Scars are most prominent in the first two months after injury. They normally become red, thickened and raised, as the products required for healing are laid down and the local blood supply increases to provide energy for the healing process. Over the next six to eighteen months, remodeling takes place with flattening of the scar, and the tiny blood vessels decrease in number, causing its color to become pale. In other words, the scar matures.
When the red and raised condition of the scar is prolonged, it is termed a ‘hypertrophic scar.’ In rare instances, and as a result of a genetic predisposition, a scar can proliferate, become nodular and invade the surrounding tissue. This is a ‘keloid scar.’ Although the condition is rare, the term is often used indiscriminately by the general public to describe any scar they don’t like.
It should be noted that genetic factors play a part in all scarring, not just in the formation of a keloid scar.
“We make them feel like they’re our only patient. Because at that moment, they are.”
– Dr. Boyd
Plastic surgeons, including myself, cannot eliminate scars! If a scar is excessively wide due to a healing problem (e.g. infection or wound breakdown) it may be revised simply by excision and re-suturing. Sometimes the direction or position of a scar may be altered to help conceal it. The skin has a ‘grain’ and scars going against this grain are worse than those going with it. Also, a scar placed in a natural fold is far less conspicuous than one crossing it. Sometimes, scars may be made less obvious by breaking them up using geometric alterations in shape (‘W of Z plasties’).
Hypertrophic scars may be treated with scar reduction products together with massage. A series of cortisone injections into the scar itself can often help. Pressure dressings with silicone inserts are effective in many cases. Surgical revisions, if necessary, should await maturation of the scar so as not to compound the hypertrophy.
Keloid scars are a special case. Some individuals will develop keloid scars wherever they are injured; others will only develop keloid scars with wounds in specific locations – earlobe, central chest and shoulder – while forming normal scars elsewhere. Keloids may be excised and the new wound treated with repeated cortisone injections. Pressure dressings or devices can help prevent their recurrence.
In difficult cases, postoperative radiotherapy is occasionally necessary.
Scar revision is a very straightforward procedure that holds minimal risk; however, all surgical procedures carry an element of risk. These include:
I shall discuss these risks with you during your consultation.
The recovery time dramatically varies from patient to patient, mainly depending on the extent of the scar revision required. Non-invasive methods, such as scar reduction products, massages, or cortisone injections, require no recovery period.
Surgical revision may result in a short downtime; however, most patients can return to work and resume strenuous physical exercise within a few days. I will give you detailed individualized instructions on the appropriate return to physical activity.
Patients typically return for a check-up and suture removal one week after their procedure.
You should be able to notice the results within one week of having the procedure. However, the normal process of healing causes the scar to reach maximum prominence at two months. It can take up to a year for the scar to fully remodel and reach its definitive appearance.
Scar revision can be performed at any age.
Scar revision is a cosmetic procedure, which means it’s typically not covered by insurance. However, if the scar is a result of an injury or interferes with function, you may receive insurance coverage depending on your policy.
Contact your insurance provider directly for more information.
All surgical cosmetic procedures where the skin has been incised to its full depth result in scars. Plastic surgeons are trained in scar placement and techniques to minimize scarring; however, there is no way to influence your genetics or how your body scars.
Scar revision is commonly considered after plastic surgery procedures, such as facelift surgery, tummy tuck surgery, breast lift surgery, or Mommy Makeover surgery.
Yes, combining procedures can save you money and combine your recovery times. Depending on the extent of your scar revision, some standard combinations may include chemical peels, mole removal, and injections of BOTOX® Cosmetic, among others.
Please mention if you would like to combine procedures during your consultation, and I will confirm if this is safe and reasonable.
During your consultation, I shall assess your scar and let you know what’s going on. Some scars, though disturbing to the patient, are healing normally and should simply be kept under review until maturation is complete.
We do have a scar minimization regime involving pressure, massage, sun block, and the use of scar gel for those cases where maturation seems delayed. Surgical revision is reserved for those scars that are mature, still conspicuous, and have a reasonable chance of improvement by employing the techniques outlined above.
Some images may be models.
Before and After Photos - individual results may vary.
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