Introduction
Acne scars and wrinkles have always been a challenge for treatment. Surgery for acne is usually indicated either for acne scars or post-inflammatory hyperpigmentation. Pitted facial scars, although commonly caused by acne, also result from a variety of conditions such as chicken pox, herpes zoster, and more. They are deep with well-defined margins, which cast a shadow, thus making them cosmetically more conspicuous. These deep pitted scars are either crateriform or ice pick-shaped with a depressed fibrotic base and with firm, indurate, rolling, or sloping edges.
What Is Meant by a Scar?
A scar is a body’s way of healing and replacing damaged skin. A scar may be caused due to various reasons like infection, surgery, inflammation, or injury. Scar consists of fibrous tissue, which can be formed anywhere in the body and may appear flat, lumpy, sunken, or colored. The scar can be painful or itchy, the appearance of the scar depends on,
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Skin type.
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Location.
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The direction and type of the injury.
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Nutrition status.
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Age of the injured person.
What Is the Type of Acne Scars?
Acne scars are of three types:
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Ice Pick Scars: Ice pick scars are very small scars that are very common on the cheek region. Ice pick scars are narrow, less than two millimeters deep, and sharply marginated with vertical extents to the deeper layers of skin.
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Rolling Scars: This scar makes the skin surface look very wavy and uneven. These scars have varying depths and sloping edges. Rolling scars occur when scars are adherent to the dermis with relatively normal-looking skin. They are wider than four to five millimeters. The abnormal adherence of scars to the dermis leads to superficial shadowing and rolling or undulating appearance of the overlying skin. In this type of scar, subcision is essential for successful treatment.
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Boxcar Scars: These scars are depressions with sharp edges. These are caused due to chickenpox, bigger acnes, or varicella (it is a virus that causes red, itchy blisters). These scars occur over the lower cheek or jaw, usually on the surface with thicker skin. They may be shallow or deep and are commonly up to 0.5 mm (millimeters) or more than 0.5 mm in diameter, and most often 1.5 mm to 4 mm in diameter. These types of scars respond well to punch excision or punch elevation treatment.
What Is Scar Revision?
Scar revision is a procedure that is performed to alter the appearance of the scar formed. This procedure helps to improve the cosmetic appearance of the scar and also helps to restore function if it is interrupted by the formation of the scar. It also helps to improve an itchy scar, no procedure can completely eliminate the appearance of a scar.
How Does a Person Prepare for Scar Revision Surgery?
Before starting with any scar procedure, the scar should be examined by the doctor, and various characteristics are considered, such as:
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Color of the scar.
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Contour.
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Thickness.
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Vascularity.
The position and the region where the scar is formed are also considered and any tissue stiffness is taken into consideration. Then the doctor will discuss the opinion, risks, and benefits with the person. Some pre-op instructions should be followed which can help with the procedure such as smoking and drinking alcohol.
What Are the Various Techniques to Treat Acne Scars?
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Subcision - A technique of uplifting the scars by cutting the underlying fibrous band with the help of hypodermic needles.
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Punch Excision and Closure - A kind of circular blade is attached to a pencil-like handle. In this method, the scar tissue will get cut and sutured back.
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Punch Incision and Elevation- In this method, the scar tissue will just get incised with a punch and uplifted to the level of surrounding skin by elevation techniques. This procedure is useful for deep boxcar scars.
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Punch Excision and Graft Replacement - In this type, pitted scars of up to four millimeters in diameter are first excised with the help of a punch and immediately replaced with a skin graft taken from other parts of the body.
What Are the Factors That Decide Which Technique Has to Be Followed?
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Number of Scars: If plenty of closely placed scars are present, subcision should be preferred. If scars are less in number, then other techniques can be done subsequent to subcision for a better result.
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Orientation Along RSTL: Scar lying along or parallel to RSTL (relaxed skin tension line) should be punched excised and closed primarily for best results.
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Scar Surface: When a few scars are present, not along the RSTL, then two alternatives are available. Punch incision and elevation are performed for scars with normal surface texture and punch excision with graft replacement for those with atrophic surface and irregular skin texture.
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Size of Scar: The excision with grafting should be avoided for scars more than four millimeters to prevent poor esthetic results. In these types of scars, elliptical excision and suturing can be done.
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Shape of Scar: Linear scars are best excised and closed primarily. Circular scars probably require punch float.
What Are the Complications Caused Due to Scar Revision Procedure?
The complications of scar revision surgery are
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Infection.
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Wound dehiscence.
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Graft rejection.
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Allergic reaction to dressing.
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Scarring.
What Are the Risk Factors and Precautions of Scar Revision Surgery?
One of the biggest and most common risk factors is the person may not be satisfied with the result produced post-scar revision procedure. Each scar procedure varies, the procedure followed on one scar cannot be followed on other scars.
Other Possible Risk Factors of the Scar Revision Procedure Are:
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The reaction to anesthesia used during the procedure.
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Bleeding, discoloration, or swelling at the surgical site.
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Thrombosis of the deep vein.
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Surgical site numbness.
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Infections.
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Pain.
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Incisions that do not heal properly.
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Need for additional revision surgery.
Conclusion
The scar is caused due to various forms of injury. Scars can vary in shape, size, location, texture, and thickness. Some of these scars are barely noticeable. A scar revision procedure is performed to change the appearance of the scar, but no procedure can completely change the appearance. The scar revision procedure depends on the texture and region of the scar. Some surgical procedures will be the correct option, so consultation with a doctor before the start of any procedure is recommended.