Scar tissue forms as skin heals after an accident, injury or surgery. Scar revision surgery improves or reduces the appearance of scars. If the scar is affecting function – for instance by limiting movement at a joint – scar revision may help that too.
Scars are often actually lengthened by scar revision, but may be narrowed or placed in a less noticeable location. So they should be less conspicuous following scar revision, even if they are slightly longer.
Scars can be improved in many ways, and I will advise you on which will suit you best. Depending on the type and extent of surgery, scar revision can be performed either under local anaesthesia, sedation or general anaesthesia.
Ways to improve the appearance of scars
The scar may be removed completely and the new wound closed very carefully, aiming to produce an optimal new scar.
Hypertrophic Scar Removal
Very large injuries (such as burns) can cause loss of a large area of skin and may form hypertrophic scars. These types of scars can restrict movement of muscles, joints and cause contracture of tendons. Surgery may involve a series of small incisions on both sides of the scar, which create V-shaped skin flaps (Z-plasty). The result is a thin, less noticeable scar, because a Z-plasty may re-direct the scar so that it follows the natural skin folds more closely.
Keloid Scar Removal
Keloid scars are thick scars that continue to grow outside of the original area of surgery/injury. They can become large, are difficult to treat and often recur. Keloid scars are more common in Afro-Caribbean skin and in certain parts of the body – particularly the earlobes, breastbone and shoulders.
Surgery to remove a keloid scar and re-close the wound may be considered if there was a clear external predisposing factor, such as wound breakdown or infection. If none is identified, however, we have to presume you are genetically at high risk, in which case more surgery is not generally recommended. An exception may be to debulk the scar, making sure the cuts are left within the original keloid so that we do not make the situation any worse.
Silicone gel & Steroid injections
These may be recommended for a variety of abnormal scars, including keloid and hypertrophic scars. Usually treatment needs to be continued over several weeks or months.
Rarely surgery may be performed in conjunction with radiotherapy treatment for certain keloid scars. This is very effective but used rarely, because of the risk of the radiotherapy provoking a skin cancer.
Skin Grafts & Flaps
This involves taking a thin layer of skin from another part of the body and placing it over the injured area. Flap surgery involves moving skin, associated tissues and its accompanying blood supply, making it more demanding surgery than grafting but also better able to cover certain difficult wounds. These techniques are used when a large amount of skin has been lost in the original injury, when a thin scar will not heal or when improved function is more important than improved appearance.
This procedure can be used to replace scarred skin with fresh skin produced by stretching a neighbouring unscarred area. This is done by inserting a silicone balloon beneath the skin and gradually filling it with salt water. Once we have enough new skin the balloon is removed and the new skin used to replace the scarred region.
There are a variety of ways to treat poor scars, and it is impossible to guide you for every situation. You should see a surgeon who is experienced in scar optimisation for a consultation.
Scars naturally shrink and become less noticeable as they age. You may be advised to wait to have surgery until the scar softens, which often takes a year.
Anaesthetic: General or Local Anaesthetic
Hospital stay: Variable (often none)
Surgery time: Variable (often short)
Time off work: Variable
Reasonably mobile: Usually immediately
Washing: Keep dressings dry until wound check at one week
Driving: Next day (usually)
Exercise: Some exercise not involving the body part may be ok immediately
Analgesia (pain relief) - Ibuprofen and paracetamol can be taken
Surgical skin tapes are recommended for a prolonged period – I will advise you on this
The hospital or surgeon should be contacted if you develop a temperature or in rare cases of bleeding or rapid swelling
Patients should take care not to over exert themselves in the first few weeks and to keep
pressure off the wounds