Scar Revision

Overview

Every time the skin is cut or damaged through its full thickness it will heal with a scar. The scar is the result of the body's natural repair process. During the wound healing process, all scars become red, raised and lumpy before going through a period of colour changes and texture changes until they finally mature into thin white lines. For some people, and in certain parts of the body, this process of scar maturation takes only a few months whilst in others and in different parts of the body (e.g. the middle of the chest), the process can take up to 18 months before the scar finally matures. Occasionally, the scar can stay red for much longer. It is impossible to predict who is going to produce a bad scar, but in general, patients with black skin or with fair freckled skin and red hair will tend to produce poor scars including hypertrophic (thick red scars that last longer than 18 months) scars and keloid scars (very thick scars which spread out from the original wound). These are notioriously difficult to treat.

Scars can look conspicuous for a number of reasons. For example, the scar may be irregular in shape; it may have pigment/ or dirt tattooed into it if the wound was not cleaned correctly, it may not have been sutured correctly; the wound may have got infected during the healing process; the scar may have stretched due to tension on the wound while it was healing; the direction of the scar may be out of line with the natural skin creases. In such circumstances where an explanation for the conspicuousness of the scar can be found it may be possible to perform a scar revision to attempt to produce a cosmetically better scar. Scar revisions are usually done under local anaesthesia. The old scar is excised and is reconstructed and resutured using plastic surgery techniques. Post operative pain is usually minimal. Sutures are usually removed in 4 to 6 days from the face and 7 to 10 days from other parts of the body. However, dissolving sutures are frequently used on the trunk and limbs to avoid stitch marks. Fading occurs within 6 to 24 months depending on the scar's location and the patient's skin type.

Additional procedures

A Z-plasty is used to reduce the tightness or contracture of the scar making it more comfortable and less conspicuous. It may also be used to change the position of a scar and by reducing tightness improve healing. A Z-plasty is performed by raising two adjacent skin flaps and transposing the flaps (putting each flap where the other one was. Dermabrasion and laser surgery can also be used to blur the edges of the scar and minimise surface irregularities.

Frequently asked questions

Am I suitable for a scar revision?

Will I be told the risks and complications?

What follow-up appointments will there be?

Am I suitable for a scar revision?

Not all scars are suitable for a scar revision. Suitability is a matter for you and Mr Johnson to discuss in clinic, following a thorough analysis of your medical history and a thorough clinical consultation.

Will I be told the risks and complications?

Any operation carries with it the risk of complication. Major complications, however, are uncommon following a scar revison. During your initial consultation Mr Johnson will have a full discussion with you about the risks and complications of surgery. Fortunately, with correct patient selection and appropriate procedure selection, the risks are kept to an absolute minimum. It is important that you should be reassured that Mr Johnson will not agree to perform any scar revision procedure on you unless he feels the benefits significantly outweigh the risks.

What follow-up appointments will there be?

Mr Johnson will come and see you on the ward after your surgery. After you have been discharged Mr Johnson will arrange to see you in clinic after 7-10 days to review the wounds. He will then make arrangements to see you in clinic for longer term follow-up appointments. You will be given contact details for the hospital and Mr Johnson's secretary should you wish at any time to discuss further aspects of your care or make additional arrangements for review.


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