Definition & Overview
Scar revision surgery, as the term implies, is a surgical procedure that reduces the appearance of scars caused by wounds, injury, and previous surgery. The procedure, which can also correct disfigurement and restore skin function, is typically performed to treat severe scarring. Although generally safe, it comes with the common risks associated with surgical procedures in general.
Who Should Undergo and Expected Results
The procedure can be taken advantage of anyone who wishes to reduce the appearance of their scars. However, it is typically not recommended by medical professionals for minor scars or when the extent of the scarring does not justify the risks associated with the procedure.
Thus, the procedure is more commonly performed on large, deep, keloid, and thickened scars that distort the patient’s features, compromise movement and function of the affected body part, run at an angle to the skin’s normal tension, and those that are located in highly visible areas (such as facial scars).
Scar revision surgery is ideally performed several months or even years after the wound has healed since scars tend to shrink in size and become less noticeable as time goes by. Wounds typically go through three different phases as they heal -- the inflammatory phase, the granulation phase, and the remodelling phase. Most doctors recommend waiting for at least 60 to 90 days, or until the skin has completed the remodelling phase before considering scar revision surgery.
How is the Procedure Performed?
A scar revision surgery is an outpatient procedure typically performed under local anaesthesia supported by mild sedation. However, in the case of severe scarring, general anaesthesia can be used.
The procedure can be performed using different methods, such as:
- Dermabrasion – This is a common cosmetic treatment used primarily to soften the skin’s surface. But it is also effective in reducing other skin irregularities including scars. During the procedure, the upper layers of the skin are removed using a special surgical instrument called a burr to promote new skin growth in the area.
- Scar removal – Depending on the nature of the scar, it can simply be removed and the wound carefully sealed.
- Skin grafting – This is a more complex scar revision procedure as it involves taking a thin layer of skin from another part of the patient’s body to cover up the scar. This technique may use an entire block of skin, including the skin, fat, nerves, blood vessels, and muscles to replace the injured part. This method is typically recommended for deep scars with major skin damage as well as scars that simply do not heal.
- Scar tissue removal – Typically used for treating scars caused by very large injuries, hypertrophic scars, and scars that cause strictures, the removal of excess unwanted scar tissue can restore the function of the injured body part. The procedure can be performed by making a series of small incisions on the sides of the scar, with the goal of creating a V-shaped skin flap to completely re-orient the scar, making it blend into the skin’s natural folds better.
Following the procedure, the doctor applies a light dressing over the treated area to protect the skin as it heals. If stitches were used, the patient has to come back to have them removed after 3 to 4 days if they are on the face and after 5 to 7 days for non-facial scars.
If the scar has formed a keloid, the doctor will place an elastic dressing over the area. Applying pressure after the procedure can help reduce the risk of recurrence.
Most patients who undergo scar revision surgery can return to their normal activities shortly after the procedure, as long as they avoid activities that may widen the new scar. They are also advised to apply sunscreen over the treated area on a daily basis to protect the colour of the newly healed skin.
Possible Risks and Complications
As with other surgical procedures, scar revision surgery puts the patient at a mild to moderate risk of infection, bleeding, and blood clots. Also, patients run the risk of developing allergic reactions to the anaesthetics used.
Other risks of the procedure include scar recurrence, recurrent keloid formation, and dehiscence. There is also a risk that the treated area will not match the colour of the rest of the skin, which is more likely to occur if the scar was exposed to too much sun prior to the scar revision surgery. This causes the scar to darken, which can make scar revision more challenging.
Adnan Prsic. “Scar Revision.” Medscape. http://emedicine.medscape.com/article/2250161-overview#a4
Shilpa G., Dahiya N., Gupta S. “Surgical scar revision: An overview.” J Cutan Aesthet. Surg. 2013 Jan-Mar; 7(1): 3-13.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996787/ Sharma M., Wakure A. “Scar Revision.” Indian J Plast Surg. 2013 May-Aug; 46(2): 408-418. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901922/