Scar revision

Types of scar

• Hypertrophic scars are thickened, often red and raised scars that can develop after traumatic wounds or arising from surgical incisions.
• Keloid scars are also thick and extend well beyond the margins of the original scar. Keloid scars are most often found on the upper chest, shoulders, face and neck area in darker skin types.
• Burn scars are scars that often restrict movement due to the development of scar contracture as a result of loss of skin.

Causes of scars

• Surgery
• Traumatic injury
• Burns
• Acne

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When the skin heals from a cut or trauma, it will result in a scar. Some areas of the body are more susceptible to scarring, with the middle of the chest and the top of the shoulders being some of the worst areas. Scarring will also be impacted by which direction it runs across the skin – scars within the lines of the skin often heal better than ones going across.

There are numerous types of scars which may occur on your body. Every type of scar will require different treatments.

Scar types include:

Post-traumatic scars: this will occur as the result of traumatic incidents including an accident, disease, or a previous surgery. This type of scar requires a surgical revision, where the tissue will be re-positioned. 

Burn scars: these scars may appear across a large section of skin. Scar removal will involve excising the scar tissue. Healthy, unscarred skin will be lifted and a new incision line will be formed. In cases where this is not an option, tissue expanders or skin grafts will be used.

Hypertrophic scars: these often have a thick texture which may negatively impact your self-confidence. Hypertrophic scars are treated by removing excess scar tissue and repositioning the scar, allowing it to be less visible.

Keloid scars: when skin overproduces collagen while healing, a keloid scar will form. This will make the scar look much larger than the original wound, and will be raised above the skin. Keloid scars are treated through the removal of the hard collagen within the scar, with the skin then being closed. After the scar revision, the site will need to be monitored in case the keloid returns. 

Atrophic scars: these scars are considered to be the opposite of hypertrophic scars. Atrophic scars will generally have an indentation and will lack soft-tissue substance. This type of scar can be treated with a surgical release as well as a fat transfer.

Ideal candidates for scar revision include:

• Those who have a scar that is at the same level as the surrounding skin and not raised
• Those who have a scar that runs parallel to the body’s natural skin creases
• Those who have a similarly coloured scar as the surrounding skin
• Have realistic expectations of what scar revision can achieve

Children should avoid having any scar revision procedure until they reach full adulthood. In children the skin is still actively growing and any scar in children will change over time. Patients with lighter skin types generally achieve better results than those with darker skin. Patients with darker skin have a tendency to develop hyperpigmentation with invasive scar treatments. Laser resurfacing for scar revision is not generally recommended in darker skin types for the same reason.

Scar revision can benefit any person whose life is being negatively impacted by their existing scar, either because of functional or aesthetic concerns. Factors such as age and skin type are usually not a concern, however, some skin types will be prone to worse scars than others.

You will be a suitable candidate for laser scar removal if you have a scar on your body which you wish to improve the appearance of.

You will have to be at least 18 years old to undergo scar revision. It is important to have realistic expectations about what the procedure can achieve. Scar revision will not completely remove the scar. It will, however, improve the aesthetic appearance of the scar and make the scar less noticeable. You will need to be a non-smoker, or be able to stop smoking at least two weeks before having treatment – read more here. You may also need to stop taking certain medications – read more here. Prior to undergoing treatment, you will have a consultation with one of our surgeons who will be able to assess the scar. In some instances, your scar may be better treated with non-surgical methods.

Benefits Of Scar Removal Surgery

• This an effective and quick to perform surgical procedure
• Scar removal surgery is easily performed under a local anaesthetic with no requirement for a general anaesthetic in most cases
• Scars can be significantly reduced and even made barely visible in many cases
• Scars causing pain or itchiness can be treated
• Scar which impede movement of the joints can be treated to increase range of motion in the affected area
• The successful treatment of scars can significantly improve psychological well being.

Laser scar removal removes the top layer of the skin, while also stimulating the production of new collagen, leaving you with newer, tighter and healthier tissue. For laser scar removal, Centre for Surgery uses Fotona’s SP Line multi-application laser system.

There are many advantages to undergoing laser scar revision compared with surgical scar revision, including:

• Reducing the appearance of the scar
• Improved skin texture
• Narrowed pores
• Increase the volume of the skin
• Skin resurfacing

Treatments for scar revision will vary depending on the type of scar. Most methods of scar revision are surgical in nature although non-invasive laser techniques are also very effective for certain types of scar. Well established surgical techniques include a Z-plasty, skin grafts, tissue flaps and tissue expansion techniques.

Z Plasty

A Z-plasty involves the surgical reorientation of scars to make them less obvious and also better positioned. Z-plasty is perfectly complemented by laser resurfacing or chemical peels to flatten the scar.

M-Plasty and W-Plasty

Both an M-plasty and a W-plasty are quite similar to one another but differ in the shapes and directional alignments to decrease scar visiblity. A W-plasty has more a zig-zag type configuration and is ideal for evening out tension on a scar. An M-plasty is primarily used for the end of a scar to prevent excess bunched up tissue forming also known as dog ears.

Linear Closure

For rounded scars, the linear closure method is ideal to make the scar straighter and hence less obvious. A portion of tissue is surgically removed and ellipitical scars are converted into convex scars which can then be converted into linear scars.

Skin Grafts

Skin grafts involve the surgical transfer of tissue  from one part of the body to another area. Skin grafting techniques can be used for scar revision through the transfer of healthy tissue and using it to cover cosmetically unappealing scarred areas. Skin grafting is often used for the more severe types of scarring.

