Surgical and non-surgical treatments for scar revision
A natural way of healing lost or damaged skin, scars are something that many people live with even if they are uncomfortable or unattractive. The University of Michigan’s section of Plastic Surgery is a nationally recognized leader in reconstructive and cosmetic surgery including the treatment of scars. Our team of surgeons and medical specialists guide patients through every option of surgical and non-surgical treatments of scar revision to create a customized plan for each individual that will help them reach their best appearance and comfort level.
What is scar revision?
Surgical scar revision is an option available to patients faced with scars originating from injury or through surgery. Depending on the severity of the scar, revision of the scarred tissue may aid in the restoration of both form and function.
Based on the initial consultation, your surgeon will determine which procedure is best for you. Here are some other possible options:
Steroid Applications and Injections
Steroids can help flatten and reduce the redness of hypertrophic and keloid scars. Steroids are applied or injected into the scar to break down the skin's collagen. This is especially effective on hypertrophic and keloid scars, both of which continue to form collagen after the wound has healed. These injections can also help reduce the itching and/or pain associated with these scars.
Silicone Gel Sheets
Silicone gel sheets can help flatten hypertrophic and keloid scars. These clear sheets are placed on the scar and worn 24 hours a day.
Z-Plasty and Related Tissue-Rearrangement Techniques
Z-Plasty is a technique used to re-orient scars. The scar is oriented by cutting the skin around the scar in small triangular flaps. These flaps usually follow a Z-shape (hence the name), but the technique your doctor chooses will depend on the shape of the scar. The flaps are repositioned to follow natural lines and creases of the skin. The new scar is often less noticeable. Z-plasty can also help relieve the pressure of contracture scars and is commonly used in reconstructive burn surgery.
Dermabrasion
Dermabrasion smoothes out surface irregularities such as deep lines or scars by removing the topmost layers of the skin. The afflicted area will be injected with anesthetic and then carefully "sanded" with a rotating wire brush or a diamond wheel until the desired amount of skin is removed.
Vascular Laser
A vascular laser works by shrinking the blood vessels that feed the scar, thus improving the coloration of red scars. This treatment is done without anesthetic. During the process, the sensation is much like that of a rubber band snapping on the skin.
Tissue Expansion
In this procedure, a "balloon" is inserted under a patch of healthy skin near a scar. The balloon is filled with a saline solution to stretch the skin. The scar is then surgically removed, and the balloon-stretched skin is pulled over the previously scarred area and carefully closed. This procedure is commonly used for breast reconstruction surgery and burn surgery.
Skin Grafts
In this procedure, doctors take skin from a healthy part of the body and transplant it to the injured area. Grafts aren't always cosmetically pleasing because the grafted skin may not match the surrounding skin's color or texture. The area where the graft came from will also scar -- but skin grafts can greatly restore function to a severely scarred area.
Collagen Injections
Collagen Injections are used to rise, or fill in, sunken scars. Collagen is a natural animal protein. Before using collagen, you should take an allergy test to ensure that you are not allergic to the substance. The results of collagen injections are immediate but not permanent. The scars will eventually have to be re-filled as the body slowly absorbs the collagen.
Laser Skin Resurfacing
There are two types of lasers used for reducing the uneven surface of scars: the CO2 Laser and the Erbium: YAG Laser. The CO2 laser is typically used for deeper scars, while the Erbium is used for superficial scars and deeper skin tones. Both lasers remove the topmost layers of skin, allowing new, smooth skin to form. There are some color lasers that can be effectively treat the abnormal red pigmentation of hypertrophic and keloid scars as well.
Why is scar revision necessary?
Whether caused by injury, surgery, or burn, scars can be disfiguring and uncomfortable. Scar tissue can be itchy or painful. Scars can be more noticeable due to their protrusion or depression versus the surrounding skin, their lack of orientation, their pull on other structures and their color. The severity of a scar depends on many factors, including the size and depth of the wound, the blood supply to the area, and the thickness and color of the skin. Some people - especially those with deeper skin tones - have a tendency to produce prominent, raised scars called keloids. Revision can help restore a more natural look.
Examples of scars most commonly treated include:
- Hypertrophic: scars within the boundaries of the incision or wound and are generally thick, red, and raised in appearance
- Keloid: somewhat similar in appearance to hypertrophic scars, often found on the earlobe, shoulder, and breastbone and appear most commonly in dark-skinned individuals
- Contracture: the most severe forms of a scar and usually occur as a result of a loss of a large area of skin, are most commonly found in patients that have experienced burn injuries and can cause edge of skin to pull together, affecting the muscles and tendons and causing constricted movement
What can I expect from scar revision?
No scar can be "erased" permanently. Most scars, in fact, are not easily changed. Qualities that make a scar successful in revision are raised or depressed scars, contour irregularities, poor lines of orientation, color mismatch and scars produced by blunt trauma.
If you need scar revision
You and your surgeon will reach an understanding about what you can expect from this procedure and the long-term benefits you will experience. Every patient is different, and your surgeon will choose the surgical technique and treatment plan that is right for you. During the initial consultation, you should expect:
- To provide a complete medical history, including information about previous surgical procedures; past and present medical conditions; and any medications or herbal supplements you are taking.
- Your surgeon to conduct a complete physical examination.
- To have measurements and photographs taken for your medical record.
- To discuss possible risks and complications of the procedure.
If you choose to have surgery at U of M, you will be given a pre-operative information packet that explains everything you should do and know before your surgery date. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Your procedure will take place at the University of Michigan Hospitals, which provides state-of-the-art surgical suites and recovery areas. The majority of these procedures are completed on an out-patient basis.