Scar RevisionScars -whether they're caused by accidents, burns or by surgery- are unpredictable. The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon's skills.
Factors affect the severity of scarring :
- The Size And Depth Of The Wound.
- The Blood Supply To The Area.
- The Thickness And Colour Of Your Skin.
- The Direction Of The Scar.
How much the appearance of a scar bothers you is, of course, a personal matter.
While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions.
If you're considering scar revision, this will give you a basic understanding of the most common types of scars, the procedures used to treat them, and the results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
If you're bothered by a scar, your first step should be to consult a board-certified plastic surgeon.
Facial ScarsBecause of its location, a facial scar is frequently considered a cosmetic problem, whether or not it is hypertrophic. There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar.
If the scar lies across the natural skin creases (or “lines of relaxation”) the surgeon may be able to reposition it to run parallel to these lines, where it will be less conspicuous. (See Z-plasty)
Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar.
Z-PlastyZ-plasty is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture. Not all scars lend themselves to Z-plasty, however, and it requires an experienced plastic surgeon to make such judgments.
In this procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a "Z" pattern. The wound is closed with fine stitches, which are removed a few days later. Z-plasty is usually performed as an outpatient procedure underlocal anesthesia.
While Z-plasty can make some scars less obvious, it won't make them disappear. A portion of the scar will still remain outside the lines of relaxation.
Skin Grafting and Flap SurgerySkin grafts and flaps are more serious than other forms of scar surgery. They're more likely to be performed in a hospital as inpatient procedures, using general anesthesia. The treated area may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year.
Grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area. The graft is said to take when new blood vessels and scar tissue form in the injured area. While most grafts from a person's own skin are successful, sometimes the graft doesn't take. In addition, all grafts leave some scarring at the donor and recipient sites.
Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site. In some flaps, the blood supply remains attached at one end to the donor site; in others, the blood vessels in the flap are reattached to vessels at the new site using microvascular surgery.
Skin grafting and flap surgery can greatly improve the function of a scarred area. The cosmetic results may be less satisfactory, since the transferred skin may not precisely match the color and texture of the surrounding skin. In general, flap surgery produces better cosmetic results than skin grafts.
After Scar RevisionWith any kind or scar revision, it's very important to follow your surgeon's instructions after surgery to make sure the wound heals properly. Although you may be up and about very quickly, your surgeon will advise you on gradually resuming your normal activities.
As you heal, keep in mind that no scar can be removed completely; the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. If your scar looks worse at first, don't panic-the final results of your surgery may not be apparent for a year or more.