Scar repair

Plastic surgery, whether for aesthetic or reconstructive purposes, involves numerous choices, with the most critical being the selection of a trustworthy surgeon. One of the best indicators of a physician's training is board certification. It is crucial to ask your surgeon about their board certification in plastic surgery, as this credential is the only official proof of their qualifications to perform plastic surgery on the face and all areas of the body.

To obtain board certification, a physician must meet several standards:

• Graduate from an accredited medical school.
• Complete a minimum of four years of general surgery training after medical school, followed by three years of residency in plastic surgery.
• Pass all relevant written and oral examinations.

Enhancing Life through Surgery

Improve your appearance with scar revision surgery.

Scars are visible reminders that remain after a wound heals. They are inevitable results of injuries and surgical procedures, and their formation can be unpredictable. Improper wound healing may lead to noticeable, unsightly scars. Even after a wound heals, it can leave a scar that impacts the patient’s appearance. Scars can be raised or depressed, differ in color and texture from the surrounding healthy skin, or be prominent due to their size, shape, or location.

Your treatment options may vary based on the type and severity of the scar, which can include:

• Simple topical treatments
• Minor surgical procedures
• Advanced reconstructive surgeries to close wounds

Scar revision aims to minimize scars so they resemble the surrounding tissue in color and texture. While scar revision can enhance the aesthetic outcome or improve poorly healed wounds, it is essential to understand that scars cannot be completely eliminated.

Is This Surgery Right for Me?

Scar revision surgeries are highly personal. Therefore, they should be performed for your own sake, not to meet someone else’s ideal image. These procedures can be performed at any age and may be suitable for you if:

• You feel uncomfortable due to scars anywhere on your body.
• You are physically healthy.
• You do not smoke.
• You have a positive outlook and realistic expectations for the surgery.
• You do not have active skin acne or other skin conditions in the areas being treated.

What is a Scar?

Scar revision is a type of plastic surgery aimed at improving the condition or appearance of scars anywhere on the body.

Various types of scars include:

• Hypotrophic scars: These are mild scars with color irregularities and surface irregularities that can be improved through surgical or other treatment options suggested by your surgeon. They do not interfere with physical function and include acne scars and scars from minor trauma or previous surgeries.
• Hypertrophic scars: These are raised clusters of scar tissue that form directly at the wound site. Typically red and uncomfortable, they may grow larger over time. They can be hypopigmented (lighter than the surrounding tissue) or hyperpigmented (darker than the surrounding tissue).
• Keloids: These are larger than hypertrophic scars and can be painful and itchy. They extend beyond the original wound site and can occur anywhere on the body but are more common in areas with less subcutaneous fat, such as the face, neck, chest, and shoulders.
• Contractures: These scars form due to skin and underlying tissue pulling together during wound healing, leading to limited movement. They are often seen in areas with significant tissue loss, such as burn wounds, and can restrict movement of fingers, elbows, knees, or the neck.

The type of scar you have determines the appropriate surgical technique for you.

What to Expect During Consultation

A successful and safe scar revision procedure relies heavily on your honesty during the consultation. You will be asked many questions regarding your health, desires, and lifestyle.

Be prepared to answer questions such as:

• Why do you want surgery, and what are your expectations for the outcome?
• What is your health status, including any drug allergies and treatments?
• What medications, vitamins, herbal supplements, alcohol, cigarettes, and addictive substances do you currently use?
• What is your history of previous surgeries?

Your surgeon may:

• Assess your current health status and risk factors.
• Thoroughly examine your scars.
• Take photographs for your medical records.
• Discuss alternative options and suggest a treatment plan suitable for you.
• Discuss potential results, risks, and complications of the surgery.

Preparing for Surgery

You may be asked to:

• Undergo tests and a medical evaluation before the surgery.
• Adjust or take specific medications.
• Quit smoking to improve surgical outcomes.
• Avoid aspirin and certain anti-inflammatory medications and herbal supplements that can increase bleeding.

What Happens During Scar Revision Surgery?

Step 1 – Anesthesia During surgery, medications are administered for your comfort. The choice of method includes intravenous sedation and general anesthesia, with the surgeon recommending the most suitable approach.

Step 2 – Treatment The improvement achieved through surgery depends on the severity, type, size, and location of your scar. Sometimes, a single method may suffice. However, your plastic surgeon may recommend a combination of various treatment techniques to achieve the best outcome.

Topical Treatments: These may include gels, strips, or pressure dressings that can aid in wound closure and healing or prevent abnormal pigmentation. They are effective for treating superficial scars and discoloration, assisting in surgical wound healing and scar remodeling.

Injectable Treatments: Typically used to fill in depressed areas of scars. Depending on the injectable material and your specific scar conditions, effects can last from three to several years, but maintenance injections are needed to preserve results. Another method involves steroid injections to improve the appearance, size, and structure of raised scars.

Surface Treatments: Often used to enhance the aesthetic appearance of scars, these methods improve surface irregularities and discoloration. Surface treatments involve controlled removal or alteration of the outer skin layers and include:

• Dermabrasion, a mechanical skin polishing technique.
• Laser treatments that alter skin texture and promote the formation of new, healthy skin over scars.
• Chemical peels that penetrate the skin surface, softening scar structures and improving color changes.
• Skin lighteners used to lighten pigmented areas.

Step 3 – Incision In some cases, deeper scars require removal through surgical incision.

Step 4 – Wound Closure Some wounds require layered closure. Layered closure is necessary when tissue removal reaches the deeper skin layers or areas with high movement. The initial step involves suturing the subdermal layer (beneath the skin) with absorbable or permanent sutures. Layering continues until the wound is closed and healed.

Advanced techniques in scar treatment may include complex flaps that move scars to make them less noticeable or improve flexibility in cases of limited mobility.

Synthetic tissue substitutes are utilized when healthy tissue removal is insufficient for scar closure, particularly in severe burn scars.

Tissue expanders are alternatives to skin grafts. In this technique, an expandable balloon is placed adjacent to the wound and filled with a sterile solution over time, promoting the growth of healthy skin. Once the skin has stretched sufficiently, the balloon and scar are removed, and the expanded skin is used to replace the scar tissue. This method may require multiple surgical stages to achieve the final outcome.

In conclusion, scar revision surgery offers a way to enhance one’s appearance and improve the physical and emotional impact of scarring. Selecting a qualified surgeon and understanding the procedure are essential steps toward achieving desired results.