Top New York plastic surgeon Dr. Darrick Antell
is board certified in plastic surgery, emphasizing
aesthetic / cosmetic surgery. One of the procedures
he performs is scar revision.
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.
To view more information about scar revisions,
please click on one of the links below.
If you're considering
scar revision...
Scars -whether they're caused by accidents 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.
Many variables can affect the severity of scarring,
including the size and depth of the wound, the blood
supply to the area, the thickness and color of your
skin, and 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.
[Back to scar
revisions list]
Making the decision
Many scars that appear large and unattractive
at first may become less noticeable with time. Some
can be treated with steroids to relieve symptoms
such as tenderness and itching. For these reasons,
many plastic surgeons recommend waiting as long
as a year or more after an injury or surgery before
you decide to have scar revision.
If you're bothered by a scar, your first step should
be to consult a board-certified plastic surgeon.
The surgeon will examine you and discuss the possible
methods of treating your scar, the risks and benefits
involved and the possible outcomes. Be frank in
discussing your expectations with the surgeon, and
make sure they're realistic. Don't hesitate to ask
any questions or express any concerns you may have.
Insurance usually doesn't cover cosmetic procedures.
However, if scar revision is performed to minimize
scarring from an injury or to improve your ability
to function, it may be at least partially covered.
Check your policy or call your carrier to be sure.
[Back to scar
revisions list]
All scar revision surgery carries
some uncertainty and risk
While scar revision is normally safe, there is
always the possibility of complications. These may
include infection, bleeding, a reaction to the anesthesia,
or the recurrence of an unsightly scar.
You can reduce your risks by choosing a qualified
plastic surgeon and closely following his or her
advice, both before surgery and in follow-up care.
[Back to scar revisions list]
Keloid Scars
Keloids are thick, puckered, itchy clusters of
scar tissue that grow beyond the edges of the wound
or incision. They are often red or darker in color
than the surrounding skin. Keloids occur when the
body continues to produce the tough, fibrous protein
known as collagen after a wound has healed.
 |
| This thick,
over-grown cluster of scar tissue on the earlobe
is a keloid. Here it has been removed and the
incision closed with stitches, leaving a thin
scar. |
Keloids can appear anywhere on the body, but they're
most common over the breastbone, on the earlobes,
and on the shoulders. They occur more often in dark-skinned
people than in those who are fair. The tendency
to develop keloids lessens with age.
Keloids are often treated by injecting a steroid
medication directly into the scar tissue to reduce
redness, itching, and burning. In some cases, this
will also shrink the scar.
If steroid treatment is inadequate, the scar tissue
can be cut out and the wound closed with one or
more layers of stitches. This is generally an outpatient
procedure, performed under local anesthesia. You
should be back at work in a day or two, and the
stitches will be removed in a few days. A skin graft
(see the section on skin grafting) is occasionally
used, although the site from which the graft was
taken may then develop a keloid.
No matter what approach is taken, keloids have
a stubborn tendency to recur, sometimes even larger
than before. To discourage this, the surgeon may
combine the scar removal with steroid injections,
direct application of steroids during surgery, or
radiation therapy. Or you may be asked to wear a
pressure garment over the area for as long as a
year. Even so, the keloid may return, requiring
repeated procedures every few years.
[Back
to scar revisions list]
Hypertrophic Scars
 |
| This hypertrophic
scar has formed a contracture, restricting finger
motion. |
Hypertrophic scars are often confused with keloids,
since both tend to be thick, red, and raised. Hypertrophic
scars, however, remain within the boundaries of
the original incision or wound. They often improve
on their own-though it may take a year or more-or
with the help of steroid applications or injections.
If a conservative approach doesn't appear to be
effective, hypertrophic scars can often be improved
surgically. The plastic surgeon will remove excess
scar tissue, and may reposition the incision so
that it heals in a less visible pattern. This surgery
may be done under local or general anesthesia, depending
on the scar's location and what you and your surgeon
decide. You may receive steroid injections during
surgery and at intervals for up to two years afterward
to prevent the thick scar from reforming.
[Back to scar revisions list]
Contractures
Burns or other injuries resulting in the loss
of a large area of skin may form a scar that pulls
the edges of the skin together, a process called
contraction. The resulting contracture may affect
the adjacent muscles and tendons, restricting normal
movement.
Correcting a contracture usually involves cutting
out the scar and replacing it with a skin graft
or a flap. In some cases a procedure known as Z-plasty
may be used. And new techniques, such as tissue
expansion, are playing an increasingly important
role. If the contracture has existed for some time,
you may need physical therapy after surgery to restore
full function.
|
|
|
| Using Z-plasty, the scar
is removed and several incisions are made on
each side, creating small triangular flaps of
skin. Then the flaps are rearranged and interlocked
to cover the affected area |
The incision
is closed with a Z-shaped line of sutures. The
new scar is thinner and less visable, and allows
the finger to be extended. |
[Back to scar revisions list]
Facial Scars
Because 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.
[Back to scar revisions list]
Z-Plasty
Z-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.
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|
|
| The scar crossing the
natural line, or crease, between the nose and
mouth is removed and repositioned using Z-plasty.
The forehead scar, located in the natural lines,
is excised with tapered ends. The skin is then
loosened and brought together with stitches. |
The repaired
scars now lie partly within the natural skin
crease, where they are less visible. |
[Back to scar revisions list]
Skin grafting and flap surgery
Skin 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.
[Back to scar revisions list]
After scar revision
With 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.
If you would like to contact New York plastic surgeon
Darrick Antell, or if have any further questions
about scar revision or any of our plastic surgery
procedures, please use our contact
form.
Phone: (212) 988-4040
