Scar Revision

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 form and function.

Whether caused by injury, surgery, or burn, scars can be disfiguring. 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 the 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.

WHO IS A GOOD CANDIDATE FOR SCAR REVISION?

First, you must be in good health, have no active diseases or serious pre-existing medical conditions, and you must have realistic expectations of the outcome of the surgery. No scar can be “erased” permanently. Most scars, in fact, are not amenable to revision. Qualities that make a scar more amenable to successful revision are raised or depressed scars, contour irregularities, and poor lines of orientation, color mismatch, and scars produced by blunt trauma.

NOTE: If you smoke, recently quit smoking or have been unable to stop completely, or you are exposed to second hand smoke, you may not be a candidate for surgery. Primary and secondary smoking decreases blood supply to the body’s tissues resulting in prolonged would healing, skin loss, infection and increased scarring. See Smoking and Wound Healing.

Examples of scars most commonly treated included: hyper tropic scars, keloid scars, and contracture scarring. Hypertonic scars occur within the boundaries of an incision/wound and are usually thick, red, raised in appearance. Keloid scars generally grow beyond the boundaries of an incision/wound. Keloids are commonly found on earlobes, shoulder over the breastbone, and appear most commonly in dark sin individuals. Contracture scares are the most sever scars, which are commonly found in patients that have burn injuries. In that instance, the scars formed cause the edges of the skin to pull together affecting muscles and tendons, causing restriction in movement. Minor scars can be treated sometimes by injecting a steroid medical directly into the scars.

HOW IS THE PROCEDURE PERFORMED?

Based on your initial consultation with Dr. Aguilar it will be determined which procedure is best for you. Here are a few possible options:

  • Steroid Applications or Injections – Steroids can help flatten and reduce the redness of hypertrophic and keloid scars. Steroid are applied or injected into the scar to breakdown the skin’s collagen. This is especially effective on hypertrophic and keyloid scars. These injections can also aid in reducing the itching/pain associated with these scars.
  • Silicone Gel Sheeting – Silicone gel sheets can help flatten hypertrophic or keyloid scars. These clear sheets are placed on the scar and worn 24 hours a day.
  • Dermabrasion – Dermabrasion smoothes out surface irregularities such as deep lines or scars by removing the top most layers of your skin. The affected is 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 a rubber band snapping on the skin.
  • 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 of these lasers remove the uppermost layers of the skin, allowing new smooth skin to form. There are some color lasers that can treat the abnormal red pigmentation of hypertrophic and keyloid scars, as well.
  • Z-PLasty and Related Tissue-Rearrangement Techniques – Z-Plasty is a technique used to re-orient scars. The scar is orientated by cutting the skin around the scar in small triangular flaps. These 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.
  • Injectable Fillers – Injectable fillers are used to rise, or fill in, sunken scars. These results are immediate but not permanent, lasting anywhere from 4 months to 2 years. Dr. Aguilar will determine if this is appropriate for you during your consultation.

PLANNING FOR YOUR SURGERY

First, schedule a personal consultation with Dr. Aguilar. Communication is vital in reaching your goals. You will have the opportunity to discuss your goals and the results you would like to achieve. Dr. Aguilar will work with you to reach an understanding about what you can expect from this procedure and what long-term benefits you will experience. Every patient is different, and Dr. Aguilar will choose the surgical technique and treatment plan that is right for you, during your initial consultation.

  • Provide a complete medical history. Include information about any previous surgical procedures; past and present medical conditions; and all medications or herbal supplements you are taking.
  • Expect Dr. Aguilar to examine your abdomen, including the quality of your abdominal skin, the location of any existing scars; the amount of any excess fat and the status of underlying muscles.
  • Photographs will be taken for your medical record.
  • Be prepared to discuss possible risk and complications of the procedure with Dr. Aguilar.

PREPARING FOR YOUR SURGERY

You will be given specific instructions on how to prepare for your surgery. A pre-operative information packet will be provided that explains everything you should do and know before your surgery date. Dr. Aguilar will instruct you on how to prepare for surgery, including guidelines on eating and drinking, smoking and which medications, vitamin and herbal supplements should be taken or avoided prior and post operatively. you should arrange for someone to drive you home after your surgery, whether your surgery is done on an outpatient or inpatient basis. you may also want to make arrangements for someone to help you at home for a day or two after your surgery.

WHERE WILL YOUR SURGERY BE PERFORMED

There are several different facilities which Dr. Aguilar operates from and he will discuss your options with you at the time of your consultation.

TYPE OF ANESTHESIA

General anesthesia is used so that you will sleep and remain comfortable throughout the procedure. Dr. Aguilar will discuss this with you at the time of your consultation.

AFTER YOUR PROCEDURE

You will be provided information about how to care for yourself after your surgery at the time you schedule your  surgery. Dr. Aguilar will also discuss this with you during your consultation.