctor will evaluate and suggest the treatment.

• Surgeons may take pre-operative photographs to examine the scars and improve the areas which require treatment.

• Also, pre-operative photographs help to evaluate the difference in the appearance of the scars after the surgery.

• Surgeons will discuss different scar revision procedures and the outcome of the results.

• Surgeons also will discuss potential risks and complications of the surgery.

How Is Scar Revision Done?

• The surgeon will evaluate the scar and suggest the best treatment to achieve the results.

• Depending on scar size, color, and depth, the procedure is done under local or general anesthesia.

• It is essential to have a person to accompany the patient during the procedure; if it is done under general anesthesia, the patient may need to stay overnight in the hospital.

What Are Different Types of Scar Revision Procedures?

Depending on the kind and severity of scarring, there are a variety of treatment choices, including:

• Simple topical treatments.

• Minimally invasive procedure.

• Surgical treatment.

Simple Topical Treatments

These include:

• Steroid Creams: Hypertrophic and keloid scars can benefit from steroids' flattening and calming effects. To dissolve the skin's collagen, steroids are given topically or injected directly into the scar. This works particularly well on hypertrophic or Keloid scars since they produce collagen after the lesion has healed. The discomfort and/or itching brought on by these scars may also be lessened with these injections.

• Gel Silicone Sheets: Silicone gel sheets can flatten keloid and hypertrophic scars. These transparent sheets are applied on the spot. These reduce the size of scars and are worn round-the-clock. It is safe and effective.

Minimally Invasive Procedure

These include:

• Dermabrasion: The required skin is carefully "sanded" off using a rotating wire brush or diamond wheel. The anesthetic will be given to the affected area before the procedure. By eliminating the top layers of skin, dermabrasion smoothes out surface imperfections like deep lines or scars.

• Laser Vascular: A vascular laser improves the appearance of red scars by constricting the blood vessels that supply the scar. This can be performed without an anesthetic agent.

• Collagen Injections: An organic animal protein called collagen is injected into the sunken scars to raise and make them less noticeable. To ensure individuals are not allergic to collagen, they should get tested before utilizing the chemical. Collagen injections produce an instant but transient benefit. As the body gradually absorbs the collagen, the scars will eventually need to be filled again.

• Resurfacing with Lasers: The carbon dioxide (CO2) laser and the Erbium: YAG laser are the two types of lasers used to smooth out the uneven surface of scars. Erbium is used for shallow scars and darker skin tones, whereas the carbon dioxide (CO2) laser is often used for deeper scars. Both lasers eliminate the outermost layers of skin, allowing fresh, smooth skin formation.

Surgical Procedure

These include:

• Techniques for Tissue-Rearrangement Using Z-Plasty: Z-plasty is a method for reorienting scars. The scar is orientated by creating tiny triangular flaps of skin surrounding the scar. Typically, these flaps have a Z-shape. However, the method doctor will depend on how the scar is shaped. The flaps are moved to follow the skin's natural creases and contours. Usually, the new scar is less apparent. Z-plasty, frequently used in reconstructive burn surgery, can also aid in relieving the strain on contracture scars.

• Grafted skin: Skin from a healthy body portion is removed and transplanted to the wounded area during this surgery. Because the grafted skin may not have the same color or texture as the surrounding skin, grafts are not always aesthetically attractive. The grafted area will likewise scar, although skin grafts can significantly improve the function of a badly damaged area.

• Tissue Expansion: This surgery involves inserting a "balloon" under a healthy skin area close to a scar. To expand the skin, the balloon is filled with a saline solution. After the scar is surgically removed, the site is meticulously stitched together using the balloon-extended skin. Surgery for burns and breast reconstruction frequently uses this method.

What Are the Complications of Scar Revision?

• Wound infection for which antibiotic treatment may be necessary discomfort near the incision sites.

• Hematoma (a collection of blood around the surgical area that may require drainage).

• Skin discoloration.

• Numbness around operated sites is typically temporary and will disappear over several months.

• Skin lesions that do not heal.

• Loose skin.

• Persistent pain.

• Excess fluid accumulation under the skin (seroma) around an operated site.

• Fat necrosis (death of fat cells below the skin).

What to Expect From Recovery of Scar Revision?

• The first week of a surgical scar revision recovery may be regional swelling, discoloration, or discomfort.

• For several weeks, the new scar will heal and gradually improve and diminish as it does so.

• In addition to general sensitivity, patients will encounter conditions comparable to those described above at the treated region with dermabrasion, chemical peels, or laser resurfacing.

Conclusion

Scar revision surgery will have long-lasting effects, but it can take some time before one sees them. In some situations, it might even take a year for the new scar to recover and fade entirely. The best method for scar revision should be decided in consultation with a qualified and experienced medical expert, taking into account the kind, location, and personal goals of the patient. Although scar revision cannot entirely remove scars, it may greatly improve their look, boosting one's self-esteem and overall quality of life.