What is Involved in Scar Revision?

Scars may be noticeable due to their size, shape or location. They can be raised or depressed. They may differ in color or texture from the healthy surrounding skin.

Hypertrophic scars are raised. They are often thick and red and form right on the wound site. They can be hyperpigmented (dark) or hypopigmented (light).

Keloids are thick clusters of scar tissue. They grow much larger than the wound or incision that caused the scar. Keloid scarring can be painful or itchy. Keloids usually develop on the face, neck, ears, chest or shoulders. They are more common in people with dark skin.

Contracture scars restrict movement due to skin and underlying tissue that pull together during healing. They can occur when a large area of skin is lost, such as after a burn.

Treatment options vary based on the type and amount of scarring. Multiple treatments may be required. Procedures may be performed under local or general anesthesia.

“The size and type of the scar generally reflect the degree of the original injury,” Dr. Pacella says. “Other factors play a part, such as genetics and where the scar is located. Some scars may be minimal, while keloids and other thick scars can cause significant problems.”

Topical medications, such as silicone gels or silicone sheets, may be used to treat surface scars and discoloration, and to help in the healing of scar revision procedures.

Surface treatment methods may be used to smooth the surface of the scar and reduce discoloration by removing the top layers of skin and allowing new skin to grow over the area. Treatment options include dermabrasion, laser or light therapy, chemical peel solutions and skin bleaching agents.

Injectable fillers made from natural ingredients or synthetic products can improve the appearance of sunken scars. Steroid injections can reduce collagen formation and alter the appearance, size and texture of raised scars.

Scar revision surgery and non-surgical treatments may be done alone or in combination. Procedures vary depending on the type of scar. They may be done for cosmetic reasons or to restore function to a part of the body that is restricted by a scar or both.

With any type of procedure there are risks of complications, such as infection and bleeding. So it is important to follow your physician's direction to prevent any problems.

Skin grafting involves removing healthy tissue from one part of the body and attaching it over the damaged skin. Skin flaps are similar to skin grafts, but the section of skin used has its own blood supply.

Z-plasty is a procedure used to revise more serious scars. A surgeon cuts along either side of the scar, and creates angled flaps that can reposition or change scar direction, interrupt scar tension and make the scar less visible.

Tissue expansion helps the body grow additional skin to cover a scar. An inflatable balloon is placed under the skin near the scar site and gradually stretches the skin. The extra skin tissue is used for the procedure.

Cost is a factor in any elective surgery. Most health insurance plans will not cover scar revision surgery, so make sure to check your health plan. If you proceed, make sure your plastic surgeon is highly trained and board-certified.

“Undergoing a cosmetic procedure is very personal decision. Before deciding if scar revision is right for you, discuss the procedure with your plastic surgeon, learn what results you can achieve and explore the risks and benefits,” Dr. Pacella says.