Scar revision reduces the prominence of scars resulting from injury or previous surgery. Although many scars fade over time and become barely noticeable, disruptions to the healing process can cause them to become red, raised, indented, or otherwise deformed. The prominence of a scar depends on the type and severity of the injury that caused it, overall health, and ability to heal. For people who are unhappy with or embarrassed by their scars, there are a number of procedures available to make scars less noticeable.
Scars are by definition permanent, but certain treatments can narrow, fade and otherwise make them less noticeable, which is especially helpful when they form on conspicuous areas such as the face and hands. Although there are many surgical scar-revision methods, including surgical excision, skin grafts and flap surgery, not all are appropriate for treating all types of scars. The best procedure for scar revision varies depending on the location and severity of the scar, the age and overall health of the patient, and the extent of revision the patient wants.
Subcision is a procedure for treating scars that are indented. A needle is directed into the skin to break up the fibers that attach the scar to below-the-surface tissue, raising it back to the elevation of surrounding skin. It also promotes healing by creating new connective tissue that repairs and smooths the skin.
Surgical excision is most often used for severe contracture (skin-tightening) scars and involves using a scalpel to surgically cut away the scar and surrounding damaged tissue. A skin flap or graft may be used to restore the appearance of the skin in the treated area and also improve movement and flexibility that may have been affected by the contracture.
Particularly effective for certain types of acne scars, punch elevation uses a punch tool rather than a typical scalpel to precisely remove small quantities of tissue without affecting nearby skin. The punch tool is used to elevate the base of the scar, making it appear much less recessed or pronounced.
Many cosmetic procedures, such as microdermabrasion, chemical peels, and skin bleaching, effectively treat discolorations and mild surface irregularities by gently removing the top layers of skin and rejuvenating the underlying layers. Multiple treatments may be needed, however, to achieve noticeable results.
Similar to surface treatments, laser treatments gently remove damaged layers of skin to reveal new unblemished skin underneath while stimulating collagen production for further gradual improvements. The precision of laser treatments ensures that only damaged tissue is treated while the healthy surrounding tissue remains intact.
Dermal fillers are quite successful at “filling in” depressed scars and creating a smoother skin surface. Fillers are U.S. Food and Drug Administration-approved and safe for most patients. Many fillers are made from substances found naturally in the body or are synthetically made to mimic natural substances or stimulate collagen production. Fillers are injected directly into the skin of the targeted area to restore volume to the scar. However, results from fillers are not permanent, and follow-up injections are necessary to maintain the improvement. Prior to undergoing scar revision, patients are advised to stop smoking and avoid any medications that can cause increased bleeding. We use Radiesse, Juvéderm, Botox and Kybella injections.
The effectiveness of scar revision depends on a number of factors, including the nature of the injury, the body’s healing ability, the size and depth of the wound, and the thickness and color of the skin.