What is surgical scar revision?
Scar revision is a group of surgical techniques used to improve the appearance or the functional impact of a scar. It is important to realise that most scars are permanent and cannot be fully removed. However, they can be modified to make them less visible or to allow normal bodily function. A number of problematic scar types and their treatment options are discussed below.
All new scars undergo a process of change lasting 1 – 2 years. This is called scar maturation. A typical surgical scar is a very fine line for the first 2-3 weeks. It then becomes red and a little raised and thickened as the body produces scar tissue. This lasts for 3 -6 months, at which point the scar usually starts to soften, flatten and become paler. The whole process can take up to 18-24 months and usually leaves a flat soft scar that is paler than the surrounding skin. Good scar management by experts can help with scar maturation, such that surgical revision is not necessary as a good functional and cosmetic outcome has been achieved.
Some scars become stretched during scar maturation and can be re-sutured using plastic surgery techniques to make them finer. Scars on the back and over joints often stretch, because there is so much movement in the skin at these sites, and in these cases scar revision surgery may be of limited benefit.
Sometimes following surgery or an injury, a scar may become tethered to deeper structures. This can make it appear more visible in certain positions as the overlying skin moves and folds. Scar revision can help by permanently releasing the deeper attachments and therefore helping to improve the skin contour making the scar less visible.
Some patients develop cross-hatching from stitch marks. This can make a scar very visible. The stitch marks can usually be removed by re-excising the whole scar and stitch marks and resturing in a different way. This may produce a slightly longer scar, but it should be less visible once matured.
The visibility of a scar can be affected by it’s alignment in the skin. In some cases, scar appearance can be improved by realigning it to lie within the natural lines of the surrounding skin.
Hollows or depressions in scars can create shadows that make the scar more visible. This can be treated by excising the depression and closing the deeper layers, or by filling the depression with fillers or Structural Fat Grafting.
Hypertrophic or keloid scars are caused by a genetic or familial tendancy to produce too much scar tissue. Treatment options include non-surgical interventions such as steroid injections, topical silicone gel and pressure garments. In general, scar revision on its own is not appropriate as it produces a larger scar and therefore a bigger keloid. In extreme cases scar revision is used with post-operative radiotherapy. If you are prone to keloid scarring, careful management by your plastic surgeon is essential in the initial healing phases.
How long will I need to stay in hospital?
This type of surgery is generally performed under local anaesthetic as a day case procedure in the Consulting Suite’s on-site operating theatre. Patients can go home the same day and generally recover quickly, without much discomfort.
How long does scar revision surgery last?
Scar revision results are life long. Recurrence of scar problems due to the in-built responsiveness of your tissue is a possible complication that is usually amenable to further treatments. Mr Kirkpatrick will be able to guide you as to what you may expect to be achieved.