Scar Revision

Hypertrophic Scars-In normal healing, scars are initially red, slightly raised and somewhat firm. Over time, sometimes up to one year in adults or two years in children, the scars become softer, more flat and the color fades to the same color as the surrounding skin. A hypertrophic scar is one that remains red, raised and sometimes thicker. They are frequently painful and itchy.

Keloids-Keloid scars are similar to hypertrophic scars except that the abnormal scar grows beyond the scar edges and becomes more raised.

Atrophic Scars-An atrophic scar is one that is thin, flat and usually shiny.

Excessive Redness-Inflammation is a normal part of healing. It is the inflammation that causes the redness. As a scar matures, the inflammation and redness improves. In certain situations, the redness persists too long.

Scar Contracture-Part of the healing process involves tightness. Occasionally, the tightness is excessive, resulting in restricted motion and pain.

Dark-Colored Scars (Hyperpigmentation)-Dark changes in the color of the skin is referred to as hyperpigmentation. This commonly happens as a result of excessive sun exposure, hormones and inflammation. Medically based creams, chemical peels and lasers can be used to treat and prevent this condition.

Light-Colored Scars (Hypopigmentation)-Lightening of the skin is a potential side effect of certain skin treatments including laser skin resurfacing, certain chemical peels and cryotherapy used to treat precancerous skin lesions. Some people simply make scars that lose color and look lighter than the surrounding skin. Prevention and camouflage are the only treatments for this condition.

What are the options for improving scars?
The goal of scar revision is to make the scar less noticeable. This can be achieved through a number of techniques. Often many surgical and non-surgical interventions are combined to give the best result.

Skin Creases-Scars are excised (cut out) and hidden in one of the natural skin creases or wrinkles.

Z-plasty & W-plasty-these two techniques are used to treat scar contracture and to camouflage a scar by changing a straight line to a zigzag line, which tends to be more difficult to detect.

Skin Grafts-In severely scarred skin, especially scarred skin with scar contracture, the scarred skin is replaced with skin taken from another area of the body. Skin grafts do not always have the same thickness or color match as the surrounding skin.

Tissue Expanders-This surgical technique can actually create skin and produce a very dramatic result. A deflated, balloon-like sac is placed under the normal skin next to a scar. In the office over several weeks the sac is filled with fluid, stretching the skin as it is filled. Once the expander is sufficiently filled and the skin is stretched, the scar is cut out and the stretched skin is used to replace the scarred skin that was removed. This technique is also commonly used in breast reconstruction and treatment of male-pattern baldness.

Non-surgical Treatment of Scars
Time-all scars are initially red and unattractive. However, all of them become less noticeable over time. It is important to allow a scar an adequate amount of time to mature before considering a revision.

Pressure-Pressure is an effective and easy technique to flatten raised scars. Clip-on earrings are useful in treating keloids on earlobes that result from ear piercing. Girdle-like compression garments are used on burn scars to make them more flat.

Collagen Injections-Collagen is a “filler” material that can be placed under the skin to fill in sunken areas. In the past, collagen was made from cows, and allergic reactions were not uncommon. Now there is human collagen that has been treated so that allergic reactions do not occur. The effect of collagen is immediate, but none of the collagens last forever. It’s possible the human collagen may last longer than the cow collagen, but this varies from person to person. Human collagen comes in an injectable form and a sheet. The injections are performed in the office. Larger collagen sheets can be used in the office or an outpatient surgery center.

Steroid Injection-Glucocorticoids are medications used to treat scars. They are injected and can be used to treat keloids, hypertrophic scars and scar tissue under the skin. While they are effective in reducing itching and pain, a possible side effect of steroids is “fat atrophy,” so they should be limited in their use.

Silicone Gel Sheeting-Silicone gel sheeting is thin sheets of silicone gel that are placed on top of a raised scar, such as a hypertrophic scar or keloid, to flatten it. It is easy to use and is often used in conjunction with steroid injections.

Kelo-cote or Scar Guard-This is a liquid form of silicone gel that is applied to a raised scar and allowed to dry.

Microdermabrasion-This new instrument can be used in the office to smooth the surface of a scar. It is used for scars which are rough and only slightly raised. More raised scars require more aggressive treatment-dermabrasion or laser resurfacing.

Dermabrasion & Laser Skin Resurfacing-These two techniques are the most aggressive way to smooth the surface of a raised scar. Both of these techniques require local anesthesia. Dermabrasion uses a rotating attachment that “sands” the scar flat. The laser “vaporizes” the raises part of the scar to make it flat. It is performed in the office or the outpatient surgery center. The healing time is five to 10 days. The new skin is red, and this fades over the next several months. Use of sunblock is important after treatment. In certain raised scars, more than one treatment is sometimes necessary.

Vascular Laser-The vascular lasers target the blood vessels in the scar to reduce the “redness.” In the office, two to five treatments at six-week intervals are generally required. Topical anesthesia applied as a cream helps reduce the rubber band-like discomfort. Purple discoloration of the scar results after a treatment and subsides in seven to 10 days.