Tissue Expansion

Tissue expansion techniques are ideal for areas where the overlying skin is too tight. A tissue expander can be surgically inserted beneath the scarred and tight area of skin before inflated to stretch out the overlying skin. By stretching out the scar, the appearance is markedly improved as the new stretched skin now covers the area where the scar was originally situated.

Hair Grafts

Hair is often unable to grow in areas of scarring due to disruption of the local blood vessels network. Scars that affect visible parts of the scalp and other visible areas can look very obvious to others. Hair follicles can transferred to the scarred area to make the scar less visible. The procedure of hair transplantation involves the harvest of hair follicles from an area of the body where the hair is able to regrow and surgically implanted in the area of the scar. Hair transplantation techniques for scars are ideal for flatter scars that are not raised from the surrounding skin.

Chemical Peels

Chemical peels exert their action on the superficial layers of the skin by removing the epidermal layer to a variable depth depending on the strength of the peel Powerful chemical peels such as TCA peels are able to penetrate to the dermal layer when used in an appropriate strength. Deep peels are able to induce scar remodelling by stimulating the production of new collagen which results in the production of healthier looking skin in the region the scarred tissue. Stronger chemical peels carry a period of downtime and this is often about 2-3 weeks on average.

Laser techniques

Laser scar revision is done using Fotona’s SP Line laser system, which involves dual-wavelength scar-revision therapy. The first wavelength is the Er:YAG wavelength, which is used for ablation of scar tissue and collagen remodelling. It also uses the Nd:YAG wavelength which improves the aesthetic appearance and tissue quality of the scar. This is a handheld device which precisely targets the scar, reducing its appearance. The laser will only target the area where the scar is and will leave the surrounding skin and tissue undamaged. Other non-surgical procedures will target the entire area, while laser revision allows for more control, resulting in precise and accurate treatment. You will start to see results immediately after treatment. However, you may need to undergo multiple treatments to achieve the desired results. This is performed as a day procedure, so you will be able to return home once the procedure is complete.

Laser scar revision is a non-surgical procedure, so there is minimal recovery time.

You may notice some redness or swelling on the treated area, which should last around 24 hours. You may wish to place an ice pack on the area to help reduce any symptoms.

You may need to undergo multiple treatments to achieve the desired results.

Your recovery period will vary depending on the size and location of the scar.

You will be able to return home the same day as your procedure, once the effects of the anaesthetic have worn off.

After surgery, you may feel some pain and discomfort. This can be managed by taking pain medication. You may have to wear supportive dressing or garments after the procedure, however, this will depend on the size and location of the scar.

You should be able to resume work within one week. You will need to avoid strenuous activity and exercise for six weeks.

You will need to take care of the surgical area. You will need to avoid too much sun exposure, by either wearing clothes or using sunscreen.

Closure of lip piercing scar:

Before

After:

After a Caesarean Section or C-section, women are often left with a scar that they are unhappy with. This scar can often get worse over time, particularly if there has been any weight gain in the lower abdomen area. If you are unhappy with your Caesarean section scar, you may benefit from Caesarean section scar revision surgery.

When considering whether you should have surgery, it is often difficult to know if you are deciding on the right procedure. If you have muscle laxity or are of a larger weight, then you may be more suited for a mini-abdominoplasty which also removes the old caesarean section scar. You will be able to attend a consultation with a surgeon prior to the procedure, where the correct procedure for you will be clarified. An ideal candidate is a slim patient with a scar localised on the lower abdominal contour. There are situations when women have a difficult labour and the doctor decides to perform an emergency Caesarean section. In this situation, the scar is the reminder of an unpleasant event and they want to have it removed. Our expert surgeons at Centre for Surgery use special suture techniques to improve the deeper tissues and the look of the scar. Depending on the particular case of the patient, if a woman experiences muscle laxity or significant fat, then it may be recommended to have a mini-abdominoplasty.

It is important to know whether you are planning on having more children, as this will stretch the lower abdomen skin and you may lose the benefits of the procedure.

Ideal Candidates for Caesarean section scar revision

You may be a candidate for c-section scar revision if you:

• Are in good health both physically and mentally
• Have a body mass index in the normal range
• Have a scar localised to the lower abdominal contour

Best results are achieved on people who are a healthy weight for their height. Therefore, if you are considered overweight, your surgeon may recommend that you lose weight before the surgery. The surgeon will be able to recommend appropriate diets to follow before the procedure. If you are a smoker, you may be advised to quit, as this will help with the healing process.

Caesarean section scar revision procedure

The surgery is easily performed under local anaesthetic, however, the procedure can also be performed under TIVA general anaesthetic if you prefer. The procedure takes around one hour to complete. The procedure involves surgically removing the old c-section scar followed by undermining of the wound edges above and below to increase the mobility of the skin. This results in less tension being placed on the new surgical wound. The procedure may also involve liposuction to equalise the thickness of abdominal skin both above and below the scar. This involves using small cannulas to remove any fat around the scar. The combination of the two methods of surgical removal of the old scar and supplementary liposuction will ensure you have a reduced scar and an aesthetically pleasing lower abdomen. Immediately after the procedure, you should minimal or no discomfort due to the injection of a long-acting local anaesthetic. However, once this wears off, you may feel some pain and discomfort which is easily relieved with over the counter pain medication. Your doctor will be able to recommend pain management medication for you to take during this period. After procedure, you may notice that the new scar looks red, however, this should fade with time.

Recovery after Caesarean section scar revision

After the c-section scar revision surgery, you should try and avoid any strenuous activity for at least 10 days. After this time, you will be able to resume your usual day-to-day routine. You may notice that the new scar will become red and raised. However, with time the scar will appear pale, fine and flat. Your surgeon will be able to give you advice on how to improve the look of the new scar.