There are many reasons why a scar could need to be revised. Some individuals may have a biological tendency to develop dark, raised, uncomfortable scars that they would like to have minimized. Others may suffer from poorly formed scars in visible locations and would like them more natural looking. Still others may have scars that actually limit their movement or abilities. Whatever the reason, scars can be physically uncomfortable, visually distracting, and psychologically troublesome for many people.
Can a scar be removed or revised?
Scar revision can commonly fix poorly formed scars, to make them less visible, less noticeable and less troublesome. However, it is important to understand the dynamics and life of a scar.
Scars mature over time and can take up to two years to heal. While they can begin to look much better at three months, you will continue to see remarkable improvement for the next 21 months.
Each person scars differently. A person’s unique biological makeup along with the size and direction of the wound can contribute to how a scar forms. Typically, people with thicker skin or darker skin color tend to develop more pronounced scars.
Keloid and hypertrophic scars
Keloid and Hypertrophic scars are different types of scars that share some characteristics. They both produce large, raised, dark scars. The difference is that keloid scars are often physically uncomfortable, tender to the touch, and often itchy. Keloids grow outside of the wound area. Hypertrophic scars, on the other hand, form within the boundary of the wound, but still protrude and become bothersome and highly visible.
Treatment options for keloid and hypertrophic scars
Steroid injections. Steroid injections can relieve some of the scar’s physical discomfort such as itchiness and tenderness. They can also lessen the scar’s discoloration and size.
Removing scar tissue. Sometimes removing the scar tissue and re-suturing the wound with very small stitches can fix these types of scars. Keloid scars, however, have a tendency to reappear and may require several procedures.
Skin grafts. Skin or flap grafts may be able to fix the results of keloid or hypertrophic scars, but run the risk of developing the keloid characteristics as well.
Combination treatment. Sometimes the best plan of attack is to combine treatments: removing scar tissue while treating the area with both steroid injections and topical creams. Other treatments that can be used include radiation and wearing pressure bandages that minimize swelling and support healing.
Another type of scar that can be successfully treated are Contracture scars, where the skin is pulled towards the wound and limits mobility and can create slight deformity. Scars that go against natural facial lines or contours can also be successfully altered to create a more natural appearance. Contracture scars can be treated in several ways including Z-plasty, skin grafts or flaps, and tissue expansion. Scars that interfere with lines and contours can be modified to run more naturally along existing contours. While no scar can be removed completely, an adept and experienced plastic surgeon is trained to minimize scars and maximize mobility.
Common treatments for scars:
Z-plasty. Z-plasty uses a dynamic that at first may seem counterproductive to minimizing the appearance of a scar. Z-plasty reshapes a scar by adding two new incisions: one that runs perpendicular on the top of the scar line and one that runs perpendicular at the bottom of a scar line, resulting in a wound that looks exactly like the letter Z. When the wounds are sutured up, the skin flaps are transposed creating a smaller scar that runs in a different direction from the original scar. The scar becomes smaller, more natural looking, and allows for more function of the muscles below the scar. Z-plasty is commonly used in all scar revisions, including times when a scar needs to run along a naturally occurring facial line and not against it.
Scar minimizing. By removing the scar tissue in an enlarged or keloid scar, the physician can actually make the scar smaller and less noticeable. Very fine sutures are used and the scar becomes less noticeable and troublesome.
Dermabrasion. Dermabrasion is the removal of the top layers of skin. Often performed to minimize the effects of fine lines and wrinkles, dermabrasion can successfully minimize scars, including acne or chicken pox scars. For more serious cases, laser skin resurfacing may be more appropriate that dermabrasion.
Most deformed scars can be successfully treated. While it is impossible to remove a scar completely, there are many treatments that minimize a scar, making them less noticeable while relieving the discomfort they may bring.
If you have a scar and would like Dr. Volshteyn, our board certified plastic surgeon, to evaluate, please call us at 732-641-3350